In response to the rise in opioid-related deaths, communities across Ontario have developed opioid or overdose response plans to address issues at the local level. Public Health Ontario (PHO) leads ...the Community Opioid / Overdose Capacity Building (COM-CAP) project, which aims to reduce overdose-related harms at the community level by working with communities to identify, develop, and evaluate capacity building supports for local needs around overdose planning. The 'From Design to Action' co-design workshop used a participatory design approach to engage communities in identifying the requirements for capacity building support.
A participatory approach (co-design) provided opportunity for collaborative discussion around capacity building needs at the community level. The co-design workshop included three structured collaborative activities to 1) prioritize scenarios that illustrated various challenges associated with community overdose response planning, 2) prioritize the challenges within each scenario and 3) prioritize the supports to address each of these challenges. It was conducted with fifty-two participants involved in opioid/overdose-related response plans in Ontario. Participatory materials were informed by the results of a situational assessment (SA) data gathering process, including survey, interview, and focus group data. A voting system, including dot stickers and discussion notes, was applied to identify priority supports and delivery mechanisms.
At the workshop, key challenges and top-priority supports were identified, for development and implementation. The prioritized challenges were organized into five categories of capacity building supports addressing: 1) stigma & equity; 2) trust-based relationships, consensus building & on-going communication; 3) knowledge development & on-going access to information and data; 4) tailored strategies and plan adaptation to changing structures and local context; and 5) structural enablers and responsive governance.
Using a participatory approach, the workshop provided an opportunity for sharing, generating, and mobilizing knowledge to address research-practice gaps at the community level for opioid response planning. The application of health design methods such as the 'From Design to Action' co-design workshop supports teams to gain a deeper understanding of needs for capacity building as well as illustrating the application of participatory approaches in identifying capacity building needs for complex public health issues such as the overdose crisis.
The syndemic that is COVID-19 and the disproportionate policing of Black communities have recently generated mass social consciousness of the anti-Black racism (ABR) pervading health, social, and ...cultural institutions. However, little is known about the implementation of public health measures addressing ABR in an evolving pandemic context. The objective of this scoping review is to provide an overview of public health initiatives undertaken to address ABR across North American jurisdictions between December 2019 and June 2022. A search for public health initiatives was conducted in June 2021 across MEDLINE, Ovid Embase, EBSChost, CINAHL, SocINDEX, and Google.ca. Included initiatives were those focussing on Black, African diasporic, or African American communities in the North American context. Community-led action, as well as initiatives in primary healthcare care, academic journals, and those broadly focused on racialized communities, were excluded from this review. This research provides insights on public health accountability to social justice. This research outlines activities in upstream interventions, organizational transformation, and resource allocation in shaping anti-racist change, and require evaluation and input from those whom initiatives are intended to serve.
Abstract
Background
Many communities across North America are coming together to develop comprehensive plans to address and respond to the escalating overdose crisis, largely driven by an ...increasingly toxic unregulated drug supply. As there is a need to build capacity for successful implementation, the objective of our mixed methods study was to identify the current planning and implementation practices, needs, and priority areas of support for community overdose response plans in Ontario, Canada.
Methods
We used a situational assessment methodology to collect data on current planning and implementation practices, needs, and challenges related to community overdose response plans in Ontario, consisting of three components. Between November 2019 to February 2020, we conducted ten semi-structured key informant interviews, three focus groups with 25 participants, and administered an online survey (
N
= 66). Purposeful sampling was used to identify professionals involved in coordinating, supporting, or partnering on community overdose response plans in jurisdictions with relevant information for Ontario including other Canadian provinces and American states. Key informants included evaluators, representatives involved in centralised supports, as well as coordinators and partners on community overdose response plans. Focus group participants were coordinators or leads of community overdose response plans in Ontario.
Results
Sixty-six professionals participated in the study. The current planning and implementation practices of community overdose response plans varied in Ontario. Our analysis generated four overarching areas for needs and support for the planning and implementation of community overdose response plans: 1) data and information; 2) evidence and practice; 3) implementation/operational factors; and 4) partnership, engagement, and collaboration. Addressing stigma and equity within planning and implementation of community overdose response plans was a cross-cutting theme that included meaningful engagement of people with living and lived expertise and meeting the service needs of different populations and communities.
Conclusions
Through exploring the needs and related supports for community overdose response plans in Ontario, we have identified key priority areas for building local capacity building to address overdose-related harms. Ongoing development and refinement, community partnership, and evaluation of our project will highlight the influence of our supports to advance the capacity, motivation, and opportunities of community overdose response plans.
By 2020, the child population is projected to have more racial and ethnic minorities make up the majority of the populations and health care organizations will need to have a system in place that ...collects accurate and reliable demographic data in order to monitor disparities. The goals of this group were to establish sample practices, approaches and lessons learned with regard to race, ethnicity, language, and other demographic data collection in pediatric care setting.
A panel of 16 research and clinical professional experts working in 10 pediatric care delivery systems in the US and Canada convened twice in person for 3-day consensus development meetings and met multiple times via conference calls over a two year period. Current evidence on adult demographic data collection was systematically reviewed and unique aspects of data collection in the pediatric setting were outlined. Human centered design methods were utilized to facilitate theme development, facilitate constructive and innovative discussion, and generate consensus.
Group consensus determined six final data collection domains: 1) caregivers, 2) race and ethnicity, 3) language, 4) sexual orientation and gender identity, 5) disability, and 6) social determinants of health. For each domain, the group defined the domain, established a rational for collection, identified the unique challenges for data collection in a pediatric setting, and developed sample practices which are based on the experience of the members as a starting point to allow for customization unique to each health care organization. Several unique challenges in the pediatric setting across all domains include: data collection on caregivers, determining an age at which it is appropriate to collect data from the patient, collecting and updating data at multiple points across the lifespan, the limits of the electronic health record, and determining the purpose of the data collection before implementation.
