Monthly Bulletin of the Alliance's Learning Health System |
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2SLGBTQI+ Families' Precarious Inclusion
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Co-Designed Virtual Care Guidance |
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Learning from our 1st Learning Collaborative |
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Learning Events & Programs |
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Get Involved: Research & Sharing |
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The Power of Digital Storytelling
Revealing the Precarious Inclusion of 2SLGBTQI+ Families
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When the All Families Are Equal Act (2016) passed, Julia Gruson-Wood’s partner was in labour with their child. As claimants in the Charter challenge that led to the new legislation, they were ecstatic. The new law meant that they would be treated like any other family in Ontario. Julia would have the same rights as a biological parent without having to go through a lengthy and costly adoption process. She and her non-binary partner would both be named as parents on the birth certificate with the correct parenting titles - Julia's non-binary partner would not be named as "Mother." If something went wrong during birth, Julia could make any needed decisions.
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That feeling didn’t last long. It dissipated when Julia’s non-binary partner was wheeled into a room labeled “Mother and Baby Unit,” when a nursing consultant instructed them to burp the baby “on Daddy’s strong shoulder,” when a stranger asked Julia if her daughter’s red hair “came from her father,” and when they had to wait a year and a half to receive the long-form birth certificate that listed them both as parents, meaning they couldn’t access other documents like a passport for their child. Experiences like this led Julia, an interdisciplinary health scholar at the University of Guelph, to explore the nature and impact of systemic homophobia and transphobia, especially in the health, social services, and education sectors.
The resulting project, Precarious Inclusion, uses digital storytelling to expose what’s hidden behind rainbow stickers and narratives of equality: Rights that hang in a delicate balance, like Jenga pieces that could tumble with a shift in the wind. Everyday language that erases queer families and non-binary identities. Intersections of transphobia, racism, ableism, and heteronormativity that leave people unsafe and unseen.
Because every story in Precarious Inclusion is a moment of vulnerability, it is the participants who decide where their stories go and how they are used. A few of the films have been submitted to equity-oriented film festivals; others are being used for training purposes with service providers in health care, social services, and education. They are also circulating in conferences and upcoming workshops. Individual service providers who wish to access the films in order to advance their own learning can contact Julia at jgrusonw@uoguelph.ca to access the videos through a password-protected website.
To further support learning and to help organizations use the lessons from the stories in their own journeys towards anti-oppression, the research team has created a series of infographic tip sheets for client-facing staff in health care, social services, education, and service industries.. These tip sheets can be used when designing your space and services and training staff, and posted on office walls as daily reminders. Examples include asking what parenting labels your clients use, writing and sharing your commitment to 2SLGBTQI+ families, requiring all staff to undergo training for 2SLGBTQI+ cultural competency, and ensuring forms and policies are inclusive of all and families.
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- How the project was designed to centre people with intersectional identities.
- How the research team built trust with communities who had been harmed by health and social care organizations.
- The poignant and powerful juxtapositions participants shared between their private and public experiences.
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How digital storytelling can create community amongst participants, researchers, and knowledge users.
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Navigating Change Together
How a Design Collaborative Created a new Clinician Toolkit
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When COVID-19 brought virtual care into the mainstream, understanding how best to implement it became a high priority for the health system. Providers, funders, and health system partners wanted to know how to identify and implement ways of delivering virtual care to improve outcomes and experiences for clinicians and clients.
To lay the groundwork, Infoway conducted an environmental scan and stakeholder outreach to identify existing virtual care resources and priority areas of needs. Through stakeholder engagement activities, clinicians and support staff identified three key areas where support for virtual care was required: appropriate use of virtual care, safe and quality virtual care interactions, and use and optimization of virtual care services.
