Career Headways, a 4-year-old nonprofit community
agency dedicated to improving the quality of life
for people with acquired brain injury, is located in the
medium-sized city of Regina, Canada. A summary of a
series of interviews conducted in the spring of 1998
with its executive director, Lisa Brownstone, follows.
Although Brownstone did not use the term best practices
in the initial stages of setting up Career Headways,
the approach used was clearly similar to the approach
discussed in this article, and, in retrospect, Brownstone
identifies it as such. The motivation for the choices
made was “to build a workplace that was a satisfying
one for the people who worked there and delivered the
needed services for the people who were coming
through the door . . . something that would evolve out of
the needs of people with acquired brain injury.”
In Brownstone’s view, a number of elements exist in
the Career Headways program that meet what she
would define as best practices criteria:
• It has measurable goals and objectives. “The whole
organization is now set up on a goals and objectives
basis. And it’s all measurable.”
• It is participant driven. “The program is the participants’
program . . . they’re in the driver’s seat, we’re the
driving instructor. They’re the ones who are driving it.”
This occurs through ongoing consultation with participants
concerning what’s working and what’s not and an
“open-door” policy to allow for informal feedback. In
addition, participants set their own program goals.
• It is evolutionary. “It evolves with the knowledge base.
The dream that we started with is very different from
what’s in place here . . . it’s constantly evolving and
changing and getting better . . . ‘best practices’ equals
constant improvement, or constant questioning, and
always knowing that there’s more to learn, and there’s
always a better way. And that’s really critical here.
There’s a constant making sure that we’re delivering
the right program to the right people, and that they’re
getting the most out of it that they possibly can.” For
example, “with the actual programming, we started
with staff developing a plan of action about how they
were going to work treatment, and they spent a month
and a half before participants arrived, developing that
and setting it up—and threw it out the first week the
participants were on board. It didn’t work. And slowly
we’ve been evolving it ever since. So it’s been a year and a half of evolution. And it evolves based on staff
perceptions and participant feedback.”
Based on information provided through the interviews,
the Career Headways program meets the best
practices criteria that we have defined in another section
of this article in a number of ways. These are
described below.
Its processes and strategies reflect health promotion
values and goals. For example, implicit in the program’s
overall goal is the desire to increase participants’
opportunities to have as high a quality of life as
other people; in other words, a desire for equity.
Another program value and goal relates to empowerment;
for example, in terms of aiming to have participants
“living independently” and increasing their control:
“They’re taking control back, they’re people whose
lives had become totally enmeshed in the medical system,
and totally enmeshed and dependent on others.”
Empowerment is strongly connected to the goal and
value of power sharing and participation by all key
stakeholders. Thus, at the participant level,
I meet with the participants quarterly as a group and I
have a series of questions that I ask them that allows us
to explore the degree to which they find the program
acceptable. . . . I then take [participants’ feedback] to
the staff, and we adapt the program according to the
feedback.