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Building Research Capacity at your Community Health Centre

Yogendra B. Shakya Senior Research Scientist, Access Alliance Member, Research Working Group, CACHC

CACHC Conference 2015 Ottawa

www.researchforchange.ca

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Agenda Drawing on 10 years of research work at Access Alliance (and other CHCs), discuss:

A. why more CHCs should be doing research

B. different operational models on how to build research capacity within CHCs.

i. Leadership model

ii. Active Collaborator model

iii. Active Facilitator model

C. The Other Side of the Equation: Taking control and sharing your internal evidence/reports

D. Resources and Tools

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Research at Access Alliance

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How we began Became involved in research from early 2000 – as passive collaborator 2004 -- First Access Alliance led research project focused on homeless

immigrants and refugees in Toronto Converted a “Health Promoter” position into a Community based

Researcher position

2005 -- Received Canadian Institute for Health Research (CIHR) grant to start the Racialized Groups and Health Status research agenda

2007-2010 Strategic Plan -- Developing a robust CBR program one of

three strategic priorities

2011 onwards – research is integral program and seamlessly linked across the agency

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3 Full-time permanent staff; project staff as needed Research time built into work plan for other colleagues (e.g. Director of

Primary Care Services, Registered Nurses; Front Line Workers)

14 academic partners; over 20 community agency partners; strong partnerships with key government agencies/policy champions

Over $2 million in research grants (90% success rate) Successfully completed two dozen multi-collaborative research

projects. Recognized leader/expert re evidence on SDOH for newcomer and racialized groups (we have one of the largest repository of qualitative evidence on this).

Over 30 publications (a dozen in peer reviewed journals); 20-30 presentations per year (conferences, symposiums, guest lectures, keynote)

Over 100 Community/Peer researchers trained and engaged Host/supervise 6-8 graduate students every year Developed numerous hands-on CBR tools (300 page CBR toolkit; plain language

guide to doing research called Everyone can do Research)

Deliver over 100 hours of research/CBR training annually

Snapshot of our Research Infrastructure

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Leader in Community Based Research (CBR) For Access Alliance, CBR is a transformative framework of

knowledge production grounded on principles of ‘Three Cs’: Community (empowerment) Collaboration, and Change

In CBR

“community of interest are empowered and engaged as partners/collaborators in knowledge production geared explicitly at mobilizing social change on issues that are important to the community.”

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Early work (2004-2006) • Homeless immigrants (City introduced interpreters services in

shelters) • Barriers facing internationally trained social workers (led to

bridging program at Ryerson) • Status and Health Security

Racialized Groups and Health Status Income Security, Race and Health Access to Healthcare for Racialized Groups Race-based Discrimination and Mental Health

Determinants of Newcomer Health Newcomer Youth Mental Health project (with Dr Nazilla

Khanlou) Refugee Youth Health project (Dr Michaela Hynie and Dr Sepali

Guruge Migration and Diabetes project (with Dr Ilene Hyman) Interactive Computer Assisted Psychosocial Assessment

Screening (iCCAS) (with Dr Farah Ahmad) Models of Care for Government Assisted Refugees Internal Chart Review based research (parasites, cervical cancer

screening, pediatric screening, NIWIC)

1. Leadership in Critical Research Agendas

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2. Knowledge Building through Research Partnerships

Poverty and Precarious Employment in Southern Ontario (PEPSO) – Dr Wayne Lewchuk and United Way Toronto

Impacts of Changes to Interim Federal Health Program (Dr Anneke Rummens and Dr Rick Glazier)

Strength in Unity study (assessment of community-based anti-stigma interventions) (Dr Sepali Guruge, Dr Josephine Wong, Dr Ken Fung)

Risk for Heavy Metals in Newcomer Women (Dolon Chakraborty, Dr Donald Cole, TPH, Health Canada)

3. Our Knowledge Synthesis Work

The Global City: Newcomer Health in Toronto report (with TPH) Racialization and Health Inequities report (with TPH) Over 10 literature Reviews Toronto Community Health Profiles portal

4. Pilot test Innovative Solutions

iCCAS Employment Quality Screening tool (EMBER project with St Mikes)

Strength in Unity project (community mental health ambassadors training)

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Our Capacity Building Work Training and Engaging Peer

Researchers (over 100)

Mentoring graduate students (6-8 per year)

Developing user-friendly CBR tools/resources (e.g. CBR Toolkit, Everyone can do Research Toolkit)

Championing and providing training on CBR (e.g Student as Researcher project, SAMI post-doc CBR training, CAMH homeless newcomer youth study, Strength in Unity study, Metals in Newcomer women study)

Research Policy/Review Functions (CACHC Research Working Group. OCASI Policy and Research Working Group, AOHC Research Proposal Review)