Based on more than 150 virtual care resources identified through the environmental scan, HEC and Infoway developed the Clinician Change Virtual Care Toolkit, a streamlined selection of validated resources that can be used to support virtual care based on the identified priority areas. It was created through an iterative process of testing and review: From October 2021 through March 2022, a Design Collaborative of 25 teams from across Canada prepared, implemented, and evaluated virtual care tools and resources for community-based primary care. Several Alliance member organizations and the Alliance itself participated, ensuring that the needs and insights of our providers and clients were well represented. Each iteration was reviewed by an expert review panel consisting of providers and clients.
Here’s what’s inside the final version:
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Streamlined information from trusted sources that can be used to plan for and improve virtual care services.
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Virtual care evaluation resources that can be consulted to inform plans and approaches for evaluating virtual care services and identifying areas for improvement.
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Additional tools and resources identified from the environmental scan and stakeholder outreach activities that were leveraged in the development of the toolkit.
The members of the Design Collaborative received tailored learning supports which included coaching, peer-to-peer networking, and dedicated workshops and change management support. It was this peer-to-peer networking that the teams found especially valuable. When asked if there had been any surprises, one of the project leads pointed to how every team had identified peer networking as the most valuable aspect of the collaborative. An all-teach, all-learn approach had always been seen as key to the project, but the team was surprised by how unanimously and enthusiastically the participants agreed.
Although this iteration of the learning collaborative has concluded, the work continues, as reflected in the numbering of the Toolkit as “Version 1.0.”
Want to learn more about the Design Collaborative and the Clinician Change Toolkit?
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Want to learn more about the Design Collaborative and Clinician Change Toolkit?
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Learnings about Learning:
What our first-ever Learning Collaborative taught us
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This spring, the Alliance's first-ever learning collaborative wrapped up. It focused on equitably reducing cancer-screening backlogs. We conducted an evaluation to understand the impact of the learning collaborative and learn how to make the next ones even better. The results of that evaluation are now available here.
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A Learning Collaborative (LC) is a short-term learning system that brings together peers from multiple organizations to seek improvement in a focused topic area, with guidance from a coach or practice facilitator. The Alliance for Healthier Communities implemented its first LC last year with teams participating from 10 Community Health Centres and 3 Aboriginal Health Access Centres.
The first objective of this collaborative was to build quality improvement (QI) knowledge and skills among participating teams. The second objective was to improve cancer screening rates impacted by the COVID-19 backlog through utilization of QI theory, tools and resources.
How we implemented our Learning Collaborative
The first step in implementing this LC was to select a key topic of interest. We did this in collaboration with Alliance member centres and the Equity, Performance, Improvement, and Change (EPIC) committee, taking into account emerging evidence and data trends that indicated the existence of a backlog.
Participation was open to all Alliance member organizations. Each participating organization established a Quality Improvement (QI) team to participate in the LC and lead their improvement project. The makeup of QI teams varied, but each of them had a QI lead and a combination of healthcare providers, a data management coordinator and administrative staff. Each team was supported throughout the LC by an assigned QI coach, who attended team meetings and provided feedback and support where needed.
The learning collaborative consisted of a meet 'n' greet, three learning sessions interspersed with three action phases, a sharing session, and a capstone event. During the learning sessions, teams developed their QI knowledge and skills; in the subsequent action phases, they applied what they had learned. At the sharing session and final capstone, LC participants celebrated together and shared their progress, learned lessons, and key resources they'd developed or used.
Evaluation and outcomes
In evaluating the LC, we set out to answer two key questions:
- Was the learning collaborative implemented as intended?
- Did the learning collaborative meet its intended objectives and/or planned outcomes?
We did this using surveys, interviews, and run charts showing each team's cancer-screening rates over time. Three key findings arose from these evaluation activities:
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QI Coaches supported teams on their QI journey. All survey respondents reported receiving the support they needed throughout the LC process.
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Teams developed their QI knowledge and skills. 93% of respondents told us that the learning sessions had improved their knowledge of QI, and 81% said they had applied the knowledge and tools presented during the learning sessions.
