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Acknowledgements We would like to extend our appreciation and gratitude toward the Findhelp team, in particular Faed Hendry, Jackie Roddy, and Andre Paradis for their time, dedication, and expertise contributed throughout this project. We would also like to thank the doctors, professors, researchers, and staff of the Youth4Health Initiative who spearheaded Navigation Training efforts. Most importantly we want to acknowledge the hundreds of youth navigators and project participants for their enthusiasm, passion, and commitment to this project and the betterment of the health of themselves and their communities. This training has been made possible through a grant from Citizenship and Immigration Canada. Forward We hope you find this Field Guide useful as a complementary resource to the training received. The intent of this Field Guide is to outline the Health Navigation Training program and act as an additional resource while in the field.
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health navigation fieldguide Table of Contents
Introduction ......................................................................................................... 3 Learning Objectives ............................................................................................ 3 Health Navigation ................................................................................................ 3 Role of the Youth Health Navigator ........................................................................... 3 Health Navigation Model ............................................................................................ 4
Canadian Health Care System ........................................................................... 7 Health Promotion ................................................................................................ 8 Culture .................................................................................................................. 9 Safety, Security and Boundaries ..................................................................... 11 Directory of Services & Resources ................................................................. 12 Glossary of Terms ............................................................................................. 18 Notes .................................................................................................................. 20
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Introduction Youth4Health is a community-based research project that seeks to empower newcomer youth to become “health navigators”. Youth from recent immigrant families often serve as bridges between their households and their wider communities. Now, with the widespread availability of powerful information and communication technologies, such as mobile phones, search engines and web-based social networks, there are unprecedented opportunities for youth to network in support of their families while connecting with other youth playing the same role. The Youth4Health Youth Health Navigation training aims to equip young people with the knowledge, skills, and resources they need in order to support their friends and families in navigating the health care and health promotion systems in Ontario, Canada. Youth4Health is working with young newcomers across Ontario, training them in the following areas: (1) Roles and responsibilities of a health navigator, (2) Health promotion concepts, (3) The ʻ Identify, Sensitize, and Connectʼ Model of Health Navigation, and (4) Awareness of available resources and tools that support health navigation.
Learning Objectives The learning objectives of this training are as follows: • To help empower under-served populations • To identify, assess and utilize tools and resources for health navigation • To understand and practice the ʻIdentify, Sensitize, and Connectʼ model of Health Navigation • To understand the role, responsibilities, boundaries and limitations of the Youth Health Navigator
Health Navigation Role of the Youth Health Navigator The Youth Health Navigatorʼs role is to assist others by empowering under-served populations to identify and better access quality health services. They do this by creating connections within the community and helping people become more aware of the health related challenges they face and the opportunities for change. ! ! ! ! ! 3
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Health Navigation Model !
Capacity Build
The role of the Youth Health Navigator as depicted in the diagram above is to:
IDENTIFY
SENSITIZE
Establishing awareness and knowledge of particular health issues, resources, and services in a community
Understanding and working with a community始s stigma, fear, insecurity, and lack of familiarity with the issues, resources and services that are available to newcomers
CONNECT
Employing one始s knowledge of relevant health resources and promoting access to corresponding services
CAPACITY BUILD
Youth health navigators build capacity in under-served populations by not only demonstrating how to identify, sensitize and connect, but also teaching others how to do so
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Here is the Health Navigation Model in more detail:
IDENTIFY! Establishing awareness and knowledge of particular health issues, resources, and services in a community. A youth health navigator will be able to empower under-served populations to identify health challenges and opportunities in their communities. A recognized challenge for anyone in the field Information and referral is understanding the Human Service system. For you as Youth Health Navigators it is the health service sector. Your knowledge of the social determinants of health, health equity, health services available, the complexities of the system and how to access these services are part of the core competencies of a Youth Health Navigator. It is important to recognize and understand the factors that impact the availability, accessibility and eligibility for health services. A necessary skill of a Youth Health Navigator is the ability to gather information. What types of information do you need to know about a health service, organization or resource before you can connect someone to them?
