Bulletin of the Alliance's Learning Health System |
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Next Steps
for Links2Wellbeing
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PREPARED
for the Next Pandemic
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Hope and Joyous Defiance:
Communities at the Centre
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Learning from Success for Newcomer Health |
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Learning Events & Programs |
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Get Involved: Research & Sharing |
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Expanding Social Prescribing for Older Adults
Additional Funding to Grow our Partnership with OACAO
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Launched in 2021, the L2W project teams and their community health partners work with health providers across Ontario to build sustainable local frameworks for social prescribing. These frameworks enable referrals for socially isolated older adults to a range of tailored, non-clinical services available through their local Seniors Active Living Centre (SALC). To date, the project has worked with 93 SALC programs and over 200 healthcare organizations, including 27 Community Health Centres and Community Family Health Teams. As a result, more than 1,500 older adults in Ontario have been referred to a SALC program through L2W.
The referrals, primarily made to address social isolation, loneliness, and depression, have yielded remarkable results. Over a six-month period, 52% of referred clients reported a decrease in loneliness, a figure that rose to 62% after a year. Additionally, 40% reported improved physical and mental health, as well as a stronger sense of community, since joining programs at the SALC.
An L2W Learning Collective
Thanks to an anonymous funder, the Links2Wellbeing project will continue for another four years. The next phase of the project aims to further integrate social prescribing into Ontario’s healthcare system and the community-based seniors’ sector and to increase the program's capacity and reach. As part of this funding opportunity, the Alliance has just launched a Links2Wellbeing Social Prescribing for Older Adults Learning Collective to help Alliance member organizations implement and improve equity-focused social prescribing pathways for older adults.
Participating teams engage in a variety of educational activities, including asynchronous online learning modules on equity-focused social prescribing, team coaching sessions, and sharing sessions with peers. They will also be provided with supports for accessing external resources and technical assistance where and when necessary, and they'll receive funding to support their work in the learning collective. This suite of resources and supports will assist them as they work to design, implement, test and improve formalized processes for social prescribing in their organizations.
Enrollment for this inaugural session is closed. Participating sites will receive support through April 2025, and the next call for applicants will be released in Spring 2025.
Coming Soon: Self-Paced Online Learning
We will be releasing ten new health equity—focused, online Social Prescribing training modules by the end of June 2024. These self-paced learning modules are designed for teams in health care settings who are interested in implementing or improving their social prescribing process. Modules include Getting Buy in from Interdisciplinary Teams, Building a Process Map, Building an Asset Map, Meeting with Clients, and Using the EMR, among others.
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Hope and Joyous Defiance:
Co-designing our future with communities always at the centre
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by Cormac Russell
On the afternoon of June 6th, I had the privilege of delivering the final plenary address at the Alliance for Healthier Communities. I spoke about two competing stories in health and wellbeing:
The first and more dominant is a model of institutionalization. It looks for deficits and tries to repair them through programs, services, and other institutional responses. Everything and everyone is viewed through a sickness lens; even prevention is thought of as reducing the risk of disease. Ultimately, this story falls short. While institutional supports are and will always be essential, they are insufficient to meet current population health challenges and seriously risk being profoundly overwhelmed by the realities of climate crisis and the new normal of poly-crises.
The second story is one of hope and joyous defiance. It affirms the power of community animation towards community health creation and solidarity. People and their associations are recognized, resourced, and enabled as health creators in their own right. Institutions participate as alongsiders; they are engaged in community-building, and they supplement community capabilities with services.
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There is a growing abundance of evidence that neighbourhood belonging, social connectedness, and community control are key determinants of health and wellbeing. They are influenced by social conditions that depend on local action, as well as changing societal structures. This evidence base lifts up the importance of community development as an essential step in enabling generative communities to emerge.
Moving at the speed of trust
It's crucial to understand that this shift is not just about referring people to social activities or directing their participation. That is simply another form of transactional institutionalization. Shifting power is about identifying, connecting, and animating people's and communities' strengths and resources first, and resourcing those community-led initiatives with sufficient equity. It means deliberately decentralizing power and resources to make space for a community-first approach, moving upstream from the acute end of the healthcare system towards the true source of health creation: communities. It's about democratizing support, allowing people and communities to form rich associational networks, and then stepping back (but not abandoning) to let communities lead.