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Preliminary results indicate improvements in cancer screening rates. Ten teams participated in all learning and sharing sessions, and six of these saw improvements in their rates.
Some of the change ideas that led to measurable improvement in outcomes included:
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Stratifying screening rates by race/ethnicity to tailor outreach to those who had never been screened or were overdue.
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Adding reminders in the Electronic Medical Record (EMR).
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Providing quarterly reports on screening performance to providers.
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Creating a client script to educate on the benefits of screening.
Even better next time!
Our evaluation indicated that, overall, the learning collaborative was a success. However, we also heard about ways we can improve the experience and, hopefully, the outcomes in future learning collaboratives. Using these findings, we have made a number of changes to the structure of our learning collaboratives. These include:
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More clearly clarifying roles and expectations.
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Providing additional data management support.
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Creating space to clarify content covered during learning sessions.
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Adding more learning sessions and reducing the content in each.
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Lengthening the action phases.
Check out the table below to for a full list of recommendations and actions.
Our second learning collaborative, Foundations of Equity: Improving sociodemographic data collection and use launched in May 2022 and will conclude in April 2023. This learning collaborative will help teams improve the completeness, timeliness, and useability of their sociodemographic data, in order to better understand the clients and populations they serve, as a foundational step to advancing health equity in their communities. We look forward to sharing the outcomes with you here.
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Learning Events & Programs |
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August
Friday, August 26, 12-1 pm. POPLAR EDIIA Webinar Series, Pt 2: Building Research Projects with an EDIIA Lens. This is the second in a monthly series of webinars hosted by POPLAR, Ontario’s provincial primary healthcare Practice-Based Learning and Research Network. These webinars are for anyone who wants to learn more about building Equity, Diversity, Inclusion, Indigeneity, and Accessibility (EDIIA) principles into their work.
- Keynote Speaker: Dr. Vivian R. Ramsden, , Director of the Research Division, Department of Family Medicine at University of Saskatchewan
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Learn more or register here.
September
Thursday, September 15, 12-1 pm. Webinar: Wellness Check: Dealing with Transitions and Managing Stress. Hosted by AFHTO in partnership with the Canadian Mental Health Association Ontario, and presented by Nancy Hood, the head trainer of the Your Health Space program. Gain insight into change processes and their impact on workplace mental health, and learn strategies for managing hybrid working models and combating stress. Learn more and register here.
Friday, September 16, 12-1pm. Lunch ‘n’ Learn: Learning Health Systems within the Alliance and beyond – past, present, and future. Learn about the emergence and growth of the Alliance Learning Health System (LHS), its role as a key facilitator in the creation of provincial and national LHSs, and where we hope to go from here. You’ll hear from a panel of researchers and quality improvement leaders who all have a wealth of expertise in learning health systems. Participants will engage with the panelists in a discussion of next steps and how Alliance member organizations can benefit from being part of our LHS initiative. More information, including panelist bios, is available here. Register here.
Wednesday, September 21, 12-1 pm. POPLAR EDIIA Webinar Series, Pt. 3: Embedding Equity in Leadership and Teams – Measuring EDIIA. This is the third in a monthly series of webinars hosted by POPLAR, Ontario’s provincial primary healthcare Practice-Based Learning and Research Network. These webinars are for anyone who wants to learn more about building Equity, Diversity, Inclusion, Indigeneity, and Accessibility (EDIIA) principles into their work.
- Keynote Speaker: Dr. Nicole Kaniki, Director of Diversity, Equity and Inclusion in Research and Innovation at University of Toronto.
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Learn more or register here.
Thursday, September 22. 1-4:30pm. Virtual Workshop: Turf, Trust and Virtual Collaboration: Practical Tools for Building Trust. Presented by the Tamarack Institute. Information and registration here.
September 22 & 23. NPAO Annual Conference. This year's conference will be held in person. The theme is The NP Experience: Pushing Boundaries Towards Common Goals. Registration and program here.