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Examples are: • Urgency (how quickly do they need the service?) • Who the service is for? • Health status • Age • Family composition • Previous attempts at getting help for the situation • Address or general location • Access to the Internet • Status or residency requirement
SENSITIZE! Understanding and working with a communityʼs stigma, fear, insecurity, and lack of familiarity with the issues, resources and services that are available to newcomers. A health navigator must be sensitive to an individualʼs feelings and needs as well be able to sensitize an individual to the issues. Focus on the feelings of the person whom you are assisting: It is where the trust and rapport between you, the Youth Health Navigator, and the person needing assistance, is developed. The connection you build with the other person will ! 5
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reflect your abilities and enthusiasm to help. At this step you are communicating that you are ready, willing and able to connect them to help services. Focus on the problem or issue: Here you will be actively listening, staying focused on what is being said and asking key questions to help clarify what is needed. It is important at this step that you do not jump to conclusions, be judgmental or interrupt while the person is explaining their issue. It is also at this step that you are clarifying the person始s eligibility for some possible programs and explaining the requirement to access possible programs.
CONNECT! Employing one始s knowledge of relevant health resources and promoting access to corresponding services. A health navigator will be able to identify appropriate resources and facilitate access to those resources for their friends and families. In addition, the health navigator will be able to empower others to identify and access resources on their own. Once you have information from the individual you can suggest referrals. A referral requires identifying services and providing enough information about each service so the person can make an informed choice. Make sure the individual is eligible for the service. When possible and appropriate, people should be given choices and options. Provide the person you are helping with some choices as to what is available to them. It is important to confirm that you have understood what is being said to you and that you are being understood. Provide the person with the choices. Ask the individual what they may do next, or if they can summarize for you what they have understood. You may at this point need to go back and seek greater clarification of the issue. It is important that you close the interaction in a manner that still maintains the trust and rapport that was initially developed. The information that you provide is only as good as the person始s ability to use it and her/his belief that you have guided them in the right direction.
CAPACITY BUILD! Youth health navigators build capacity in under-served populations by not only demonstrating how to identify, sensitize and connect, but also teaching others how to do so.
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Canadian Health Care System It is also important for Youth Health Navigators to know, understand and effectively communicate how human services operate. Providers of service include: Federal Government Health programs at the federal level are provided by Health Canada. Health Canada is responsible for helping people maintain and improve their health, while respecting individual choices and circumstances. The department relies on high-quality scientific research as the basis for their work. Part of the departments mandate is to communicate information about disease prevention to protect Canadians from avoidable risks. The department also encourages Canadians to take an active role in their health, such as increasing their level of physical activity and eating well. Provincial Government Health programs at the provincial level are provided by the Ontario Ministry of Health and Long Term Care. This Ministry provides a range of services helping people stay healthy, delivering good care when people need it, and protecting the health care system. Their mandate includes establishing an overall strategic direction and provincial priorities for the health system; developing legislation, regulations, standards, policies, and directives to support those strategic directions; and monitoring and reporting on the performance of the health system and the health of Ontarians. Key programs of the Ontario Ministry of Health and Long Term Care are: • Ontario Health Insurance Plan (OHIP) • Assistive Devices Program • Ontario Drug Benefit Program • Seniors' Care: Home, Community and Residential Care Services for Seniors (CCACʼs) • ConnexOntario (Mental Health, Addictions and Problem Gambling) • Health Care Professionals – Regulation • AIDS and Sexual Health Information • TeleHealth Ontario Municipal Government Toronto Public Health is responsible for the delivery of health promotion and protection for the citizens of Toronto. Toronto Public Health delivers a number of key programs: • Air quality improvement • Beach water monitoring • Day nursery inspection • DineSafe (restaurant inspection) • Emergency response • Environmental protection • Food safety • Dental screening ! 7
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• • • • • • • • • • • • • •
Disease surveillance Food handler training HIV/AIDS hotline Immunization Infection control Methadone clinics Nutrition programs Parenting support Physical activity promotion Pre and post natal support Sexual health promotion Smoking cessation Health Schools Sun safety programs
Community Health Centres (CHCs) are non-profit organizations that provide primary health and health promotion programs for individuals, families and communities. Typical Community Health Centres have primary care teams that include physicians, nurse practitioners, nurses, social workers, health promoters, community health workers and often chiropodists, nutritionists or dieticians. For example, the services offered by the Regent Park Community Health Centre include: • Health Services • Chronic Conditions • Social Work and Community Health Work • Homeless, Outreach and Harm Reduction • Immigrant and Refugee Programs • Infant and Child Development • Youth Programs • Community Development Initiatives !
