Addressing the Social Determinants of Health:Making CBR Work for Communities in Ontario Sean B. Rourke, PhDScientific and Executive Director, Ontario HIV Treatment Network (OHTN)Associate Professor of Psychiatry, University of TorontoScientist, Centre for Research on Inner City Health, St. Michael’s Hospital

Making CBR Matter: A Recipe for Success

1. Strong Strategic Plan 2. Strong Sector 3. Mobilizing People4. Building Capacity 5. Mobilize Knowledge 6. Addressing What's Important to People

OHTN Strategic Plan to 2010:Seven Major Objectives

1) Increase #/Capacity of Health Care Providers for HIV Care2) Support Community to Address Social Determinants of Health3) Invest Strategically in Research4) Support Effective and Innovative eHealth and IT Initiatives5) Revitalize OHTN Cohort Study to Enhance Care in Ontario6) Support KTE Expertise and Capacity7) Monitor and Evaluate OHTN Activities

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

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

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

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

Building an Evidence Base – Methods Making Research Work for Community-Based AIDS Organizations in Ontario:

Strategies for Linking Research to Action

• For Ontario ASOs, modified Canadian Health Services Research Foundation Survey “Is Research Working For You”?

• Acquire, adapt, assess and apply knowledge administered using an on-line service

• Email distribution for participant recruitment

• Augmented by on-line and in-person focus groups

Team• Sean Rourke, PhD (OHTN)• Robb Travers, PhD (OHTN)• Michael Wilson, MSc. Cand. (OHTN) • John Lavis, PhD, MD (McMaster University)

Jean Bacon, MA (OHTN)• Tarik Bereket, MA (OHTN)• Shelley Cleverly, MHSc (Ontario AIDS

Network)• Evan Collins, MD (Hassle Free Clinic) • Rick Kennedy (Ontario AIDS Network)• Edward McDonnell (OHTN)• Peggy Millson, MD (University of Toronto)• Ron Rosenes (Canadian Treatment Action

Council)• Ruthann Tucker (Fife House)

Building an Evidence Base – MethodsFacilitating CBR in Ontario’s Community-Based HIV Sector:

Baseline Assessment and the Development of a Strategy for Change

• For Ontario ASOs, modified tool Barriers and Facilitators for CBR in Canada (Savan, Flicker & Travers, 2005).

Measures:• Experiences with CBR• Perceptions of CBR• Barriers and facilitating factors

for CBRAdministered using an on-line service:

• Email distribution for participant recruitment

Team• Robb Travers, PhD (OHTN)• Sarah Flicker, PhD (York

University) • Tarik Bereket, MA (OHTN)• Michael Wilson, MSc (cand)

(OHTN)• Shelley Cleverly, MHSc (OAN) • Colleen McKay, MA (OHTN)• Anna van der Meulen, MA

(OHTN)

0%10%20%30%40%50%60%70%80%90%

100%

Assessmentof Commun.

Needs

Program Eval. IncreasingCommun.Awareness

New ProgramEval.

Policy Change Other

Why do Community Organizations do CBR Projects?

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

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

Mobilizing PeopleLiving & 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

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 healthapproach 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

Building Capacity

Capacity-Building Grants

Investment of $400,000.00 for:• development of CBR partnerships• question identification/priority setting• protocol development

Compass Community Toolkit (CBR e-learning)

Mobilizing KnowledgeKnowledge 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.

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.

Compass Newsletter

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