Category: Income Security & access to the social determinants of health

Making the Mental Health Recovery Model a Community/Hospital — two way street

Sean Kidd, Kwame McKenzie, and Gursharan Virdee, bridge our community based and recovery focused care to the hospital context.  As a front line worker I found it a refreshing relook at the challenge of

“…situate this very large care sector with a dialogue that, to date, has focused almost exclusively on outpatient and community practices. …”

Mental Health Reform at a Systems Level: Widening the Lens on Recovery-Oriented Care Sean A Kidd, PhD, CPsych, CPRP,1 Kwame J McKenzie, MD, MRCPsych,2 and Gursharan Virdee, MSc (PsyD Candidate)3

…However, should hospitals more effectively engage in efforts toward mental health reform, the challenges of transition out of hospital may be considerably reduced. First, there would be a less radical shift in the model of care, with recovery-oriented hospital care more seamlessly merging with outpatient and community care. …

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4079144/

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The power of burnout and taking action to address macro issues

Leo Eisenstein links everyday practice to the social determents of health within organizational contexts.

The clinician who coined the term “burnout” was not a primary care physician buried under paperwork, nor an emergency physician beset by an unwieldy electronic health record. He was Herbert Freudenberger, a psychologist working in a free clinic in 1974.1 Discussing risk factors for burnout, he wrote about personal characteristics (e.g., “that individual who has a need to give”) and about the monotony of a job once it becomes routine. He also pointed to workers in specific settings — “those of us who work in free clinics, therapeutic communities, hot lines, crisis intervention centers, women’s clinics, gay centers, runaway houses” — drawing a connection between burnout and the experience of caring for marginalized patients.

In recent years, burnout has become a chief concern among physicians and other front-line care providers. But somewhere along the way, the concept was separated from its original free-clinic context. The link between marginalized patients and clinician burnout seems to have gotten lost. …

Visit NEJM.org

See the article: https://www.nejm.org/doi/full/10.1056/NEJMp1803771

Report on Child Poverty by 2018 Federal Ridings

This Campaign 2000 (End Child and Family Poverty) report  https://campaign2000.ca/ is shared by Lynn Sherwood who explains: “Apparently the feds are supposed to publish their new child poverty strategy in the next few days.  If you follow the links you can find the child poverty rate for each federal riding in Canada.  It is over 28% here in Ottawa South.  Child poverty correlates with the number of recent immigrants, indigenous people and single parent families.  Who Knew.”

In the lead up to Canada’s first federal Poverty Reduction Strategy, Campaign 2000 reveals a disturbing picture of the magnitude of child poverty in every federal riding. The latest data paint a stark portrait of inequality in Canada with high- and low-income families living in close proximity while divided by wide social and economic gaps that leave too many children hungry, sick and stressed beyond their years.

Troublingly, this report shows that the federal ridings with the highest levels of child and family poverty are home to a higher proportion of Indigenous, racialized and immigrant communities and lone-parent led families. This correlation signals the persistence of discrimination and systemic inequalities that translate to higher unemployment, lower labour market participation rates and higher proportions of renters and people spending more than 30% of their income on housing.

The presence of child and family poverty in every riding in Canada demands strong and decisive federal action through the Canadian Poverty Reduction Strategy (PRS). Clearly, every community, every Member of Parliament and all political parties have a stake in the eradication of poverty. …

See the report here: https://campaign2000.ca/child-poverty-by-federal-ridings/

…“I am more than what happened to me, I’m not just my trauma”…

Shawn Ginwright’s article The Future of Healing: Shifting From Trauma Informed Care to Healing Centered Engagement, provides a useful and in depth beacon of how we can take a broader focus in our alignment of services and individual practice.  It outlines that we can make trauma informed care along with the care of the individual, relevant to: families, neighborhoods and communities, shifting our focus to citizenship.  A kick, to move us to take a whole person approach to the recovery model. 

…The term “trauma informed care” didn’t encompass the totality of his experience and focused only on his harm, injury and trauma. For Marcus, the term “trauma informed care” was akin to saying, you are the worst thing that ever happened to you. For me, I realized the term slipped into the murky water of deficit based, rather than asset driven strategies to support young people who have been harmed. Without careful consideration of the terms we use, we can create blind spots in our efforts to support young people.

While the term trauma informed care is important, it is incomplete. First, trauma informed care correctly highlights the specific needs for individual young people who have exposure to trauma. However, current formulations of trauma informed care presumes that the trauma is an individual experience, rather than a collective one….

Please read the article herehttps://medium.com/@ginwright/the-future-of-healing-shifting-from-trauma-informed-care-to-healing-centered-engagement-634f557ce69c

Social Planning Council of Ottawa 90th Anniversary Celebration

From The Social Planning Council of Ottawa. https://www.spcottawa.on.ca/   “We are beyond proud that we have had the opportunity to serve our great city for nine decades, working along side and with other great organizations, groups and businesses to be able to be a catalyst for economic and social development.”

…Did You Know?…

The first meeting of the Ottawa Council of Social Agencies took place in 1928 at the Chateau Laurier. There were 24 agencies in child and family welfare, health, education, and recreation. The constitution for the Council of Social Agencies was actually approved in 1933. Its principle purposes were to “promote the study of the social needs of the community; establish how agencies could improve their services or respond to unmet needs; and increase the awareness and interest members of the community in the social needs of all community members.” (Moscovitch, 2003)

 

May 23rd, 2018

5:45 – 8:00 p.m.

Knox Presbyterian Church – 120 Lisgar St, Ottawa

The event will start at 5.45 pm with the business portion (AGM).