Community-based organizations like those that make up the Alliance have a vital role to play in supplementing and not supplanting the health-creating capacities of communities of place and affinity, especially those facing structural inequities and poorer health outcomes. Such organizations are essential intermediaries between the state and individuals. It is in aligning with the second story of health and wellbeing and in hopeful and joyous defiance of the first, that we can boldly co-create health beyond healthcare, with those we serve. This work can never go faster than the speed of trust.
Looking Forward
In my plenary address, I shared many international and local examples of this approach, including the stories of Judith Snow and the Blueprint for Peace (see sidebar). These stories and data demonstrate the need for an integrated approach to health and public services. With that in mind, I am partnering with Jodeme Goldhar and Walter Wodchis at the International Foundation for Integrated Care (IFIC) in Canada to support the growth and deepening of a social movement around these community-first principles and the integration of healthcare and social care in Ontario. We will announce further details soon!
I wish you all the very best in your important work. Onwards!
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Empowered Examples: Judith Snow and Blueprint for Peace
Shifting power from institutions to people and communities is liberating at an individual level and means restructuring our service institutions. Below are two stories I shared as examples during my keynote address.
Judith Snow, who lived with quadriplegia, was the first Canadian to receive an individualized budget to co-create a life of her own choosing. She spent over 40 years as an author, trainer, and educator; founded many community-based and non-profit organizations; and travelled widely to promote community development. Her story is a testament to the incredible value that individuals can add to multiple communities when enabled to do so with equity and solidarity, not charity.
In 2017, the Milwaukee Police Department participated as partners in implementing the nonviolent peacebuilding strategy known as the Blueprint for Peace. Grounded in an understanding of Adverse Community Experiences and Resilience (ACERs), Blueprint for Peace has fostered a stronger commitment to neighbourhood leadership and collaboration across different sectors. It has shifted power from enforcement-focused policing to resourcing the neighbourhoods that are most affected by trauma. Doing this involved a shift in mindset: Institutions had previously viewed these neighbourhoods as pools of criminals and victims, places that required tougher enforcement. The Blueprint applied a public health lens, revealing the people of these neighbourhoods to be leaders, health creators and peacebuilders in their own right.
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How REAC! is Drawing Lessons from Success
New ways of collaborating can support newcomers' health
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During the COVID-19 pandemic, it became more important than ever for public and community-based organizations to work across sector lines in supporting newcomer health and wellbeing. Difficult living and working conditions put many newcomers at a high risk of exposure to the virus, even as access to in-person supports was hampered by mandatory social distancing. New forms of collaboration had to emerge. From them, we can draw lessons to inform a sustainable response to the needs of newcomers.
Introducing REAC!
Responsive services for newcomers in the context of the COVID–19 pandemic (REAC!) is a participatory research project that seeks to find these lessons. The REAC! team, headed by Dr. Lara Gautier at Université de Montréal, have been documenting and analyzing intersectoral, newcomer-supporting collaborations that arose in Montreal, Sherbrooke, and Toronto during the COVID-19 pandemic.They collected stories and data from 161 participants in Ontario: 80 were service-providers, including frontline workers, managers, funders, and decision-makers; 81 were service-users, including refugees, asylum-seekers, and non-status migrants.
Each of the study’s selected intersectoral collaborations involved at least one partner organization from the public sector and one from the community sector. Some were specifically COVID-related (infection prevention and control, or support for vaccination) and others focused on supporting the social and structural determinants of health in times of crises. Among the selected initiatives, several were designed by the Alliance and member organizations, including:
In analyzing the data, the team looked at how intersectoral collaborations were implemented in response to the pandemic, and how effective they were in responding to newcomers’ needs and expectations.
Lesson 1:
Maintain communication for seamless transitions and adaptive care
In responding to the challenges posed by the pandemic, pre-existing relationships and trust between partnering organizations and communities proved invaluable in facilitating rapid planning and response efforts. Maintaining continuity of services across various organizations, including transitions from in-person to virtual service delivery, was deemed essential. But that shift to virtual services did not always go smoothly, especially because newcomer service users faced multiple barriers to access computers and/or a decent Internet connection.
