1

The story of asset-based interventione and theirs link to mental health in Sherbrooke,

CanadaPaul Morin, Chantal Doré, Maryse Benoît, Nicole

Dallaire, Jeannette LeBlanc

CAU CSSS-IUGS, Université de Sherbrooke

Glasgow, september 7 th, 2012

Outline

• Trieste’s experience

• Capabilities approach

• Sherbrooke’s experience

• Conclusion

Coordination devices

- Social and Health care District and Social Plan: joint programmes on the same Zone

- Integrated projects and monitoring on Microaree (500 to 2500 inhabitants)

- Formal accord bewteen sanitary agency, Municipality and Council Housing

- Social entreprises and voluntary association are embedded in the process

10 micro-territories

Caracteristics of the action:- Plurial: All the people are concerned by the

action- Global: the action is intersectoral because it

want to address all the determinants of health;

- Local: the action is situated in an specific social context.

Microarea Microarea ValmauraValmaura

Microarea MelaraMicroarea Melara

The projects want to have an impact:

- on the health of the residents;

- on the amelioration of practices;

- on the right to have access to health and social services;

- on the reduction of inefficient services;

- on the ressources of the community

The projects want to have an impact :

- On a paradigm shift : from the structure to the person and to all the persons;

- On their level of capability and of their power in the management of their health.

To be able to be a system

• The territory as the setting of services;

• The care of places;

• The territory as a place of institutional reflexivity;

• Quality of services but also capability of the service users to decide and to do by themselves.

The informational flow in the Micro-area Program

The Regional Health budget:

The appropriateness issue Reconversion of the health and social spending

Partnerships between local Authorities (health agency, public

housing agency, municipality)

Community projects at the micro level: A practical inquiry

The inhabitants’ voices (voice to be helped to develop and organize, and plurality of voices to be combined)

From the top dow

n Back

from

the

bott

om u

p

Capabilities approach

• Public institutions have the obligation to empower those found in situations of poverty, to strenghten their capacities in such a way that they can choose the functionnings that they consider valuable.

• CA is above all a paradigm for assessing outcomes of public action and policy design, proposing as evolution criterion to what extent they empower individuals to act and to choose.

Sherbrooke’s Research objectives

• Describe three Neighbourhood Intervention practices deployed in a mid-sized city as primary health and social service interventions most likely to contribute to the accessibility, continuity, quality and effectiveness of the delivery of services by the health and social service centre (CSSS in French).

• Shed light on the effects perceived by stakeholders, including third sector organizations, on the health of individuals, the quality of life of individuals and the community, and the accessibility of social and health services.

Sherbrooke’s Research objectives

• Describe three Neighbourhood Intervention practices deployed in a mid-sized city as primary health and social service interventions most likely to contribute to the accessibility, continuity, quality and effectiveness of the delivery of services by the health and social service centre (CSSS in French).

• Shed light on the effects perceived by stakeholders, including third sector organizations, on the health of individuals, the quality of life of individuals and the community, and the accessibility of social and health services.

Design

• Realistic, qualitative assessment

Groups involved

• Users

• Workers

• Third sector partners in the neighbourhood

• Managers

• Volunteers

14

Data collection

• Group interviews (n = 3)• Individual interviews (n =

27)• Observation days (n = 6)• Monitoring of the

interventions• Analysis of administrative

documents• Analysis of workers’ daily

logs

Data analysis

• Open-ended thematic analysis with emerging categories added

• Team discussions during the research process

15

Ascot• Large majority of users of Neighbourhood

Intervention services are immigrants and refugees.

• Limited use of health and social services

• The three local communities that make up Ascot have the top three percentages of immigrants

• Presence of many community organizations16

Jardins-Fleuris

• Various types of Neighbourhood Intervention clients: single people and disadvantaged families (limited education, little or no social network)

• Densely populated area

• Quarter of families are single-parent families

• Community life quite dynamic17

Downtown

• Most of the users of the roaming team live in the downtown area

• Mainly highly marginalized men

• The downtown community has the highest jobless rate among men in the Eastern Townships, and 47.1 % of families living in rented accommodation spend 30 % or more of their annual income on rent