October
October 3-7, 9:00-10:30 am daily. Virtual Learning Event for Privacy Officers. This is the Alliance's seventh annual professional learning event for privacy officers. Join us for five one-hour presentations over five consecutive days. Each one is followed by an optional 30-minute networking session. Details and registration link here.
Wednesday, October 12. AFHTO 2022 Conference. The Association of Family Health Teams of Ontario's 2022 conference is a hybrid in-person/virtual event on the theme of Reconnect and Reimagine: Moving Forward Together. Registration opens soon; watch this page for updates.
October 17-23. Community Health and Wellbeing Week 2022: Confronting inequity, Celebrating Community. Join the Alliance for a week of celebration and advocacy. Stay tuned for more about this year's health equity pledge, themed days, tailored messaging templates, and other activities to celebrate and advance our sector's work.
Wednesday, October 19, 2-1 pm. POPLAR EDIIA Webinar Series, Pt. 4: EDIIA and Data - Building Capacity. This is the fourth in a monthly series of webinars hosted by POPLAR, Ontario’s provincial primary healthcare Practice-Based Learning and Research Network. These webinars are for anyone who wants to learn more about building Equity, Diversity, Inclusion, Indigeneity, and Accessibility (EDIIA) principles into their work.
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Keynote Speaker: Dr. Andrew Pinto, Scientist and Founder of Upstream Labs at Unity Health
- Learn more
- Register
Thursday, October 20. Save the date for our virtual Social Prescribing conference: Current Practices and Community Conversations. The Alliance for Healthier Communities is hosting a one-day virtual conference, showcasing current practices in Social Prescribing from many perspectives and on many topics. Paid registration on a sliding scale: FREE for those with ow or fixed income, $15 for students and seniors, and $30 regular daily rate. For more information please contact Natasha Beaudin, Social Prescribing Project Lead (Natasha.Beaudin@allianceON.org) or Josephine Pham, Social Prescribing Knowledge Mobilization Specialist (Josephine.Pham@allianceON.org).
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Research & Sharing Opportunities |
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Calls for Abstracts
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Ready to write? Submit a 200-word abstract to dkent@longwoods.com. It should summarize your proposed submission with a brief description of the intervention and what the readers will be able to take away from your paper and apply in their own work.
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Need support? The Alliance research team can help you put your story into words. Email your idea to Catherine Macdonald and Sara Bhatti at LHS@AllianceON.org.
Research Partners Needed
We’re recruiting clients and community members to help guide our research. Client & Community Research Partners will help us ensure that Alliance research is focused on what matters most to clients, that it’s done in ways that are culturally safe and inclusive, and that it leads to the creation of meaningful tools and information. No previous expertise is required; participants will support researchers’ decision-making based on their own priorities and lived experience. Partners will need to be sponsored by someone from their primary health care organization and should have some previous experience sharing their perspectives with an advisory council or focus group. We’ll compensate participants $50 per meeting. Read about the program here, and check out our FAQs for participants and sponsors. Email Catherine Macdonald at LHS@AllianceON.org for more information.
Primary care clinicians needed: Help guide comparative research about the care and outcomes in different PC models for people living with dementia. A research team from Arizona State University and Dalla Lana school of Public Health want to understand what enables effective communication and diagnoses with primary care clients who have mild cognitive impairment (MCI) or early-stage Alzheimer disease or related dementia (ADRD). They're comparing different models in Ontario, Arizona, and New York State. Interested? Consider joining the project's steering committee. For more information, please email Allie Peckham (Allie.Peckham@asu.edu).
Clinical Trials and Participatory Research
Research opportunity: Goal-oriented care in Community Health Centres A research team at the Lunenfeld-Tanenbaum Research Institute is recruiting primary health care teams (6-8 clinicians and interprofessional providers) at four CHCs to participate in this study. If you are familiar with goal-oriented care and have either used this approach or are willing to do so, you can help them understand how it’s implemented in a real-world setting. They’ll use what they learn to make the model more accessible and feasible. Participants will be asked to reflect on their experiences with goal-oriented care in interviews. Check out the infosheet or email Carolyn Steele Gray for more information.