The “pay-as-you-can” dinner will commence at 6;30 pm followed by our celebration speeches and cake!

Please RSVP to office@spcottawa.on.ca including any requested accommodations or special diet needs.

We truly hope you are able to make it out this special occasion and celebrate with the SPCO board, volunteers and staff.

 

 

Practice based commentary on the pitfalls of sorting the worthy and unworthy – in social assistance reform

Reuel Amdur shares his critic of the most recent report on income security reform in Ontario.  For background, please see this earlier post on the report Here:  https://socialhealthpracticeottawa.wordpress.com/2018/01/05/getting-on-hey-send-an-email-on-the-long-overdue-business-of-transforming-ontarios-income-security-system/

http://www.thecanadiancharger.com/cms/contributors/images/5/RA-new.jpg

Roadmap into a Swamp

On September 1, a working group headed by Judge George Thomson produced a report for the Ontario government on social assistance reform entitled “Roadmap for Change.” While it would take a very long essay to go over the report in detail, I will address a few matters-the proposed increase in Ontario Works rates, changes in the policy regarding so-called dependent and independent adults, and continuation of two programs for social assistance, one for employables, Ontario Works (OW), and the other for the disabled, the Ontario Disability Support Program (ODSP).

The report calls for an increase in Ontario Works rates by 22% over three years.  Premier Mike Harris cut the rate by 21.6% in 1997. Since then, the Liberals have not put the money back.  Harris cut the money all at once, but the Thomson report proposes to repair the damage over three years.  It’s been a long wait.

Harris also introduced the distinction between dependent and independent adults.  This applies to adults living with a parent or parents.  Dependent adults, as defined in the complex regulation, are included in a payment to the family, not individually.  The amount paid is less.  How do we determine if a person is independent and entitled in his own right?  He must, during his lifetime, have been self-supporting for a cumulative 12-month period.  However, if the family had ever rented out the room where he was living, the distinction did not apply.  There are other complications.  You get the idea.  The whole thing is a dog’s breakfast, difficult and time-consuming to administer.  The Thomson report calls for a revision of the regulation.

An earlier report headed by Thomson in 1988 called “Transitions” pointed to the complexity of social assistance as a major problem.  Right on!  Would Thomson 1988 take one look at the dependent-independent adult mess and simply have said to scrap the whole thing?  And the distinction applies only for OW, not for ODSP recipients living with family.

Now to our third bone to pick with “Roadmap for Change.”  The report justifies different rates of assistance for OW and ODSP because, it claims, it is more expensive to live with a disability. No evidence whatever is provided for the claim.  In fact, there are separate additional amounts provided for special needs, beyond the rates for social assistance as such.  It would have made more sense if the report had called for a determination of what it costs to live in conditions of dignity and decency.  Talking about the costs of living with a disability as such makes no sense.  Which disability requiring what supports?  The current system does provide extra funds for special needs. Ontario governments of all stripes have refused to base assistance on cost of living, preferring instead to act on whim.  Contrary to Thomson, in 2012 Senators Frances Lankin and Munir Sheikh issued a report for the Ministry of Community and Social Services in which they recommended a single system of social assistance.  It was not evident to them that there were additional costs across the board.

An additional argument has been made that OW is only short term.  But in fiscal 2014-15, average time on OW was 27 months.  The Toronto Star, in an article on the Thomson report, featured a woman who has been on OW for nine years.  Getting on ODSP is a matter of luck of the draw.  Anyone who has worked in or around the system can easily cite examples of unjustified rejections.  Some are reversed on appeal.  Other applications make it the second or third time around.

Having lived through changes in Ontario social assistance, I take a different explanation for the discrepancy in rates for OW and ODSP.  Over the years names and coverage have changed, so I will refer to the programs as municipal and provincial.  The current provincially administered program is ODSP, with OW being operated municipally.

When I came to Canada in 1969 to take a position with the Social Planning Council of Hamilton and District, the rates for the two programs were almost the same, although they were calculated using somewhat different building blocks.  However, under Premier Bill Davis the province chose to increase provincial rates preferentially.  The differential has increased constantly to the point where the provincial rate comes close to doubling that municipally for a single person.

Then in 1985 I was employed as a welfare worker in Toronto.  At that time, single parent families were part of the provincial program, no longer the case unless the woman is disabled.  However, there was a waiting period on the municipal program for single parents.  That is, unless the woman was a widow, in which case provincial eligibility was immediate.

You are probably getting the picture.  The worthy poor versus the unworthy.  Then Mike Harris made it explicit.  He complained that welfare recipients were a bunch of beer-swilling pregnant women.

Judge Thomson’s committee missed the boat.

Ontario poverty reduction and the elephant in the room, the provincial election

TVO’s, The Agenda https://tvo.org/programs/the-agenda-with-steve-paikin provides a useful overview of the current status of the Ontario provincial poverty reduction strategy and relevance to the Social Determinants of Health, that touches on:

  • the historical failed efforts of 30 years ago – where it went wrong
  • the racialization of poverty currently happening
  •  anecdotal early gains identified from Ontario’s basic income pilots, so far
  • “trickle up” components of whole system approach, including the federal child benefit increases

What haunts the discussion is how will the Ontario government’s effective policy change efforts manage the storm of the May election. 

The reportIncome Security: A Roadmap for Change, is a useful anchor in the storm, see it here:   https://www.ontario.ca/page/income-security-roadmap-change

See the panel discussion here: https://tvo.org/video/programs/the-agenda-with-steve-paikin/committing-to-poverty-reduction