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Our Policy/System Change work Our reports/evidence are widely and regularly

cited by advocacy groups, community agencies, academics (e.g. course syllabus) as well as policy makers

We proactively seek partnerships and participation in producing knowledge/reports geared at developing policy/program solutions The Global City report Racialization and Health Inequities report LCO’s Vulnerable Workers report Color of Poverty policy briefs AOHC policy briefs OCASI policy recommendations

We are regularly invited to major policy

consultation meetings in which we provide evidence-informed recommendations City of Toronto’s Poverty Reduction Strategy, Ministry of Labor Employment Standards consultation meeting, Ministry of Finance’s consultation meeting on retirement income for

self-employed

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Research on Income Security, Precarious Employment and Health

Why we need more CHCs to do research?

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Second Wave of CBR in Toronto: Community/CHC Led

Since mid-2000, a growing number of community agencies in Toronto have established research department/staffing and are taking a leadership role in developing research priorities/agendas Access Alliance Multicultural Health and

Community Services Women’s Health in Women’s Hand Community

Health Centre StreetHealth Planned Parenthood Toronto Black Creek Community Health Centre Regent Park Community Health Centre East Mississauga Community Health Centre Family Services Association of Toronto Ontario Women’s Health Network Ontario HIV Treatment Network Sistering National Aboriginal Health Organization

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Transformative Reasons ‘Knowledge Democracy’ and ‘Cognitive

Justice“ Knowledge democracy is about intentionally linking values of democracy and action to the process of creating/using knowledge.” – Budd Hall

Overcome exploitative and unethical practices in

research Transform research as a ‘means’ to promote

inclusion and empowerment Transform research into tangible tool for positive

social/policy change Ensure community accountability for research

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Operational Reasons

Because CHCs have strong and meaningful connections

to community groups whose voices and issues have not been heard

Because CHCs hold a lot of rich, intimate knowledge about SDOH, health equity, and vulnerable communities.

Because most of us are operationally mandated and/or committed to do evidence-based planning and advocacy

Because academics need help from community agencies to succeed in their research (particularly during recruitment); this gives us power and responsibility over research rigor/quality and impact.

Because we can !!! “Research is not rocket science” -- Gail McDonald,

former First Nations Centre Director at the National Aboriginal Health Organization

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Three Operational Models for Doing Research at your CHCs

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Type of Engagement: Your CHC takes a leadership role in setting multi-collaborative long-term research agenda(s) on issues important to your client communities.

Internal Agency Resource Requirement:

Coordinating body: Internal Research team/committee meet at least once a month or as required to discuss research priorities and activities.

Staffing: At least one dedicated full-time equivalent research staff Dedicated research time:(e.g. 10 hours per month) built into workplans of

other staff (e.g. physicians, nurses, health promoters, front line workers) External Research Advisory (optional) Supportive internal infrastructure and resources

In-house research training capacity Solid support for grant application adequate office/desk space for research staff/team plus one or two research assistants; locked cabinets and storage spaces; Administrative support (e.g. payroll, HR, office supplies) Access to webspace and other Knowledge Translation platforms Earmarked internal funding (e.g to hire RAs to conduct chart review research,

literature review, assist with knowledge exchange)

1. Leadership Model

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Internal Operational Requirements

Formal Research Policies and Protocol Research activities outcomes built into Performance Review, Reporting

and Accountability structure Dedicated oversight by Managers/Directors, ED, and Board and

commitment to utilize evidence for internal planning and external advocacy work

Hands-on tools and resources for implementing research and ensuring uptake of research evidence

Output and Impact

Lead at least one research project/agenda per year Active collaborator and facilitator in other research projects Very active knowledge production and sharing (the right mix of academic,

community and policy geared KTE products) Solid track record of using evidence to influence policy change

1. Leadership Model

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Type of Engagement: Your CHC is a proactive collaborator or co-investigator in research projects led by external partners on issues that are important to your client communities. Active collaboration means not just passively helping with recruitment, but critically engaged in shaping research focus, methodology, research ethics, and KTE in ways that lead to positive community and policy impact.

Internal Agency Resource Requirement:

Coordinating body: Internal Research team/committee meet once every two month or quarterly to discuss research priorities and activities.