Do you have older adult clients who are experiencing loneliness? A research team at Baycrest is studying the use of a virtual, at-home program aimed at promoting brain health. Participants will engage in either mindfulness meditation or brain training for 8 weeks and complete online sessions and surveys to assess the impact of the interventions. Compensation will be provided. To be eligible, participants must be over 60 years of age, living in Ontario, and have access to a mobile device or computer with an internet connection. Full details and contact information here. Register here.
Need help with client engagement and communication? Get access to the Canadian Primary Care Information Network (CPIN), tailored messages for your vaccine-hesitant clients, and up to three additional communications and survey campaigns on topics of your choice. Family physicians at the University of Ottawa and Monfort Hospital are studying how automated patient engagement systems like CPIN can improve communications with clients about COVID-19 vaccines. Get more information here or email the study team at info@cpin-rcip.com.
Leadership Opportunities in Quality Improvement
Ontario Health Seeking Regional Clinical Leads: In addition to providing clinical leadership, Clinical Leads help direct OH strategy, establish best practices, design and implement system improvements, translate knowledge into practice, and conduct measurement and evaluation of programs, practices, and performance. This is an opportunity to help build a more equitable health system for everyone in Ontario. Here are a few roles that may be particularly relevant to our sector (links open Word documents). There are roles for physicians and other regulated health care providers. A full list can be found here.
Interviews and Focus Groups
Who "deserves" access to health care? Researchers at York University are studying how health care advocates help individuals with precarious immigration status to navigate Ontario's health care system. They're looking for individuals who have experience living without citizenship in Ontario and those who work as service providers or community organizers. For more information, contact Sarah Marshal at SMarsh4@my.yorku.ca.
Urban health care organizations: How have you incorporated health equity into virtual care? A team of researchers from Women's College Hospital is conducting case studies of health equity and virtual primary care across Canada. If you'd like more information or are interested in participating, contact the research coordinator at Simone.Shahid@wchospital.ca.
Surveys
Does your organization provide health care or other supports to refugees and asylum seekers? Researchers at the University of Calgary are looking for people working in clinical, public health, or settlement organizations to answer some questions via an online survey. They want to understand who provides care to refugees and asylum seekers in Canada, how this care is coordinated and delivered, how it differs among jurisdictions, and how COVID-19 has impacted it. Participate by completing this short survey. In lieu of an honorarium, the research team will donate $10 to support refugee student scholarships. See flyer (English or French) for more information.
Social workers in primary health care: What has your daily practice looked like during the COVID-19 pandemic? Dr. Rachelle Ashcroft from the University of Toronto is leading a mixed-methods study called The Structure of Social Work Practice in Ontario Primary Care Teams. Participants will be asked to complete a survey about the role of social work, the current and optimal state of practice, and social work leadership. At the end, participants can optionally sign up for focus group. For more information, contact Rachelle Ashcroft at Rachelle.Ashcroft@utoronto.ca.
Collaborative Learning
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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Funding Available
Clinicians: Get up to $1500 to support your participation in a research project about measuring client outcomes and experiences. The Alliance is a partner in a multinational project sponsored by the Organization for Economic Cooperation and Development (OECD) which aims to evaluate a tool called Patient Reported Indicators Survey (PaRIS). PaRIS was created to measure patient-reported experience and outcome measures (PREMs and PROMs) for people receiving primary care services, so providers and policymakers can direct funding and improvement efforts to the things that matter most to clients. The OECD study will evaluate how well PaRIS captures this information and help determine the best way to implement it. If you are a physician or nurse practitioner with at least 300 clients over 45 years of age in your roster, you may be eligible to participate and influence what is measured. Up to $1500 in financial support will be provided to cover the costs of administering the survey. For more information, email Jennifer.Rayner@AllianceON.org or see this flyer.