Newcomer service users also had evolving demands; and to meet these evolving demands, organizations had to quickly adapt through changes in funding, human resource deployment, and transitioning to virtual service delivery, necessitating regular and transparent communication. Coordination across agencies with dedicated resources was critical for adequately addressing multisectoral needs beyond just healthcare, to ensure newcomers' holistic well-being.
An illustrative example of how community actors provided more holistic response to newcomer service users’ need was the Vaccine Engagement Teams initiative run by the Together Project and the Crossroads clinic in Toronto. Newcomer service users appreciated the fact that vaccination team workers were equipped to provide answers to several needs (tools/resources made available to users), and not just to raise awareness of vaccination (their primary mandate). Many other service user participants expressed the wish to have access to one single resource person, who could provide them with support/answers on all fronts: housing, employment, children's schooling, etc.
Lesson 2:
Build, repair, and draw on relationships of trust
Both newcomer and service provider participants also highlighted the importance of trust between the organization and service users – especially because trust was particularly difficult to build during the pandemic repeated crises, where people had to stay home and wear a mask when meeting others. Another intersectoral collaboration, the Community Ambassadors program, run by the Newcomer Office of the City of Toronto in collaboration with Toronto Public Health and a wide array of community organizations, played a critical role in rebuilding trust between newcomer communities and public health institutions.
These ambassadors were volunteers, themselves community members who had pre-existing trust relationships; they were placed in specific geographic areas to engage with local communities and were trained based on the needs of that specific area. Their success was highlighted in multiple reports.
Our research has thus highlighted the importance of (re)establishing trusting relationships, showing that organizations should take time to build trust with the communities they aim to serve, especially in times of crises. To achieve this, and to improve responsiveness to changing needs, organizations from different sectors can draw on each other’s strengths, such as community knowledge.
To be continued...
The REAC! project is still in progress, and the findings described above are early results. The team is continuing to collect input from partner organizations, which will inform a set of recommendations that will be shared with organizations providing health and social care to newcomers across Canada. Stay tuned!
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PREPARED
Helping Canada be Ready for the Next Pandemic Crisis
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The Upstream Lab, in partnership with the Alliance for Healthier Communities and institutions across the country, has received $18.9 million from the Canada Biomedical Research Fund to create a new approach to pandemic preparedness. Pandemic Preparedness Engaging Primary Care and Emergency Departments, or PREPARED, will integrate two essential elements of pandemic response - disease surveillance and research. This, in turn will enable faster development of tests, treatments, and vaccines.
Having an early warning system and a way to connect people to clinical trials is essential to ensuring that Canada is prepared for future pandemics. But we know that the impacts of a pandemic are shaped by much more than the pathogen itself, so PREPARED builds on existing research on the social factors that influenced COVID-19. “Upstream prevention means thinking about the interplay between infectious threats and social threats” says Dr. Andrew Pinto, Upstream Lab director and project lead.
Lessons in Equity from COVID-19
The Alliance and our members saw first-hand how the impacts of COVID-19 worsened existing inequities. Personal support workers, who are disproportionately racialized women and often precariously employed, experienced disproportionately high disease burden. So did Black and Indigenous people and communities, newcomers, people experiencing homelessness, workers who lacked access to paid sick days, and people who were incarcerated. Alliance members, in partnership with their communities, worked hard to address these inequities by providing community-based testing and vaccine clinics, ensuring people could still access essential care, by supporting vaccine confidence and uptake, and by advocating for better policy responses. They delivered food hampers and hot meals and found new ways to keep people connected during lockdowns, tailoring their responses for equity-deserving communities. Researchers at the Alliance studied how the pandemic negatively impacted health equity, and we collected data and stories to demonstrate the positive impacts of our members’ work. By participating in PREPARED, we can help ensure that these lessons in equity inform how Canada prepares for and responds to future pandemics.
Looking beyond COVID-19
In addition to enhancing pandemic preparedness, the initiative will go beyond monitoring respiratory illnesses. "We would like to adapt this approach to track other emerging infectious diseases, such as mpox. It could be adapted to perform surveillance during other public health emergencies, such as those driven by climate change," said Dr. Benita Hosseini, Upstream Lab research scientist and a project co-lead.
Part of the project is to train the next generation of researchers through the PREPARED Talent Development Program, Dr. Hosseini added. Trainees can choose a learning stream to focus on surveillance, data science, implementation science or community-based participatory research.
