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The story of asset-based interventions and their link to mental health - Paul Morin
The story of asset-based interventions and their link to mental health - Paul Morin
The story of asset-based interventions and their link to mental health - Paul Morin
The story of asset-based interventions and their link to mental health - Paul Morin
The story of asset-based interventions and their link to mental health - Paul Morin
The story of asset-based interventions and their link to mental health - Paul Morin
The story of asset-based interventions and their link to mental health - Paul Morin
The story of asset-based interventions and their link to mental health - Paul Morin
The story of asset-based interventions and their link to mental health - Paul Morin
The story of asset-based interventions and their link to mental health - Paul Morin
The story of asset-based interventions and their link to mental health - Paul Morin
The story of asset-based interventions and their link to mental health - Paul Morin
The story of asset-based interventions and their link to mental health - Paul Morin
The story of asset-based interventions and their link to mental health - Paul Morin
The story of asset-based interventions and their link to mental health - Paul Morin
The story of asset-based interventions and their link to mental health - Paul Morin
The story of asset-based interventions and their link to mental health - Paul Morin
The story of asset-based interventions and their link to mental health - Paul Morin
The story of asset-based interventions and their link to mental health - Paul Morin
The story of asset-based interventions and their link to mental health - Paul Morin
The story of asset-based interventions and their link to mental health - Paul Morin
The story of asset-based interventions and their link to mental health - Paul Morin
The story of asset-based interventions and their link to mental health - Paul Morin
The story of asset-based interventions and their link to mental health - Paul Morin
The story of asset-based interventions and their link to mental health - Paul Morin
The story of asset-based interventions and their link to mental health - Paul Morin
The story of asset-based interventions and their link to mental health - Paul Morin
The story of asset-based interventions and their link to mental health - Paul Morin
The story of asset-based interventions and their link to mental health - Paul Morin
The story of asset-based interventions and their link to mental health - Paul Morin
The story of asset-based interventions and their link to mental health - Paul Morin
The story of asset-based interventions and their link to mental health - Paul Morin
The story of asset-based interventions and their link to mental health - Paul Morin
The story of asset-based interventions and their link to mental health - Paul Morin
The story of asset-based interventions and their link to mental health - Paul Morin
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The story of asset-based interventions and their link to mental health - Paul Morin

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Professor Paul Morin of Sherbrooke University, Quebec presented his research finding to an IRISS seminar in September 2012, Glasgow.

Professor Paul Morin of Sherbrooke University, Quebec presented his research finding to an IRISS seminar in September 2012, Glasgow.

Published in: Health & Medicine
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  • The research design we chose was a realistic, qualitative assessment conducted with various stakeholders, including users, workers and third sector partners. The method chosen to assess the intervention was based on Pawson and Tilley ’ s (1997) realistic evaluation, which considers the logics within the action systems being studied. We therefore documented the mechanisms at play (action, communication, coordination processes, etc.,) and their interaction dynamics to understand the system effects that are likely to produce the desired as well as undesirable outcomes.
  • After identifying various data sources, we conducted three semi-structured group interviews with managers and community partners, and 27 semi-structured individual interviews with institutional workers, community partners, users and volunteers. We completed six days of observations in the three neighbourhoods. Then the research team did a thematic analysis of the neighbourhood workers ’ daily logs and an analysis of relevant administrative documents. Finally the interventions were followed up and modeled in situ with two neighbourhood clinical committees comprising institutional and community workers and a member of the research team. We did a qualitative and thematic analysis of the data and added emerging categories. Regular team discussions helped refine our understanding of the different logics at play in this initiative.
  • The first neighbourhood is Ascot, which has a large immigrant population and many community organizations.
  • The second neighbourhood is Jardins-Fleuris, which has a diversified population of relatively poor single people and single-parent families but quite a dynamic community life.
  • The third and last neighbourhood is downtown, where most of the work is with people who are homeless and marginalized.
  • The general objectives of the Neighbourhood Intervention are to: Improve the assistance provided to residents by strengthening the links between neighbourhood stakeholders: citizen, community and public networks Reach the most vulnerable residents.
  • These are the functions that were determined when the project began and what they became as the intervention progressed. The functions are now better defined and more refined and are broader in scope, especially those consisting of developing an intervention community and taking action on the social determinants of health.
  • Neighbourhood interventions are an innovative approach whose real impact on individual and community capacity should be assessed. Creating links between individual, group and community action intervention practices – of both institutional and third sector organizations – is at the core of this type of intervention, initiated by a public health and social service institution. The neighbourhood is viewed as a place of social cohesion from which to intervene through the development strategy of the communities. This strategy aims to build capacity of the local people and stakeholders, encouraging them to develop better control over local health determinants, including social support, the social network, access to services and poverty.   The five approaches that emerged from the Neighbourhood Intervention initiative were: Take into account the types of neighbourhoods and residents Optimize the proximity of the intervention Include a proactive dimension Prioritize the relational dimension and networking for mobilization Continuously adjust the intervention using a variety of mechanisms
  • Two types of group were created: open groups fostering social participation and information sharing, and closed groups focusing on support, therapy or education.
  • The analysis of the impact of the neighbourhood interventions showed recurring effects across all three neighbourhoods, including participating in the creation of social networks, fostering social support, improving access to institutional and community resources, and encouraging social participation.
  • I will leave you to read the following slides about the effects. Other types of effects were also identified on individuals, groups, networks and health determinants.
  • For example, community organizations confirmed the importance of participating in building a dynamic of solidarity and cohesion across the territory where they work or where their members live. An intervention community emerges from the links between the neighbourhood community organizations and public services, illustrating? an activity conducted on a common territory. We also saw that neighbourhood interventions could have a ripple effect on individuals, groups and the neighbourhood. Supporting and strengthening individuals and communities is the outcome of the impact on individuals related to the links between community organizations ’ interventions and institutional practices producing the beginning of a synergy acting on the neighbourhood (Ninacs, 2008).
  • We observed effects on networks and the neighbourhood, including better quality of life and a feeling of security and trust. The idea of a community intervention refers to relying on people and organizations to take action in a variety of concrete and consistent ways in order to “ come together as a community ” in the intervention.
  • The effects on the health care system and the social determinants of health were documented. Concerning the health care system, we noted access to health services, crisis reduction, and less mistrust.
  • Concerning the social determinants of health, we documented access to housing, food security, and social support, in particular.
  • The study also pointed up some undesirable effects, such as the need for adjustments and better coordination in the clinical/administrative mechanisms related to the coordination of the interventions, and for communication and support mechanisms to be better defined in order to preserve and improve the intervention model. The interface between the practices of civil society organizations and institutions lies in successful links between these diverse intervention practices which, synergistically, create an intervention community that is effective in supporting and strengthening individuals and communities.
  • The CSSS-IUGS considers the Neighbourhood Intervention promising and structuring. It has decided to establish two teams with specific territories, and to do a continuous analysis and assessment of the Neighbourhood Intervention.
  • One of the major issues involves the creation of an intervention community interfacing between the intervention practices of third sector organizations and public institutions in order to effectively bolster individual and community potential.
  • One of the major issues involves the creation of an intervention community interfacing between the intervention practices of third sector organizations and public institutions in order to effectively bolster individual and community potential.
  • Transcript