Is your organization is new to research? Up to $10K is available from the Canadian Institutes of Health Research to help plan, implement, evaluate, scale, or spread programs that support LGBTQIA/2S health and wellbeing. To be eligible, your organization must have no prior research experience or be the current recipient of a grant from the same program. Projects must have an intersectional lens. More information here. Application deadline: August 30, 2022.
Training and Learning Resources
Healthcare Provider Training on Female Genital Mutilation/Cutting (FGM/C). Women’s Health in Women’s Hands CHC is relaunching the Flourish project, which provides anti-oppressive, trauma-informed support to survivors of FGM/C. As a part of that they will be delivering training workshops to health care and community service providers in Ontario over the next two years. For more information, see the Training Framework poster and email Tomilola John (tomilola@whiwh.com).
Governing for Health Equity. This five-part, self-paced online course was created by the Alliance to help boards go beyond diversity and inclusion, and build organizations that are better equipped to advance health equity at every level in the organization, the community, and the health system. Discounts for Alliance members and health equity builders. Register here.
Foundations of Indigenous Cultural Safety (ICS): This is the first course in the Anishnaabe Mino'ayaawin - People in Good Health ICS Training program from the Indigenous Primary Health Care Council. This course has been created for individuals working in the health care system to learn the importance of adopting culturally safe and appropriate practices when serving Indigenous clients and patients. This training will be hosted online and will take users approximately three hours to complete. Cost is $175 per person. For more information and to begin the registration process, please email ics@iphcc.ca.
Rainbow Health Ontario's Online Learning Platform: LGBT2SQ Health Connect includes online courses on delivering safe and affirming care, a Trans health knowledge base, clinical resources, research opportunities, brochures and publications, and more.
learn more and sign up your team.
Toolkits
New resource to help you provide even better virtual care. Regardless of your level of experience providing virtual care, this new toolkit from Canada Health Infoway and Healthcare Excellence Canada can support your efforts to make it safer, more effective, and more accessible. It contains information synthesized from existing resources and tools, tested and refined by 25 teams from across Canada through the Virtual Care Together Design Collaborative. Topics covered include:
- Appropriate use of virtual care
- Quality and safe virtual care interactions
- Use and optimization of virtual care
Newly Published
Article - COVID-19 Vaccine Coverage and Sociodemographic, Behavioural and Housing Factors Associated with Vaccination among People Experiencing Homelessness in Toronto, Canada: A Cross-Sectional Study. This paper, just published in Vaccines, finds that, amongst a cohort of people experiencing homelessness and staying in emergency shelters, shelter hotels, and encampments in Toronto, over 80% had received at least one dose of COVID-19 vaccine. Older age, being vaccinated for influenza, and male gender were associated with higher rates of uptake; being Black was associated with lower rates. This contrasts with an earlier study which found low COVID-19 vaccination rates amongst people experiencing homelessness in the city, and it suggests that advocacy and outreach efforts targeting this population may have been effective.
In Case You Missed It (or Want to Revisit It)
POPLAR EDIIA Webinar Series, Pt : Embedding Equity in Leadership and Teams. This was the first in a monthly series of webinars hosted by POPLAR, Ontario’s provincial primary healthcare Practice-Based Learning and Research Network.
Did you register for the Action Now! Conference? Slide decks and and poster presentations are available to you in our free community portal!
As soon as we've confirmed your conference registration, we'll approve your membership in the group, so you can view or download the resources.
Looking for more?
To get the most updated information from an Indigenous lens on the most recent news releases and updates, please subscribe to the Indigenous Primary Health Care Council bi-weekly newsletter! In it you will find CEO updates, member spotlight for upcoming events, IPHCC program updates alongside helpful resources and opportunities to learn from. To subscribe or to contribute to the content, please contact afasihuddin@iphcc.ca or abarlow@iphcc.ca.
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