PREPARED will help Canada be ready for the next pandemic. "We are excited about working with many partners to create a shield that will help protect Canada, now and in the future," said Dr. Pinto.
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Stay in Touch with PREPARED |
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Learning Events & Programs |
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July
ECHO Open Sessions
Monday, July 8 & Wednesday, July 10, 12:00 pm | Online | Free
ECHO OPEN Sessions at UHN are an opportunity to "sample ECHO" by attending single session. Register here.for one or both of these sessions:
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Liver-Hepatitis C: Pre-treatment & regimen selection (July 8)
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Concussion: Recap of Key Principles & Assessment of Emerging Evidence (July 10).
PRAIDA: Strategies for Supporting Asylum Seekers in Canada
Wednesday, July 10, 1:00 pm | Online | Free
Developing Your Collaboration Impact Story
Tuesday, July 16, 1:00 | Online | $219-$249
Join Liz Weaver and Sylvia Cheuy from the Tamarack Institute for this newly developed, virtual workshop that will guide you and fellow changemakers in crating your collaboration's own impact story. Learn more here. Register here.
Unlocking Nurse Retention Success: Strategies for Internationally Educated Nurses
Wednesday, July 24, 1:00 pm | Webinar | Free
Join this session from the National Newcomer Navigation Network to explore the new national nurse retention toolkit. The presentation is tailored to the unique considerations of nurses who received their education outside of Canada. Presented by the National Newcomer Navigation Network (N4). Learn more and register here.
August
Removing the Barriers: Making your Organization 2SLGBTQ Friendly
Wednesday, August 7, 10:00 am | Webinar | $20
Join this session to learn how you can enhance the visibility and inclusion of 2SLGBTQ employees, volunteers, and clients; to increase your capacity to provide welcoming, friendly, professionally, and culturally competent care; and to make your organization's policies, spaces, programs, and services 2SLGBTQ positive. Learn more here. Register here.
September
Removing the Barriers: Making your Organization 2SLGBTQ Friendly
Tuesday, September 10, 10:00 am | Webinar | $20
Join this session to learn how you can enhance the visibility and inclusion of 2SLGBTQ employees, volunteers, and clients; to increase your capacity to provide welcoming, friendly, professionally, and culturally competent care; and to make your organization's policies, spaces, programs, and services 2SLGBTQ positive. Learn more here. Register here.
Improving Access to Mental Health Services for Newcomer Children and Their Families: Insights from a Citizen Panel and Stakeholder Dialogue
Wednesday, September 18, 1:00 pm | Webinar | Free
This webinar will provide participants with a summary of the key insights that emerged from a citizen panel and stakeholder dialogue convened on this topic, where best evidence was considered alongside views and experiences to help identify next steps to address this challenge. Presented by the National Newcomer Navigation Network (N4). Learn more and register here.
Advancing Social Prescribing for Health & Wellbeing
September 26-27 | In Person (Toronto) | $50-$500
This conference, presented by the Red Cross and the Canadian Institute for Social Prescribing, will increase awareness, demonstrate and celebrate cross-sectoral collaboration, and generate momentum in advancing social prescribing. Learn more here. Register here.
October
North American Conference on Integrated Care
October 15-17 | In Person (Calgary) | $550-1550
5th Annual London FASD Virtual Conference
October 22-23 | In Person (London} | Cost TBD
This year's theme is Neurodiversity Throughout Development: From Misperceptions to Understanding. Save the date - registration opening soon! Learn more here.
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Ongoing Training and Collaborative Learning
Fostering Canadian Integration for IEHPs: From Learning to Action
Pre-register now for Fall 2024
This free,12-week, multi-modal program is designed to support internationally educated health care providers with the challenges of finding their place in Canada. It is presented by St. Paul University in partnership with the National Newcomer Navigation Network and is funded by Immigration, Refugees, and Citizenship Canada. Limited spots are available. Pre-register here for the Fall 2024 English cohort.
ECHO at UHN
Echo at UHN is an interactive, interprofessional, collaborative learning program funded by the Ontario Ministry of Health. It's free and open to all health care providers, and CPD credits are available. Participants get access to weekly didactic lectures and anonymized, peer-led case discussions. Registration is open now to join ongoing cohorts on liver, concussion, rheumatology, and chronic pain & opioid stewardship, or to sign up for the fall concussion series. Learn more and register here. If you're curious and just want a "sample," consider registering for one of their open sessions. Details here.