Health Promotion “Health promotion is the process of enabling people to increase control over, and to improve, their health. To reach a state of complete physical, mental and social well-being, an individual or group must be able to identify and to realize aspirations, to satisfy needs, and to change or cope with the environment. Health is, therefore, seen as a resource for everyday life, not the objective of living”. (Ottawa Charter for Health Promotion, 1986) The social determinants of health are factors and conditions that influence health of individuals and their communities. The unequal distribution of the social determinants of health means that some people have the resources to be healthier than others. By understanding health issues and determinants, a health navigator can be better equipped to promote health equity, the process of enabling equal opportunities for health for all. ! ! 8
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Social Determinants of Health include: 1. Income and Income Distribution 2. Education 3. Unemployment and Job Security 4. Employment and Working Conditions 5. Early Childhood Development 6. Food Security 7. Housing 8. Social Exclusion 9. Social Safety Network 10. Health Services 11. Aboriginal Status 12. Gender 13. Race 14. Disability !
The Ottawa Charter for Health Promotion (1986)
! Can you think of other social determinants that affect your health? ! ! ! !
Culture The Canadian health care and health promotion systems can be challenging to navigate for anybody, especially people who are not familiar with the system and are trying to learn and adapt to a new language and/or culture. In immigrant homes, youth often serve as bridges between the home culture and that of the wider community. Culture is an aspect of life that influences everything we do. It can be described as:
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The sum of the total way of living. Some examples include values, beliefs, standards, language, thinking patterns, behavioral norms, and communication styles. Culture guides decisions and actions of a group through time.
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Culture influences the way people understand and approach situations, and can shape social stigma and stereotypes. Differences in cultures can have an impact on the types of health services or resources people want, choose, and consider appropriate to access.
You can think about culture in different ways:
Concrete Culture refers to visible/tangible culture that can generally be seen or heard. Some examples are music, food, and clothes. Behavioural Culture is what defines social roles and can include the language we speak or our approaches to non-verbal communication. Some examples are language, body gestures, and gender roles. Symbolic Culture refers to how we generally see the world. Some examples include values, customs, beliefs, spirituality, and religion. ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! !
Dress
Iceberg Concept of Culture
Age Gender Race or Ethnicity Accent
Language Surface level
Sense of self Body language Notions of modesty
Facial expressions
Decision making processes Emotional response patterns
Approaches to problem solving
And much more‌
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Safety, Security and Boundaries It is important to recognize your role, boundaries and limitations as a Youth Health Navigator. You are Not a: • Doctor or medical professional • Counselor or Psychiatrist • Medical Escort !
You Are a: • Resource and Support for your friends and family • Person who can find information about health resources. • YOUTH HEALTH NAVIGATOR! !
It is up to you to decide how much personal and contact information to share with other people. Remember: If you wouldnʼt have shared the information before this training, you probably shouldnʼt now.
Good Luck Navigators! ! 11
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Directory of Services & Resources !
NavigateThis.org has the tools you need to be a health navigator!! " Health Navigation: ‘The Basics’ training video " ‘The Navigators’ mental health game developed with mindyourmind.ca " Web documentary on food security " Health resources, interactive games, a discussion board, an online community of other navigators and much more…
Are you ready?…then, Navigate This!