18

Intervention objectives

• Improve the assistance provided to citizens by strengthening the links between neighbourhood stakeholders (citizen, community and public networks)

• Reach vulnerable neighbourhood residents who do not know what resources are available and/or will not ask for help

19

Neighbourhood workers’ functions

When the project started

• Provide proactive psychosocial support

• Liaise with and provide clinical support for partners

• Support influential citizens

• Facilitate various groups

How they look now

• Provide proactive psychosocial support– Crisis intervention

• Develop an intervention community (formal and informal network)

• Create links between residents and build the community (group intervention)

• Take action on the social determinants of health 20

Five approaches to intervening differently

1. Specific characteristics of the neighbourhoods and citizens

2. Proximity of the intervention

3. Proactive dimension

4. Relational dimension and networking for mobilization 

5. Continuous adjustments 21

Diversity of the groups created

22

Recurring effects across all three neighbourhoods

• Breaks the isolation

• Fosters access to resources

• Informs people

• Builds networks

• Helps create a feeling of trust

• Encourages social participation23

Effects on individuals

• Action on individual quality of life– Breaks the isolation– Helps create a feeling of trust– Encourages involvement– Takes concrete action

"This feeling of trust extends to other activities in the neighbourhood. I’ve seen people who went through the Neighbourhood Intervention who are now involved in activities and in neighbourhood organizations and have taken on some responsibilities." (Institutional worker) 24

Effects on groups

• Social integration by community arts group

People with mental health problems and people from the community. "This group helps people get to know each other, to talk in an unstructured "non-therapeutic" way. It’s not part of their therapy." (Institutional worker)

25

Effects on third sector partners

• Strengthens links with partners

• Supports their actions

• Mobilization reinforced with partners

• Neighbourhood Intervention acts as a "transmission belt" between partners

26

Effects on networks

• Helps create a feeling of trust

• Creates an intervention community

"What I often try to do with the intervention community is to make people want to say: No! He or she is excluded. You can do a bit, then we can choose to do a bit, or we consider everything, then another part is you, then you, me, we’ll get there.That happens very often. We have credibility: they’re there, which makes me want to do something too." (Institutional worker)

27

Effects on the neighbourhood

• Prevention and mobilization

• Improves the quality of life

Creation of a neighbourhood dynamic that leads to working together, a better quality of life and a feeling of security (Partners discussion group)

28

Effects on the health care system

• Crisis reduction• Avoids aggravating the situation• Reduces mistrust• Medium and long-term benefits• Access to health services

"People are referred to both the CLSC and the community because […] the idea is not necessarily to refer people to the CSSS, it’s also because we see that people know very little about the resources so there are a lot of referrals made to the community." (Institutional worker)

"The Neighbourhood Intervention helps correct the CSSS’s image and publicize the services. To correct negative attitudes towards the CSSS." (Partners discussion group)

"The advantage is to reach out to population groups whose health is much more precarious." (Institutional worker)

29

Effects on the social determinants of health

• Access to housing• Food security• Social support• Social participation

"Health is also the idea of offering people in the neighbourhood an opportunity to take action." (Institutional worker)

"It’s as if the Neighbourhood Intervention has helped open doors, has given people the confidence [to get involved and take responsibility]." (Institutional worker) 30

Challenges

• Meet new unmet needs

• Intervene in crisis situations not considered at the outset

• Help workers to cope with the lack of resources, users’ distress and their own powerlessness

• Avoid creating a ghetto, needs and dependency 31

Promising, structuring intervention

• Survival of the Neighbourhood Intervention assured with:– Establishment of two teams with specific territories – Inter-division clinical support and greater fluidity in the

service corridor to improve communication between all stakeholders

– Approach focused on results for individuals, groups and the community

– Continuous analysis and assessment

32

Major issues

- Efficient interface between intervention practices of third sector organizations and public institutions in order to synergistically create an intervention community that is effective in supporting and strengthening individuals and communities.

33

Major issues

• Development process is a value-ladden entreprise that is linked to social practices

• Communities as locus of values

• Cititizen voice and deliberative democracy

• Importance of have public institutions at the forefront for the development of individual and collective capabilities

• Fragility of the experiences 34

Thank you!Paul.morin@usherbrooke.ca

35