Rapid Action & Learning Intensive on Sociodemographic Data Collection
Now available to Alliance members only
Our Rapid Action & Learning Intensive on Sociodemographic Data Collection (RALI-SDD) has launched! Participants gain access to four self-paced online learning modules, dedicated coaching support, and a workbook to help you track your progress. RALI was developed as a way to help organizations apply the learnings of our second learning collaborative, which was all about improving sociodemographic data collection. It's free to enroll and available to Alliance members only. If interested, please email QI@AllianceON.org to learn more or sign up.
SPIDER Learning Collaborative: De-prescribing dangerous medications
Can data-driven QI activities help de-prescribe potentially harmful medications, for medically complex senior clients? Help answer this question and improve health outcomes for your clients by participating in a 12-month learning collaborative. EMR queries will be provided to help participating Alliance members identify clients who would benefit. Contact Jennifer Rayner for more information.
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Research & Sharing Opportunities |
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Calls for Abstracts
London & Region FASD Virtual Conference
Submission Deadline: August 10
Conference organizers are currently accepting abstracts for oral and ePoster presentations for this year's virtual conference. The theme is Neurodiversity Throughout Development: From Misperceptions to Understanding. Abstract topics may be basic, translational, or clinical research. Presentations should be accessible and relevant across disciplines. See the call for abstracts here.
Research Partnerships and Advisory Tables
Help Ontario Health advance the use of digital practice tools
Application deadline extended to July 6! Ontario Health and the Ontario government are working on a new digital health--focused initiative, Patients Before Paperwork (Pb4P). This project aims to help phase out the use of fax machines, improve the interoperability of digital health tools, and make the health system more integrated and coordinated. They are looking for community-based clinical providers (MDs, NPs, RNs, midwives, pharmacists, & specialists) to be part of an advisory table that will provide feedback and insights on major digital health initiatives. To apply, send your expression of interest to oh-patientsbeforepaperwork@ontariohealth.ca. Include your CV and a summary of the digital tools you have experience with. For more information, see the EOI posting and the Pb4P web page.
Clinical Trials and Participatory Research
Focus Groups and Interviews
Provider Experience Study: Primary Care for Individuals with Serious Mental Illness (PriSMI)
Take part in a single 60-minute interview about your experiences
PriSMI is a CIHR-funded research program about the role of primary care in managing chronic illness among people living with serious mental illness (SMI). People with SMI often experience barriers to care, and understanding how primary care services are provided to them may help reduce avoidable hospitalizations and deaths. For the provider interview study, the PriSMI team is looking for family physicians and primary care nurse practitioners to describe their experiences caring for people living with SMI. Participants will receive a $120 honorarium for a 60-minute interview. Interested? Please check your eligibility here. For more information, contact erandall@uottawa.ca.
Needs and goals of racialized stroke survivors and family members/caregivers
Individual and group interviews - phone, Zoom, or in person
Researchers at the University of Toronto are looking for racialized people with stroke and their family members or caregivers to share their experiences. Participation involves three individual 1-hour meetings and one 2-hour group meeting with the research team, by phone, Zoom, or in person. Participants will receive a $20 honorarium after each meeting. For more information, see this flyer or email Miranda Wu.
Provider experiences using point-of-care ultrasound and/or continuous electronic fetal monitoring
Take part in one 60-90 minute interview (remote or in person)
Researchers at Western University are inviting family physicians and obstetricians to share their experiences using point-of-care ultrasound (PoCUS) and/or continuous electronic fetal monitoring (cEFM) in their care of pregnancy and childbirth. Participants will receive a $15 gift card as a token of appreciation, and minor travel costs, such as parking, will be covered for in-person participants. See details here or reach out to Grecia Alaniz for more information.
