North Simcoe Muskoka LHIN, North Simcoe Muskoka Regional Cancer Program

YWCA Muskoka – YWCAEncore

1. Mission 

1. 1. To increase circulation, mobility, flexibility and reduce effects of lymphedema for women who have experienced breast cancer at any time in their lives. 

2. At a Glance

1. 1. Location: Bracebridge, Ontario
   2. Program Site: Town of Bracebridge Culture and Recreation 
   3. Program Launch Date: March, 2009

3. Key Stakeholders in Initiation

4. Contact Information

1. 1. Website: http://www.ywcamuskoka.com/womens-programs/ywcaencore
   2. Facebook: YWCA Muskoka @ywcamuskoka
   3. Twitter: YWCA Muskoka @YWCAMuskoka
   4. Email: office@ywcamuskoka.com
   5. Phone: 705-645-9827

5. Community Partnerships and Affiliations

6. Development and History

1. 1. 1997: YWCA Muskoka was launched to empower women and girls to life in a safe and equitable society. 
   2. 2008: YWCA Muskoka partnered with YWCA Halifax to bring the YWCAEncore program to the Muskoka region.
   3. 2008: Two trainers were recruited and sent to YWCA Hamilton to complete training for the YWCAEncore program. YWCA Halifax provided Muskoka with resources (e.g., registration forms and marketing materials).
   4. 2008: A partnership was developed with Bracebridge Culture and Recreation, as their facility was well-suited to the aqua program’s needs. 
   5. 2008: Hannah Lin spearheaded program awareness efforts in the community and hospitals to raise awareness and increase program participation. 
   6. 2009: The YWCAEncore pilot program was launched. The pilot program was offered twice a year for 8 weeks at a time. 
   7. 2011: Due to challenges in adherence and difficult weather conditions (snowy conditions and transportation difficulties), the program now runs once a year for 8 weeks at a time.

7. Barriers to Program Development

1. 1. Facility access
      1. “It is a matter of a community resource being available, I think it was 2014 when we were able to do it in Gravenhurst because the YMCA built a facility with a pool.”
   2. Location 
      1. “The region we serve is big, it is 48 hundred square kilometers, so you have to choose, and if the town does not have the pool, then certainly we are seeing women come from 80 kilometers away.”
   3. Transportation 
      1. “I think one of the difficulties we always face is there is no public transportation in our region.” 

8. Facilitators of Program Development

1. 1. Community need 
      1. “We knew that there were women in our region who certainly had experienced breast cancer, but their hospital was in either Huntsville, Barrie, or Toronto…and afterwards there was very little that was customized to their needs.”
   2. Financial contributions
      1. “The very first year we had a pilot grant through Halifax to introduce it and our commitment was that we run it twice a year over two years.”
   3. Targeted promotion
      1. “We spoke to physicians at doctor’s hours to raise awareness about the program and provided them with referral scripts.”

9. Current Staff Structure

10. Core Practices

1. 1. Facility 
      1. Bracebridge Sportsplex, 85,00 square feet, equipped with therapy pool and multipurpose exercise room, and kitchen

10. 2. Parking
       1. Public parking is available on-site at no cost

10. 3. Cost Structure
       1. The YWCAEncore is free to program participants

10. 4. Funding and Support
       1. Donors (e.g., Shoppers Drug Mart Life Foundation, individual donations)

10. 5. Recruitment
       1. Referral Sources
          1. Self-referral (20%)
          2. Word of Mouth (80%)
       2. Awareness initiatives
          1. Community promotion (e.g., posters and rack cards in public areas, municipality leisure guide)
          2. Media (e.g., emails to businesses, radio, local newspapers, local news station coverage, social media)
    6. Participants
       1. Eligibility criteria: Women who have received a cancer diagnosis are eligible to participate (must be at least 8 weeks out of surgery). Physician referral is required
       2. Participants per session: 12 participants
       3. Staff to participant ratio: 2:12 leader to participant ratio
       4. Total number of participants: 12 

10. 7. Initial intake session
       1. YWCAEncore does not currently conduct intake assessments.

10. 8. Program Schedule 
       1. Session duration: 2 hours
       2. Frequency: 1 session per week, offered in the Spring
       3. Length: 8 weeks

NOTE: Participants have opportunity to re-enrol in program. However, priority is given to new members. 

10. 8. 4. Session schedule: Variable schedule
       5. Additional supports available:
          1. Occasional transportation to program provided on a needs-based basis.

10. 9. Program Design
       1. All elements of this program were designed by the developers of YWCAEncore.
       2. Exercise prescription is group-based
          1. Fitness components include weight bearing exercises targeting strength (1hr), and aquatic exercises for gentle aerobic movement and range of motion (1hr)
       3. Equipment
          1. Pool noodles, balls, and flutter boards

10. 10. Educational Components
        1. Informal education (optional): Educational elements regarding the benefits of exercise for cancer survivors are provided by co-facilitators during the exercise class.
        2. Formal education (mandatory): Guest speakers are invited to deliver seminars every other week.
           1. Example topics: Prosthetics, lymphedema, tai chi & qi gong, mindfulness & meditation, nutrition, community resources and supports for women with cancer

10. 11. Program Evaluation
        1. Self-report program evaluations are distributed to participants at the end of the 8-week program.
        2. Co-facilitators provide self-report program evaluations at the end of every 8-week program.

11. Current Barriers to Participation

1. 1. Treatment schedule
      1. “If they are still going through treatment it can be difficult because of appointments.”
   2. Body image 
      1. “I remember a lot of women not being comfortable putting on the bathing suit at all right, so body awareness, body acceptance, getting used to doing some of these activities and exercises and being able to adapt them to suit their own needs.”

11. 3. Transportation 
       1. “I think one of the difficulties we always face is there is no public transportation in our region.” 

12. Facilitators of Participation

1. 1. Social program atmosphere
      1. “They really feel the camaraderie from the other women in the group and they don’t want to miss out…friendships are built out of these eight weeks, and we found that some of the ladies have really connected.”
   2. Staff expertise
      1. “Even in just the way that they facilitate and they do check ins…being able to facilitate really positive group dynamics is an art form, it is something that you practice, and you get those that really have the ‘it’ factor and do it beautifully.”

13. Future Directions

1. 1. To strengthen our partnership with YMCA in Gravenhurst, and offer the program again in the fall or early spring of 2018 in the evening to better meet the needs of younger women, and women who are working daytime who are experiencing breast cancer.