B2 health, wellbeing, and welcoming

Integration, innovation and lessons learned providing health and wellbeing support to vulnerable immigrant populations at the Kingston Community Health Centres.

Meghan O’Leary Rasha Fahim

Presenter Disclosure Presenter: Meghan O’Leary, MSc, Director of Clinical Services, KCHC Rasha Fahim, MEd, MA, Settlement Worker, KCHC and ESL Instructor, St. Lawrence College Relationships to commercial interests: Grants/Research Support: none Speakers Bureau/Honoraria: none Consulting Fees: none Other: Employees of Kingston Community Health Centres and St. Lawrence College.

Disclosure of Financial Support This program has received financial support from Immigrant, Refugee, and Citizenship Canada (Federal IRCC) and Ministry of Citizenship and Immigration (Provincial MCI) in the form of program and project funding, as well as community donations.

This program has received in-kind support from Kingston Community Health Centres in the form of Management and clinic staff time and support in planning programming and providing care. The smoking cessation initiative receives medications through the STOP research program supported by CAMH. Potential for conflict(s) of interest: None to disclose

Mitigating Potential Bias N/A

Presentation Outline • What does Immigrant support in Kingston look like?

• Enablers for integration and collaboration • Best Practices • Knowledge exchange • Next steps

Who we are Meghan is the Director of Clinical Services Primary care at Kingston Community Health Centres

Rasha is a settlement worker at Immigrant Services Kingston Community Health Centre ESL Instructor at St. Lawrence College, Kingston

Immigrant Support in Kingston The population we serve: • Approximately 550 permanent residents and refugees annually • Close to 300 refugees (government assisted and privately sponsored) • Estimated 200 Temporary Visas • Growing number of international students between Queen’s, SLC and schoolboards (4000 annually and growing) • No clear estimate on number of visitors

The Difference Between PSRs & GARs • Privately Sponsored Refugees receive more financial support and help to settle, connect, and support during this time.

• Government Assisted Refugees are temporarily settled and assisted by government systems to find permanent housing, employment etc.

• Both receive interim federal healthcare insurance for one year.

Immigrant Support in Kingston Key Partners funded for Immigrant support: Kingston CHC: resettlement assistance program (RAP); settlement services Funding: Immigrant, Refugee, Citizenship Canada (IRCC) 85% and provincial 15% KEYS Job Centre: resettlement assistance program (RAP; employment/training support; language training (ESL)

Kingston Literacy and Skills: language training Limestone Community Education: language training; employment training Loyola: Language training; employment training

The Settlement Process at a Glance (Campana, 2017)

What We Do We help immigrants during their settlement journey and help make their transition as smooth as possible.

We provide: • Assistance with government documents (obtaining a driver’s license, health card, or bank card) • Solution-focused counseling • Help with finding a house • Referral to employment and other services • Learning English (conversation circles and referral to assessments and classes) • Information Sessions and Orientation to Ontario • Legal Aid resources and referrals • Translation services (CEOTIS) • Information about bringing their family to Canada • Finding the right school for their children • Connecting them with resources in your community

Programs • Multicultural Children’s Group • Multicultural Youth Group • Newcomer Men’s Group • New Sisters in Canada Group • Newcomers Playgroup • Newcomers Parenting Group • Sewing Club • Ethnic Cooking Classes • Social Events • Community Connections Program

Integration and Collaboration • “The management and delivery of health services so that clients receive a continuum of preventive and curative services, according to their needs over time and across different levels of the health system.” (WHO, 2008) • “When multiple health workers from different professional backgrounds provide comprehensive services by working with patients, their families, caregivers and communities to deliver the highest quality of care across settings” (WHO, 2010)

Enablers for Integration and Collaboration • Passionate and engaged staff • Diversified funding to one organization ie federal and LHIN; health and social service programs • Co-location of programming; ISKA and primary care • Warm hand off between staff; communication; • Group programming structure; co-facilitation; cross promotion • Synergies between managers of various programs working with same KCHC priorities (ie improving access to care).

