Blog Post

The future of digital/hybrid service delivery (hint: it's digital inclusion)

By: Marco Campana
November 8, 2022

I was invited to be part of an Access Alliance Fireside Chat about Digital Inclusion during their staff professional development day. I was honoured to speak and discuss with Ibukun Abejirinde who is doing super interesting research on virtual care and Newcomers, and Jay Shaw, who is also doing super interesting and relevant work and research on virtual care technologies and new models of integrated care.

Below are the questions I was asked to speak to and my notes, in case they're of interest. If Access Alliance shares video from our conversation I'll be sure to add it here. For now, you get my thoughts. 🙂

Can you get us started by talking about the context of digital or virtual services -  what do we already know about digital equity, the mechanics of the digital divide and how that is linked to the concept of social inclusion.

What some people knew before the pandemic, but now we all know, is that there is a digital divide among newcomers. The Digital Divide refers to the economic, educational, and social inequalities between those who have devices and online access and those who do not, or don’t know how to use them. On the surface this means a lack of access to high speed internet, devices, and digital literacy, foundational digital skills training which locks many people out of opportunities, with considerable costs to them and our wider society. 

The digital divide is part of broader equity issues. Not surprisingly, digital equity is an issue for those dealing with other equity challenges.  Digital exclusion or inequity is multifaceted, and intersects with culture, gender, age, class, race, immigration status, educational background and more.

The digital divide for Newcomers includes limited access to digital devices, bandwidth, and skills in some cases, but is compounded by low literacy in English or in their own languages, a disconnect between devices Newcomers predominantly use (mobile) and how information is shared (not mobile friendly), and also intersects with other equity and social justice issues. These are digital inclusion issues that are a bit below the surface, require us to spend time discovering, but are as equally important to address as devices and internet connections. For example, on the surface, a household with a device and internet access appears to be connected, but can still be part of the digital divide if the device is shared, or not shared with those who need it, and they can only afford a low speed internet connection.

And in our work, these are the kinds of things that have come up. It's a complex social challenge. And it requires well planned interventions in order to deal with. 

We've come to a better understanding of what multi dimensional digital inequality is, as well as the fact that we cannot do this alone, as individual agencies. There are systemic issues that exist in our sector, not just with clients, but also within our organizations and for settlement workers. Building inclusion and equity has always required system and organizational change. This is no different when it comes to technology. In most cases, our conversation shouldn't actually start with technology tools, but how technology might help address and create inclusion and equity.

So we need to talk about digital inclusion. Digital Inclusion refers to the activities necessary to ensure that all individuals and communities, including the most disadvantaged, have access to and use of Information and Communication Technologies (ICTs).

Working towards digital inclusion means building inclusive practices and building anti-racism, anti-oppression, diversity, equity, and inclusion into service design. And not just technology development, but how we build and roll out our services. Building digital inclusion into our programming means creating space to collaborate, come together, co-design, share resources and tools with Newcomers. It means understanding Newcomer as well as service provider perspectives and bringing them into the conversation. It means sharing power and decision-making. Some have said that no technology project team is complete without a social worker, because "Social work excels at understanding the entire system while also understanding the needs of the individual." In our sector, no technology project should be considered complete without front line workers and Newcomers present. We must centre staff and Newcomers in all technology-related planning and decision-making.

So why does it matter? Last night I read in a LinkedIn post that the FDA met yesterday for a 9-hour meeting to discuss whether pulse oximeters need to be regulated differently — or even completely reconceived— based on research showing the devices are less accurate in people with darker skin. This was an issue during the height of the pandemic. According to the article, it’s something that has emerged in studies since 2005. Which means we could have gotten it right 15 years before the pandemic started…

That’s why digital inclusion and responsible technology development and integration into service delivery matter. By being inclusive, we can get it right the first time.

