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Addressing the Social Determinants of Health:Making CBR Work for Communities in Ontario
1. Addressing the Social Determinants of Health:
Making CBR Work for Communities in Ontario
Sean B. Rourke, PhD
Scientific and Executive Director, Ontario HIV Treatment Network (OHTN)
Associate Professor of Psychiatry, University of Toronto
Scientist, Centre for Research on Inner City Health, St. Michael’s Hospital
2. Making CBR Matter:
A Recipe for Success
1. Strong Strategic Plan
2. Strong Sector
3. Mobilizing People
4. Building Capacity
5. Mobilize Knowledge
6. Addressing What's Important to People
3. OHTN Strategic Plan to 2010:
Seven Major Objectives
1) Increase #/Capacity of Health Care Providers for HIV Care
2) Support Community to Address Social Determinants of Health
3) Invest Strategically in Research
4) Support Effective and Innovative eHealth and IT Initiatives
5) Revitalize OHTN Cohort Study to Enhance Care in Ontario
6) Support KTE Expertise and Capacity
7) Monitor and Evaluate OHTN Activities
4. What kind of CBR are we doing ?
CBR that is:
• Driven by priorities in our community
• Addresses the social determinants of health
• Scientifically rigorous and policy relevant
• Will lead to improvements in health outcomes
and quality of life for people living with HIV
and our communities at risk
5. Where are we going ?
.... and what role/impact do we want to play
• Be a leader in CBR for SDOH in Canada
• Have an impact in Ontario and Canada
6. How will we get there ?
.... and what do we need to do?
• Build partnerships with community members,
research groups, policy-makers, and funders
• Build capacity in the community and with
researchers
• Facilitate and enhance communication across
sectors
• Build KTE into our work - research in action
7. The HIV Sector
• HIV/AIDS has long served as a testing
ground for progressive research designs and
methodologies.
• Many AIDS service organizations are
engaged in CBR, with some having the
capacity and desire to conduct their own
research
8. Building an Evidence Base – Methods
Making Research Work for Community-Based AIDS Organizations in Ontario:
Strategies for Linking Research to Action
Team
• For Ontario ASOs, modified • Sean Rourke, PhD (OHTN)
• Robb Travers, PhD (OHTN)
Canadian Health Services Research
• Michael Wilson, MSc. Cand. (OHTN)
Foundation Survey “Is Research
• John Lavis, PhD, MD (McMaster University)
Working For You”? Jean Bacon, MA (OHTN)
• Tarik Bereket, MA (OHTN)
• Acquire, adapt, assess and apply • Shelley Cleverly, MHSc (Ontario AIDS
Network)
knowledge administered using an • Evan Collins, MD (Hassle Free Clinic)
on-line service • Rick Kennedy (Ontario AIDS Network)
• Edward McDonnell (OHTN)
• Email distribution for participant • Peggy Millson, MD (University of Toronto)
recruitment • Ron Rosenes (Canadian Treatment Action
Council)
• Ruthann Tucker (Fife House)
• Augmented by on-line and in-
person focus groups
9. Building an Evidence Base – Methods
Facilitating CBR in Ontario’s Community-Based HIV Sector:
Baseline Assessment and the Development
of a Strategy for Change
• For Ontario ASOs, modified Team
tool Barriers and Facilitators • Robb Travers, PhD (OHTN)
for CBR in Canada (Savan,
Flicker & Travers, 2005). • Sarah Flicker, PhD (York
University)
• Tarik Bereket, MA (OHTN)
Measures:
• Michael Wilson, MSc (cand)
• Experiences with CBR (OHTN)
• Perceptions of CBR • Shelley Cleverly, MHSc (OAN)
• Barriers and facilitating factors • Colleen McKay, MA (OHTN)
for CBR
• Anna van der Meulen, MA
Administered using an on-line (OHTN)
service:
• Email distribution for
participant recruitment
10. Why do Community Organizations do CBR Projects?
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Assessment Program Eval. Increasing New Program Policy Change Other
of Commun. Commun. Eval.
Needs Awareness
11. What Makes CBR Challenging?
• too many competing demands
• lack of physical and human resources
• scarcity of funding
• time consuming nature of CBR
• difficulty accessing ethics review
• concern that results will not be acted upon
12. CBR Facilitators
Capacity-building
• skills-building opportunities for academic partners to learn about community
concerns
• skills enhancing opportunities for community organizations
• internships/practicum for students to engage in CBR
• internships for community members to engage in CBR
Structural resources
• funding for long-term research initiatives
• provision of start-up funds
• greater involvement of community members
Information resources
• documentation of CBR “best practices”
• toolkits (e.g. partnership templates)
• d-base of CBR-interested community groups and researchers
13. Mobilizing People
Living & Serving II: Ten Years Later
A community-based research project on the involvement of
people living with HIV/AIDS (PHAs) in the AIDS movement in
Ontario.
Objectives
• identify barriers to meaningful PHA involvement in Ontario
• identify changes since the mid-1990s when Dr. Charles Roy conducted
the initial study
• develop policies and practices to effect change
Methods
• 12 focus groups across Ontario with key players in the Ontario
HIV/AIDS community (n=82)
• Qualitative data thematically coded using NVivo 7.0
• Quantitative survey component for EDs at Ontario ASOs
– data collection is ongoing
14. Living & Serving II: Ten Years Later
Some emerging findings:
• The benefits of the OCAP principles
• Need for the movement to be more responsive to the diversity of
communities affected & to take a social determinants of health
approach instead of working in identity-based silos
• The difference between meaningful participation versus tokenism
• Social policy and programming inconsistent with changing nature of
HIV
• Importance of having youth PHA involvement and peer-support
• Services and programming are not gender sensitive or “women-
friendly”
• Not enough training and financing for PHA capacity building
17. Mobilizing Knowledge
Knowledge Mobilization Initiatives:
• Invested 152,000 last year in:
– Think Tanks
– Newsletters
– Seminars
• Housing & Health
• Best Practice Recommendations for NEP in Ontario
• Immigration and HIV
Knowledge Mobilization Fund
• $250,000.00
• Objective: To mobilize knowledge from HIV research in Ontario to affect
community and policy level changes.
18. Compass Innovation Series
Objectives
• identify exemplary work that supports the
operationalization of CBR principles and provide general
‘how-to’ information about CBR;
• encourage community consultations/ ‘Think Tanks’ for
feedback;
• initiate CBR capacity-building at the individual and
organizational level;
• facilitate networking and partnership development among
community members, researchers, academics, policy
makers etc.
20. Addressing What's Important to People
• Community-Based Research Ethics Review Board
• The Best Practice Recommendations for Needle
Exchange Programs (NEPs) in Ontario
• Microfinancing for positive women in the GTA
• HIV and Housing Study