Surveys
Ontario Residents: Help shape virtual care in Ontario
Researchers at INSPIRE-PHC are inviting Ontario residents to share their experiences and suggestions on how to improve virtual health care in primary group settings by taking a 15- to 20-minute survey. Participants will also have the opportunity to participate in a focus group. Responses will inform patient-centred recommendations about virtual care to the Ontario government. Honorarium gift cards and entry into a prize draw will be provided as compensation. Additionally, the study team is offering primary care clinics the opportunity to receive a personalized survey link to their clients and provide a custom report on their clients' virtual care experiences. This study from the University of Toronto and Ontario Tech University is led by Dr. Rachelle Ashcroft and Dr. David Rudoler.
Public consultation: Person-centred care in the context of integrated care
The International Foundation for Integrated Care’s 2022 survey found that the feature of integrated care consistently ranked highest was “people-centred.” Their 2024 survey aims to understand how person-centred care is practiced and experienced in different countries and settings, and to what extent people think it is being delivered today in health and care systems. They are hoping to hear from people representing as many groups and countries as possible. Follow this link to learn more and complete the survey, and please share it widely with your colleagues, clients, and communities.
Survey of Primary Care Practitioners: Infant and Early Mental Health
This survey by researchers at the Infant and Early Mental Health Promotion program at Sick Kids Hospital is seeking to better understand the needs of primary care practitioners when they work with children aged 0-3. It should only take 5 minutes to complete, and your response will help inform the development of early years mental health resources for primary care practitioners. For more information, reach out to the study team by email.
Barriers to Prescribing Medications to Help Manage Substance Use
Medications like naltrexone, acamprosate, and buprenorphine are important tools that primary care providers can use to help some individuals who use substances meet their goals. META:PHI, a provincial initiative to support health care providers working with people who use substances, would like to help increase primary care capacity for offering these medications when appropriate. We are interested in hearing from primary care providers (including both physicians and nurse practitioners) about barriers they may face to prescribing these medications and resources that might be useful in mitigating these barriers. Please consider completing this brief anonymous survey to share your thoughts about prescribing these medications in primary care. If you have any questions about this survey, please contact Sarah Clarke.
Share your experience working with young caregivers
Are you a healthcare provider working in Canada? Researchers at the University Health Network are interested in learning about your clinical experience with caregivers who are under the age of 25. More information about the online survey is available here. At the end of the survey, you can input your email in a raffle for a $25 gift card.
For your older adult clients
A graduate student at the University of Toronto is surveying older adults about how they use the Internet for health information, and how they would like to learn new information for their health maintenance and improvement. Anyone aged 55+ is welcome to participate, especially those who are Indigenous, racialized, 2SLGBTQ+; have disabilities; or live in rural/remote areas. Consent form and survey here. For further information, please reach out to Mary Hynes by email or at (416) 597-3422 ext. 7775.
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Funding Available
Canadian Harkness Fellowship
Apply by November 1, 2024
Harkness Fellowships are awarded annually by the Commonwealth Fund to promising mid-career professionals. Successful applicants are funded to to spend a year in the U.S., researching healthcare delivery system reform and critical healthcare policy issues, with the support of a mentor. Fellowship awards cover roundtrip airfare, living allowance, project-related travel and research, health insurance, and taxes. Supplemental funding for accompanying family is also included. Learn more and apply here by November 1, 2024.
Tools for Improvement and Highest-Quality Care
Determining Health: Decent Work Practice Brief. This new resource from the National Collaborating Centres for the Determinants of Health is an essential resource for public health practitioners aiming to address precarious employment and hazardous work by advancing decent work as a determinant of health. Building on the 2022 Issue Brief, the 2024 Decent Work Practice Brief describes and provides concrete examples of four equity-centred public health roles and three essential approaches for addressing the urgent issue of precarious employment and hazardous working conditions in Canada.
Mental Health Resources for Farmers, Agricultural Workers, and their Families
Agricultural Wellness Ontario is a free, government-funded counselling program designed to meet the particular needs of farmers, agricultural workers, and their families. They can access the service by calling 1-888-267-6255; within a week, they will be connected to a counsellor who they can see on an ongoing basis, for as long as they need. See the website for information about eligibility, accessibility, and privacy.
"Conversations with Clinicians" Audio Series from Ontario Health. Ontario Health has created this 4-part audio series to help primary care clinicians better understand how to use data for quality improvement (QI). Data-driven QI champions and leaders share their experiences and discuss the challenges and opportunities of collecting and using data for QI in primary care. All four episodes available on YouTube.
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