Staffing: At least one part-time research staff; and/or research hours (e.g. 10 hours per month) built into workplan of relevant staff

Supportive internal infrastructure and resources Access to research training (as part of professional development) for those involved in

research office/desk space for those involved in research (if possible, for RAs) Access to webspace and other KT platforms Administrative support (e.g. payroll, HR, office supplies)

2. Active Collaborator Model

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Internal Operational Requirements

Clear Policies on Research Collaboration (protocols for screening and prioritizing which research projects to collaborate and in what ways)

Research functions/outcomes built into Performance Review, Reporting and Accountability structure

Dedicated oversight by ED or at least one Manager with commitment to utilize evidence for internal planning and external advocacy work

Hands-on tools and resources

Output and Impact At least one research collaborator/co-investigator role per year Active role in ensuring research focus and outcomes reflect the needs of

client communities and gives back to community. Active role in ensuring research project are geared at positive social/policy

changes. Co-author in research publications and KTE products

2. Active Collaborator Model

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Type of Engagement: Your CHC takes a proactive role in facilitating and supporting studies conducted by external researchers in ways that lead to positive community and policy impact.

Internal Agency Resource Requirement: Some research hours (e.g. 10 hours per month) built into workplans of

relevant staff members Coordinating body: Internal Research team/committee (optional) Supportive internal infrastructure and resources

Access to research training (as part of professional development) for those involved in research

adequate office/desk space for those involved in research Administrative support (e.g. payroll, HR, office supplies) Access to webspace and other KT platforms

3. Active Facilitator Model

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Internal Operational Requirements Clear Policies on Research Collaboration and Support (protocols for

screening and prioritizing which research projects to support and in what ways)

Research functions/outcomes built into Performance Review, Reporting and Accountability structure

Dedicated oversight by ED or at least one Manager with commitment to utilize evidence for internal planning and external advocacy work

External Output and Impact

Active role in ensuring research focus and outcomes reflect the needs of client communities and give back to community.

Active role in ensuring research project are geared at positive social/policy changes.

Co-author or co-publish research reports and KTE products

3. Active Facilitator Model

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The Other Side of the Equation: Taking control and sharing your internal evidence/reports

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CHCs hold rich evidence: Our internal client data and the chart reviews, needs assessment, community consultations, client experience/satisfaction surveys and program evaluations we conduct are very rich source of evidence on health of client communities we serve (particularly vulnerable groups), and on community health, community-based models of care, and health equity. We need to take ownership of this evidence and share them more broadly to advance health equity.

Many CHCs have staff responsible for analyzing and reporting internal data (e.g. IS, IM, DMC staff), but their ‘research’ role and functions remain under-utilized.

Challenges with EMR and internal data system Some CHCs have dedicated Regional Decision Support Staff (RDSS)

that are linked up regionally/provincially

Taking control and sharing internal evidence

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Three simple steps for sharing internal reports more broadly: 1. Write down the methodology (how many clients did you talk to,

how format and steps did you follow in collecting information from your clients, how did you analyze this information)

2. Do an ethical review of the report – to ensure that privacy and confidentiality is maintained and that report does not put client communities at risk for harm.

3. Re-frame the language and message to external audience as well. – e.g. role of sector leaders, broader policy change recommendations.

Then share it through your website and other KTE sites/hubs, share it with decision/policy makers, and promote them through your agency newsletters, at conferences, or by drawing attention in a blog post etc.

Taking control and sharing internal evidence

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Access Alliance CBR tools 1. Community Based Research Toolkit: Resources and Tools for Doing

Research with Community for Social Change 2. Everyone can do Research: A Plain Language Guide on How to do

Research 3. Access Alliance Research Policies and Protocols Other Resources and Readings

Community Campus Partnership for Health (CCPH): http://depts.washington.edu/ccph/index.html The Wellesley Institute: www.wellesleyinstitute.org The Loka Institute: http://www.loka.org/

Flicker, S. & Savan, B. (2006). A Snapshot of CBR in Canada. Toronto: Wellesley Institute. Kreiger, James (2002) Using Community-Based Participatory Research to Address Social Determinants of

Health: Lessons Learned from Seattle Partners for Healthy Communities. Health Education and Behavior. Vol 29 (3): 361-382

Minkler, M. & N. Wallerstein (eds) (2003). Community-Based Participatory Research for Health. San Francisco, CA: Jossey-Bass.

Israel, B.A., Schulz, A.J., Parker, E.A. & Becker, A.B. (1998). Review of community-based research: assessing partnership approaches to improve public health. Annual Review of Public Health, 19, 173 -202.

Tools and Resources

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Avoid collaborating/colluding passively on external research projects;

Recognize and take ownership/control of the knowledge production role CHCs are already doing and then develop your own innovative operational solutions/strategies for becoming more actively engaged in research.

Connect with other CHCs doing research to share resources/learnings , explore research collaborations, and becoming a critical force for transforming health research in Canada towards more progressive ends (e.g. setting Community Health or SDOH focused funding stream in CIHR).

Best Practices

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Q and A

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Contact Info Yogendra B Shakya Access Alliance Multicultural Community Health Centre Tel: (416) 324-0927 ext 286 Email:yshakya@accessalliance.ca Twitter: @yshakya www.researchforchange.ca