• Leverage existing resources and processes within the organization ex. OTN or central booking or internal referrals • Engaged community partners • Cultural navigation – Two way street • Back office integration; sharing resources

Integration in Action Best Practices • The following examples showcase integrative approaches, the best practices of various initiatives we tried, what worked well and what we learned, in our attempt to better serve vulnerable newcomer populations. • Demonstrates integrated thinking and breaking down silos between programs and funders.

Best Practices – Smoking Cessation • • • • • • • •

KCHC enrolls 400 people a year for STOP, smoking cessation Identified high rate of smoking among Syrian men ISKA has a men’s group that meets weekly Clinic nurse leveraged this group to attend and offer smoking cessation; continues monthly with great up-take Benefit of adding health component into already successful social meeting group Integrated as part of group, also uses OSLER student volunteers to help with health teaching.

6-7 men receiving NRT and counselling on going, over last year about 20 Syrian men engaged in smoking cessation Note: not same success with English speaking smoking cessation group

Smoking Cessation client story • A 35 year old father of four, a patient of ours. He used to smoke 40 cpd in Syria, then 20 cpd in Lebanon, then 10 cpd in Canada. Now he smokes 3 cpd and has joined STOP for the second time last night.

• He had a very hard life in Lebanon. None of his children could go to school for two years.

• He works PT at a bakery as a dishwasher. Takes Level 3 English.

• Wants to quit because : “My health and for expenses. I am convinced smoking causes disease. I should quit it. I saw a photo on a cigarette package, of a lost throat. It was horrible. Why not now to quit smoking?"

Best Practices – Interpretation Issue: language barrier, particularly difficult for health care apts.

• Trained local interpreters -> eventually supported local business start up. In person interpretation for apts.

• Introduced over the phone interpretation (Access Alliance) for all programs (one bill) • Volunteer interpreters trained through KCHC volunteer program (only non medical!)

• Created Interpretation and Translation where to go for staff (process sheet with contact info); sent to community orgs • Created FAQ for front desks with pictures and phonetics of most asked questions • Ability to tap into translation dollars through federal funder • Benefit of many programs of KCHC tapping into this funding pot and efficient processing for finance.

Best Practices – Early learning and Parenting Purpose: Using play-based learning we integrate newcomer mothers and young children into their new community. We provide a safe environment for newcomers to develop their social/emotional/developmental skills while interacting with each other.

What we do at a glance: At Early ON in the program room every Sunday from 10 am until noon. 25+ children and mothers come together to share/ to learn/to play/ to explore/ to experience two hours of quality interactions with their children and each other.

Target audience: Newcomers, mothers, young children Shared roles: providing a safe environment where the mothers’ and children’s needs are met.

Early ON: to facilitate child-led play based learning

Immigrant Services: to provide settlement support and language support

Best Practices – Early learning and Parenting

Best Practices – Early learning and Parenting

Best Practices – Early learning and Parenting

Best Practices – Health Link Coordination • KCHC has Care Coordination available as part of Kingston Health Link • Primary care referred complex clients to health link care Coordinator on site.

• Additional complexity because of language barrier and severity of physical health issues and lack of funds for devices.

• Benefit of involving settlement worker from ISKA in the case conference and care plan; helped navigate system • Major issue: being turned away at specialist appointments because of language barrier.

• Advocacy around securing interpretation for appointments with health service organizations and specialists.

Best Practices – Community Development Integration -The Special Events Committee is a groups of community members whose objective is to bring community together in fun, by creating affordable and accessible events and activities.

-The Good Food Box helps families and individual community members access fresh and affordable produce monthly -Operation Warm Feet helps ensure our children and youth have access to affordable winter boots.

Best Practices – Community Development Integration Operation Warm Feet “Toonie Boots” Each pair of children’s boot $2 While supplies last Available to youth and children born 1999 and after.

Bring Health Cards for proof of age, new clients will be asked to fill out registration packages and return them to KCHC.