    • 1. The story of asset-based interventione andtheirs link to mental health in Sherbrooke, Canada Paul Morin, Chantal Doré, Maryse Benoît, Nicole Dallaire, Jeannette LeBlanc CAU CSSS-IUGS, Université de Sherbrooke Glasgow, september 7 th, 2012 1
    • 2. Outline• Trieste’s experience• Capabilities approach• Sherbrooke’s experience• Conclusion
    • 3. 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
    • 4. 10 micro-territoriesCaracteristics 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.
    • 5. Microarea Valmaura
    • 6. Microarea Melara
    • 7. 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
    • 8. 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.
    • 9. 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.
    • 10. 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 Back from the bottom up Authorities (health agency, public housing agency, municipality)From the top down 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)
    • 11. 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.
    • 12. 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.
    • 13. 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.
    • 14. Design Groups involved• Realistic, qualitative • Users assessment • Workers • Third sector partners in the neighbourhood • Managers • Volunteers 14
    • 15. Data collection Data analysis• Group interviews (n = 3) • Open-ended thematic• Individual interviews (n = analysis with 27) emerging categories• Observation days (n = 6) added• Monitoring of the • Team discussions interventions during the research• Analysis of process administrative documents• Analysis of workers’ daily logs 15
    • 16. 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 organizations 16
    • 17. 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 dynamic 17
    • 18. 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
    • 19. 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
    • 20. Neighbourhood workers’ functionsWhen the project started How they look now• Provide proactive • Provide proactive psychosocial support psychosocial support• Liaise with and provide – Crisis intervention clinical support for • Develop an intervention partners community (formal and• Support influential informal network) citizens • Create links between• Facilitate various groups residents and build the community (group intervention) 20 • Take action on the social determinants of health
    • 21. Five approaches to intervening differently1. Specific characteristics of the neighbourhoods and citizens2. Proximity of the intervention3. Proactive dimension4. Relational dimension and networking for mobilization5. Continuous adjustments 21
    • 22. Diversity of the groups created 22
    • 23. Recurring effects acrossall three neighbourhoods• Breaks the isolation• Fosters access to resources• Informs people• Builds networks• Helps create a feeling of trust• Encourages social participation 23
    • 24. 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
    • 25. 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
    • 26. 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
    • 27. 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
    • 28. 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
    • 29. 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) 29 "The advantage is to reach out to population groups whose health is much more precarious." (Institutional worker)
    • 30. 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
    • 31. 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
    • 32. 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
    • 33. Major issues- Efficient interface between interventionpractices of third sector organizations andpublic institutions in order to synergisticallycreate an intervention community that iseffective in supporting and strengtheningindividuals and communities. 33
    • 34. 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
    • 35. Thank you!Paul.morin@usherbrooke.ca 35

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