You have done some research in the immigrant services sector about capacity – what are some tools or resources that we should be aware of?  (virtual care matrix, road maps)

The first thing is to point out that research on settlement and technology, including digital service delivery goes back more than 20 years. The discussion isn’t actually new at all. We added to that body of research over the past 2 and a half years, hopefully this time moving the practical steps forward unlike with previous efforts. There is much we learned and can learn from those in our own sector who have achieved higher levels of digital maturity. We also looked within health and sectors like social work that have regulatory frameworks that must be met when it comes to services that are private, secure, and inclusive by design. The settlement sector doesn’t have a regulatory framework, so the idea is why not aim for high standards as a foundation, customize them for our work, and then exceed them where possible.

I like the approach taken by The Virtual Care Equity Matrix. Created by the Ontario Mental Health and Addictions Virtual Care Collaborative, the Matrix outlines key equity issues that must be addressed in the delivery of virtual care. It speaks to Ibukun’s comments about compassionate virtual care, and it is appropriate and useful for both health and the settlement sector to refer to.

The visual is a pyramid with 4 key areas.

Connectivity and Equipment is at the base of the pyramid. This is the basic foundation of digital inclusion. Whether communities and individuals have access to a telephone and/or to the internet and device to connect to it is the first condition that must be met to access virtual care. Ideally they will have access to devices they can use privately, which are not shared. Like Jay said, you have to know this about your clients and communities, which means asking them.

Platforms and Security must be affordable, accessible, and acceptable to Newcomers and practitioners. They must meet agencies’, practitioners’ and Newcomers’ diverse financial, digital literacy, language literacy, cultural, and ability circumstances. That means at times using tools Newcomers are familiar with to provide service, and other times onboarding and supporting them to use more secure and comprehensive service tools when necessary.

Relationships and Interventions are key to supporting the accessibility and acceptability of virtual care. Relationships built between providers and other staff at an agency and Newcomers receiving services help to ensure service users have what they need (equipment, digital literacy, translation services etc.) to be able to access online or hybrid services. Interventions must be adapted to fit the service provided, as well as the service user’s cultural and social context. This is also related to service referrals and where technology can be used to create “warm referrals” with data sharing, etc.

Training and Policy helps to support everything else. Getting this right ensures our policies support equitable, confidential, Newcomer-centred access to virtual care, and that you have the skills needed to deliver such care.

Within all of this are the competencies, capabilities, and capacity of service providers. What we’ve learned during sector research conducted during the pandemic is that staff and service providers need to be supported to ensure baseline competencies and infrastructure to provide digital, hybrid, or virtual care services. 

Those reports for the Settlement sector culminated in a recent report and creation of the National Steering Committee on Technology which outlined 4 core sector priorities and a roadmap to achieve them:

  • Strengthening the Hybrid Service Environment - vision & strategy, digital skills/literacy, infrastructure, culture shift
  • Ensuring High-Quality and Inclusive Settlement Services - service eligibility, accessibility, Newcomer-centred, digital inclusion
  • Enabling Innovation - innovation mindset, data use/skills, funding models
  • Mobilizing Knowledge - prioritizing & streamlining collaboration and information sharing

So as the National Steering Committee on Technology’s work rolls out, definitely plan to be part of it, learn from and contribute to it.

Where do you see opportunities to build capacity in digital service delivery in the immigrant and refugee services sector.

It requires what Maytree’s Alan Broadbent has called the Three I’s of Immigrant Integration:” intentionality, instruments, and investments. Intentionality is about “intending to create success” here defined as intending to build inclusive, accessible, & impactful digital settlement services. Instruments refer to “creating the effective mechanisms to give those intentions traction.” The tools we use, but also our approach. Committing to time, co-creation, reflection, and knowledge mobilization. And investments encompass “financial investment” to “drive success,” but also energy investment from “political leaders...and all of us”.