211 Ontario – Easy access to Community, Social, Health and related Government Services in Ontario. Website: http://www.211ontario.ca/ Twitter: @211Ontario 9-1-1 – In Canada, you can dial 9-1-1 on your telephone in case of any emergency, health or otherwise. Banyan Youth – Meaningful hands-on experiences for youth to build skills and reshape communities. Website: http://www.banyanyouth.org/ Canadian Alliance of Community Health Centre Associations - Canadian Alliance of Community Health Centre Associations supports CHCs across Canada to improve individual, family and community health. Website: http://www.cachca.ca Centre for Addiction and Mental Health - Canada's largest mental health and addiction ! 12
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teaching hospital that combines clinical care, research, education, policy development and health promotion to help transform the lives of people affected by mental health and addiction issues. Website: http://www.camh.net/ Facebook: http://tinyurl.com/2eg8x8l Twitter: @CamhMediaUpdate Centre for Community Partnerships, University of Toronto, St. George Campus – Serve, Think, Learn - Gives students the opportunity to connect to community-identified service projects and to learn from their experience. Website: http://www.ccp.utoronto.ca/ Centre for eHealth Innovation - A place where human, physical and virtual resources come together to develop and evaluate eHealth innovations, using the expertise of leaders in the social sciences, technology and health fields. Website: http://www.ehealthinnovation.org/ Citizenship and Immigration Canada - Since 1869, Canadaʼs immigration programs have helped build a community of citizens respected around the world. Website: http://www.cic.gc.ca/english/index.asp; Mobile site: http://m.cic.gc.ca/ Twitter: @CitImmCanada YouTube: http://www.youtube.com/CitImmCanada CoNEKTR - Complexity, Networks, EHealth, Knowledge Translation, Research. Website: http://youthvoices.ca/node/72 Twitter: @CoNEKTR, @CDNorman Dalla Lana School of Public Health, University of Toronto, St. George Campus – The School of Public Health at the University of Toronto. Website: http://www.phs.utoronto.ca/ East Metro Youth Services - A multi-service adolescent mental health centre, accredited by the Childrenʼs Mental Health Ontario (C.M.H.O.), which has been serving young people and their families in East Toronto since 1974. Website: http://www.emys.on.ca/ Facebook: http://tinyurl.com/2b8jrv3 ELLICSR Electronic Living Laboratory for Interdisciplinary Cancer Survivorship Research - Developed to study an innovative survivorship research strategy called a Community of Cancer Survivors. Website: http://ellicsr.ca/ FindHelp Information Services – Provides free information and guides people to community, social, health and related government services most suited to their needs, through phone, web and print directories. Website: http://www.findhelp.ca/ ! 13
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Foodshare - FoodShare tries to take a multifaceted, innovative and long-term approach to hunger and food issues. Website: http://www.foodshare.net/ Facebook: http://tinyurl.com/2eoz3rd Twitter: @FoodShareTO Green Thumbs Growing Kids - Works with urban children, youth and their families to learn about, grow and prepare fresh foods, cultivated in an environmentally sustainable manner in hands-on programs. Website: http://www.kidsgrowing.ca/wiki/wiki.php Facebook: http://www.facebook.com/group.php?gid=12491658033 Twitter: @KidsGrowing Health Promotion & Education Programs, University of Toronto, St. George Campus Actively supports the health and well being of University of Toronto students. Through various initiatives and programs we work to foster a campus culture that values health and wellness. Website: http://healthservice.utoronto.ca/Health-Promotion.htm In My Language - InMyLanguage.org provides multilingual information for newcomers to Ontario, Canada. The project is funded by Citizenship and Immigration Canada (CIC). Website: www.inmylanguage.org Kids Help Phone - Our mission is to improve the well being of Canadian children and youth by providing them anonymous and confidential professional counseling, referrals, and information through technologically-based communications media. Website: http://org.kidshelpphone.ca/en Facebook: http://www.facebook.com/KidsHelpPhone Twitter: @KidsHelpPhone MealExchange - A national student-founded, youth-driven, registered charity organized to address local hunger by mobilizing the talent and passion of students. Website: http://www.mealexchange.com/ Facebook: http://www.facebook.com/mealexchange Twitter: @MealExchange YouTube: http://www.youtube.com/user/MealXChange mindyourmind.ca – An online community where you will find everyday heroes, and celebrities sharing their stories, coping tools to help you handle stress and resources when nothing else seems to work. Website: http://mindyourmind.ca/ Facebook: http://tinyurl.com/3ypyzg5 Twitter: @mindyourmind_ca YouTube: http://www.youtube.com/user/mindyourmind ! 14