Saturday November 25, 2017 9am - 5pm KCHC, 263 Weller Ave. For more information, contact Stephanie at 613.542.2949 ext. 2169 or stephaniew@kchc.ca.

Caring. Responding. Building Community.  Prendre soins. Intervenir. Bâtir une communauté.

www.kchc.ca

$ave

$ave

Buy fresh fruits and vegetables for less than in the grocery store.  Pay $6, $11 or $17 at the “beginning” of the month  Pick up your box on the 3rd Thursday of the month.

For more information, contact at

613-530-2239 goodfoodbox@kchc .ca The Good Food Box Kingston is proudly supported by

Best Practices – Café 263 - Café currently run by newcomer volunteers with staff support - Café 263 Social enterprise with the implementation of a business plan and skills-building workshops for newcomers on commercial food handling, preparation, and serving - 13 participants Workshops consisted of: - Safe food handling - Loving Spoonful-preparing a nutritious meal on a budget - Using local produce to prepare fusion cooking - Prepare a meal to serve for the whole health center - English as a second language practice - Business Graduate from Smith School of Business to make it a social enterprise is phase 2 of the project

Best Practices – Learning opportunity for students OSLER Student Volunteers: • Queen’s med students wanted to gain experience with CHC population and willing to volunteer • Volunteer opportunities identified for the med students to support group programming and co-facilitate groups and education • Quite heavy front end working gearing med student content to CHC clients • Benefits: - New and fresh info from students; content prep helped allied - Back-up co-facilitation for groups run by allied staff - Cultural competency: Arabic speaking med students - Students gained exposure to group health teaching including smoking cessation - gained valuable client engagement experience • Lessons learned: some groups had low attendance, client focused/literacy issues

Best Practices – OTN Issue: identified need for counseling in Arabic and no Arabic speaking counselors in Kingston. Secured time-limited funding

Solution: • Worked with OTN to find options available; established process • Contracted a private SW to offer OTN appointments in Arabic from her site in Toronto with client using OTN at KCHC. • Slow up-take as clients were hesitant; offered group info session on what is SW • Referrals from KCHC and open to all; self-referral; spread word • Case notes back the provider; case conferences • Client satisfaction: rated the appointment afterwards and liked coming to a site they were familiar with.

• Improved access to allied health services in the language of choice, while Improving wrap around care through technology

Best Practices – Immunizations • Primary care rostered more than 200 Refugees in less than 2 years.

• As part of initial intake- start immunizations • Issue: lack of documentation for past immunizations as well as from Public Health on arrival.

• Established Quality Improvement process to ensure follow-up on immunization schedule. Built on similar process we use for kids • QI immunization nurse lead developed catch up schedule • Pro-actively followed-up to ensure all immunizations were completed • Group intakes (large families) worked well and would book in person interpretation and one nurse assigned to apts. and immunizations

Best Practices – Cultural competency training For clients: - Settlement workers can support clients and provide context for Canadian system and system navigation - Workshops on winter clothing - Information sessions on daily life: staying active is healthy (back pain) - Information sessions on sun protection Training for other service providers: - KCHC all staff training and with volunteers - Teachers at ESL schools - Clearing misunderstood verbal or nonverbal communication between clients and service providers

Lessons Learned The key enablers contributed to the success of these various initiatives.

These examples demonstrate integrated thinking that led to overarching outcomes including: • System efficiencies • Breaking down silos • Client satisfaction; positive feedback • Improved coordinated care; wrap around care; smoother transitions • Created more seamless system navigation including social services and primary care and specialists/other health services

Knowledge Exchange • What can we do better?

• What similar experiences do you have of program integration at your CHC that does/could apply to the newcomer population?

• What other opportunities are there to collaborate to improve access to services?

• What other ideas to add, examples that you have?

• Role of CHCs/AOHC/CACHC? Ie. advocating for interpretation funds

Contact information Rasha – rashaf@kchc.ca

Meghan O’Leary – meghano@kchc.ca