There is no single approach that will work for all organizations when collecting race, ethnicity, language and other social determinants of health data. Each organization will need to tailor their data collection based on the population they serve, the financial resources available, and the capacity of the electronic health record.
Unmet health care needs are under explored among refugees. Previously we found unmet health care needs in Syrian refugees may be higher than in the general Canadian population (Oda et al. CMAJ Open ...5(2): E354–E358, 2017; Oda et al. J Immigr Minor Health, 2018. https://doi.org/10.1007/s10903-018-0780-z). This follow-up study with Syrian refugees who entered Canada between July 2015 and July 2016 aimed to understand if there are changes in unmet health care needs 6 months to a year after baseline collection. The number reporting unmet needs was high (42.6 %). Although some refugees had their needs met, unmet health needs persist, and it seems that they are linked with sponsorship pathway and post-migration socioeconomic position. While caution should be used generalizing these results, they do suggest that greater coordination between services may be needed as many of the refugees report unmet needs within months of arriving and continue to report needs after being here for a period up to 2 years.
Setting
The Ontario government implemented a regulatory change to mandate the collection of socio-demographic (SD) data for individuals who tested positive for COVID-19. This change was informed by ...evidence of COVID-19’s disproportionate impact on marginalized communities and calls for broader collection of SD data. Given the scarcity of similar efforts, there is a significant knowledge gap around implementing standardized SD data collection in public health settings.
Intervention
Public Health Ontario provided collaborative support for the implementation of SD data collection, grounded in health equity principles, evidence, and best practices. We supported the addition of SD fields in Ontario’s COVID-19 data collection systems, issued data entry guidance, hosted webinars for training and learning exchange, and published a resource to support the data collection process. The current focus is on building sustainability and quality improvement through continued engagement of public health units.
Outcomes
By November 28, 2020, almost 80% of COVID-19 cases had information recorded for at least one SD question (individual questions, range 46.8–67.0%). We hosted three webinars for the field, and the data collection resource was viewed almost 650 times. Practitioners continue to express needs for support on applying equity principles to data analysis and interpretation, and community engagement on data collection and use.
Implications
Sharing knowledge on responsive implementation supports in collaboration with the field and using current evidence and guidance will strengthen public health practice for SD data collection. Laying this groundwork will also improve the likelihood of success and sustainability of these equity-focused efforts.
The underutilization of immigrants’ skills, particularly the skills of ethnic and religious minorities, is of considerable concern to policy makers because of its economic and social costs. Recent ...research suggests that discrimination may be contributing to this well-documented unemployment and underemployment of skilled minority immigrants. In particular, the ambiguity of immigrants’ foreign-acquired skills and personal characteristics may provide a cover for the expression of bias toward immigrants who are religious and ethnic minorities. Experiments controlling for all other variables show that discrimination may influence both the hiring of minority immigrants and reactions to claims of employment discrimination by minority immigrants. Also, factors that reduce the ambiguity of minority immigrants’ credentials and factors that suppress the expression of bias reduce these effects. These findings point to policy interventions that have the potential to improve the labor-market outcomes of skilled immigrants and contribute to host nations’ economic and social outlooks. Interventions should focus not only on skilled minority immigrants and reducing the ambiguity of their credentials and skills but also on members of the host society and their motivation to control prejudiced reactions to minorities.
Currently there are more than sixty-eight million internationally displaced people in the world (UNHCR, 2018). Canada’s part in accepting refugees may be small compared to some other countries, but ...it is still significant. In most years, Canada welcomes around 25,000 refugees (CIC 2007; IRCC 2016). However, following the crisis in the Syrian Arab Republic, Canada’s federal government made a decision to increase these numbers significantly. The government committed to open its borders in November 2015 and, in just four months, accepted as many refugees from Syria alone as they normally accept in one year from all countries. In fact, between
This dissertation compromises 2 experiments that investigated religious discrimination as it particularly affects foreign-trained job applicants. Study 1 consisted of a 3 (Applicant’s religion: ...Christian, Muslim, or No Affiliation) X 2 (Applicant’s location of training: Canada or Cyprus) between-subjects design. After viewing an advertisement for a healthcare position, Canadian participants reviewed a male applicant’s CV and watched his taped interview, in which a briefly visible pendant indicated his religious affiliation. The job applicant was then evaluated on two sets of skills: hard (technical) skills and soft (non-technical) skills. As predicted based on the justification suppression model of prejudice (Crandall & Eshleman, 2003), a significant interaction between the applicant’s religion and location of training revealed biases in the evaluation of both sets of skills. While no differences emerged within the Canadian-trained condition, results pointed to significant differences within the foreign-trained condition, such that the Muslim was consistently rated less favourably than the Christian. Study 2 partially replicated the design from Study 1 with the addition of manipulating certification to practice in Canada for the foreign trained applicant. In a 2 (Applicant’s religion: Christian or Muslim) x 3 (Applicant’s location of training: Canada, Certified/Foreign-trained, or Notcertified/Foreign-trained) between-subjects design, Canadian participants evaluated the job applicant on hard skills, soft skills, and hiring recommendation. Findings pointed to an interaction between the applicant’s religion and training on the evaluation of soft skills and hiring recommendation; a main effect of training emerged for evaluation of hard skills. As part of the goal to understand the processes underlying hiring decisions, Study 2 also examined several mediators of the hiring recommendation, and found hard skills, soft skills, respect, and admiration to mediate the link between the religion x training interaction and hiring recommendations. Taken together, the findings point to the complexity of the employment process, and the role of bias in the evaluation of foreigntrained job applicants. Implications for policy and future directions for research are discussed.
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