We are waiting for funder and sector leadership to lead us. But they’re not, so you have to do it. Training in formal settings, how you onboard and orient new staff, how you commit to organizational training and learning, time and space you give to staff to reflect and share, but also receive and analyze. The next major IRCC call for proposals will have some digital transformation aspects to it. We don’t know what yet, but we shouldn’t wait for it. Start building with what we know and the recommendations that have come out of our sector.

At Access Alliance you have a unique opportunity to learn and lead, because you’re a settlement AND a health organization. You have the health regulatory frameworks and deep sector experience looking at virtual care. You can use that to frame your settlement practice as well and influence our sector’s work and roadmap. Commit to open working, sharing often. There’s an Open Working movement and toolkit from the UK you can even use for inspiration which aligns with your approach to Community Based Research and Knowledge Mobilization. In their manifesto they say “Great things can happen when something is made open... more people can reuse it, often cheaply. People can learn from it, even if they don’t use it. And there are almost always wonderful unintended consequences.”

What do you see as the future of the sector in terms of digital service strategy?

Practically speaking our future is hybrid service delivery. At our core we’ve always worked in, but now we are formally moving towards a hybrid or blended service model. This hybrid or blended service model is made up of in-person as well as online or remote service delivery, whether in real time or not. This means really no wrong approach or no wrong door for clients. An accessible and equitable model that's flexible and innovative that offers choice and the same level of service for Newcomers in that choice. It means both in-person and digital/remote services, sometimes with the same client. But in some cases you may have fully in-person clients, in others fully virtual. In reality, this isn’t new, you’ve been providing hybrid service delivery for a long time, well before the pandemic. But we have an opportunity to formalize it now. 

What does that look like at the individual level? It means a shift in all your roles. Over and above your existing roles, potentially new roles/jobs, but also increasingly becoming part of your role - Digital Navigators. The future of the frontline worker’s job comes up a lot in this conversation, and we need to be having that conversation. A lot of it comes up as a point of anxiety. A fear of being replaced by technology. I don’t think your job is at risk. It is evolving. But you are more important than ever before. And, as we look to the future, we can and should drive the change that is happening and ensure it aligns with our sector's core values, as well as the type of work we want to be doing. In your work, you play a key role in systems navigation. Like general Settlement work, as a Digital Navigator you’re helping Newcomers navigate the digital system.

From a sector or systems perspective, the future is a hybrid service delivery system built on the foundation of an inclusion by design framework. The United Nations recently released their 2022 E-Government Survey, which included important language about inclusion. There's a strong chapter about ensuring we don't leave anyone behind in a hybrid digital society, that talks about "Activating 'digital inclusion by design' and 'leaving no one behind' strategies requires that policy choices be made sooner rather than later to remove the barriers vulnerable groups face in terms of digital access, affordability and ability using the integrated framework for optimizing data, design and delivery. Without these policy goals and interventions, leaving no one behind will enjoy limited or uneven success—or remain in the realm of rhetoric."

There are also movements focused on responsible technology development and policy-making around technology that are starting to mature and work with each other. Each of them provide a set of principles of frameworks to approach how we view what responsibility means. Equity and inclusion exists in both, among other principles such as transparency, accountability, etc.

Being more inclusive is one of the principles of this movement. I think inclusion is the foundation for these responsible tech principles. If we're inclusive, we have to be transparent, accountable, and democratic, ensuring that everyone's voice and the impact on them is considered. If we're inclusive, we need to be prudent and thoughtful, slowing down even to think about and factor in the impacts of the technology we develop. And inclusion requires us to take a systems approach, including everyone's voice, perspective, and stewardship, which is essential if we're working to ensure everyone's safety and security.

Working towards digital inclusion means building inclusive practices and building anti-racism, anti-oppression, diversity, equity, and inclusion into our service design means taking the time to create space to collaborate, come together, co-design, share resources and create better digital service tools and approaches. 

If we get inclusion right, we won’t wonder 15 years from now how we got it so wrong. We can get it right the first time.

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