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New Mentality - We engage youth in breaking the stigma of mental illness and work with them to increase Youth Engagement within mental health centres. Website: http://www.thenewmentality.ca/ NewYouth.ca - This website is an information and referral website for newcomer (immigrant and refugee) youth across Ontario, Canada. The project is funded by Citizenship and Immigration Canada (CIC). Website: http://www.newyouth.ca/ Twitter: @newcomeryouth Ontario Council of Agencies Serving Immigrants - A collective voice for immigrant-serving agencies and to coordinate response to shared needs and concerns. Website: http://www.ocasi.org People, Health Equity and Innovation (PHI) Group - Explores innovative ways to level the playing field for disadvantaged groups in society, through the use of information and communication technologies and social networking tools. Website: http://phi-group.org Physical Health and Equity Program, Faculty of Physical Health & Education - We offer co-curricular opportunities for active physical activity for the entire student body, as well as faculty, staff and members of the community. Website: http://physical.utoronto.ca/ Regent Park Focus Youth Media Arts Centre - Regent Park Focus is motivated by the belief that community arts and participatory media practices play a vital role in building and sustaining healthy communities. Regent Park Focus seeks to increase civic engagement and inspire positive change by giving youth the tools and support to create artistic works and media productions. Website: http://www.catchdaflava.com/ Twitter: @RegentParkFocus YouTube: http://www.youtube.com/user/RegentParkTV Service Ontario – Committed to providing you with fast, friendly and easy access to Ontario government information and services – online, in person, at kiosks and by phone. Website: http://www.serviceontario.ca/ Telephone: 1-800-267-8097 Settlement.org – A Website to find answers to common questions about moving to Ontario and settling into your new home. Website: http://www.settlement.org STOP Community Food Centre - The Stop Community Food Centre strives to increase access to healthy food in a manner that maintains dignity, builds community and challenges inequality. ! 15
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Website: http://www.thestop.org/ Student Life, University of Toronto, St. George Campus - A resource for staff, faculty and student leaders looking to access our services and explore partnerships with Student Life. Website: http://www.studentlife.utoronto.ca/ Students4Health, Conestoga College - Our project is dedicated to assisting students who are immigrants and their families to find support at the college and in the community. Students can connect with one another, identify important concerns, and find solutions. Website: http://www.students4health.ca TAGlab - Our goal is typically supporting cognition, communication, or social interaction. Website: http://taglab.utoronto.ca/ TakingITGlobal – The largest online community of youth interested in global issues and creating positive change. Website: http://www.tigweb.org/ Facebook: http://tinyurl.com/2ujhec7 Twitter: @TakingITGlobal Toronto Balconies Bloom, Growing Together - Toronto has acres of untapped growing space on its balconies, and an opportunity for creating a peaceful and pleasurable living environment while at the same time improving the air we breathe. Website: http://www.torontobalconiesbloom.ca/insp-proj.html Toronto Youth Food Policy Council - The Toronto Youth Food Policy Council seeks to mobilize and engage Youth to make change by building a just food system. Website: http://tyfpc.ca/ Facebook: http://www.facebook.com/TorontoYOUTHFoodPolicyCouncil Twitter: @TYFPC UForChange – A project for the youth of St. James Town that integrates arts, culture and human rights to grow community and improve livelihood. Website: http://www.wix.com/evelyne_an/site2 Facebook: http://tinyurl.com/3yu2oct Twitter: @UforChange Flickr: http://www.flickr.com/photos/uforchange/ Waterloo Collegiate Institute - Our school is proud to be a magnet for Strings, Extended French, English Language Learners and a Geotech Program. We are also pleased to offer preAP (Advanced Placement) and AP courses to our students. Website: http://wci.wrdsb.ca/ Wellesley Institute - Our focus is on developing research and community-based policy solutions to the problems of urban health and health disparities. Website: http://www.wellesleyinstitute.com/ ! 16
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Facebook: http://tinyurl.com/384s92f Twitter: @wellesleyWI Willow Breast Cancer Support Canada – A national not for profit organization that provides free information and support to anyone affected by breast cancer. Website: http://www.willow.org/ Twitter: @WillowTweeting YMCAs of Cambridge & Kitchener-Waterloo - The YMCA is a charitable organization that strengthens our community by providing opportunities for personal growth and active involvement for all children, adults and families. Website: http://tinyurl.com/338ofb5 Facebook: http://www.facebook.com/YMCAsofCandKW Twitter: @YMCAsofCandKW YMCA of Greater Toronto - The YMCA is a charitable organization that strengthens our community by providing opportunities for personal growth and active involvement for all children, adults and families. Website: http://www.ymcatoronto.org/en/index.html Facebook: http://www.facebook.com/YMCAGTA Twitter: @YMCA_Canada Youth4Health - Youth4Health is a community-based research project led by People, Health Equity and Innovation Group and Youth Voices Research Group that seeks to empower newcomer youth to become “health navigators”. Website: www.youth4health.ca Facebook: http://tinyurl.com/2bd9qv9 Twitter: @youth4health#y4h Youth Voices Research Group - We are a research and social innovation unit based at the Dalla Lana School of Public Health at the University of Toronto focused on creating accessible, responsive, and health promoting systems for youth and young adults. Website: http://www.youthvoices.ca Facebook: http://tinyurl.com/25tady9 Twitter: @YVResearch YouTube: http://www.youtube.com/user/YouthVoicesResearch Flickr: http://www.flickr.com/photos/youthvoicesresearch
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Glossary of Terms 211 – A resource that can be dialed from any touch-tone phone to get information about different services (health and other) that are in your area and available to you. Behavioural Culture is what defines social roles and can include the language we speak or our approaches to non-verbal communication. Some examples are language, body gestures, and gender roles. Community – A shared space for people with a common goal. Community can be based on ethnicity, geographical location, common interests, shared beliefs or anything that links people together. Concrete Culture refers to visible/tangible culture that can generally be seen or heard. Some examples are music, food, and clothes. Connect – Employing oneʼs knowledge of relevant health resources and promoting access to corresponding services. Culture – The sum of the total way of living; Some examples include values, beliefs, standards, language, thinking patterns, behavioral norms, and communication styles. Culture guides decisions and actions of a group through time. Eligibility Criteria – What is needed for somebody to use a service or resource. Empower – Helping people self realize the skills, confidence and resources that they have and can be used to bring positive change. Food Security – Ensuring that all people have enough affordable, nutritious, culturally sensitive, accessible to feed them and their families. Health – A state of being that involves Physical, Mental, Social or Spiritual aspects of ones daily life. Health Equity – the process of enabling equal opportunities for health for all. Health Promotion – The process of enabling people to increase control over, and to improve, their health. ! 18
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Identify – Establish awareness and knowledge of particular health issues, resources and services within a community. Mental Health – a state of being that involves ones emotional and psychological states of mind. Newcomer – Somebody that self identifies with being new to Canada. Referral – The ability to identify services and provide information about each service so that individuals can make an informed choice. Sensitize – Understanding and working with a communityʼs stigma, fear, insecurity and lack of familiarity with health issues, resources and services available to Newcomers. Social Determinants of Health – Factors and conditions that influence health of individuals and their communities. Social Media – Digital media that derives its value from user participation. Symbolic Culture refers to how we generally see the world. Some examples include values, customs, beliefs, spirituality, and religion. URL Address – The web address found in the search bar on Internet navigating systems. All websites will have a separate URL Address. Wellness – An approach to healthcare that prolongs life expectancy and increases well being. Youth Health Navigator - Youth Health Navigators are aware of health issues in their communities and help others access health services.
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