In this useful framework document, the Ontario Centre of Excellence for Child and Youth Mental Health (the Centre) and Children’s Mental Health Ontario (CMHO) provide an approach to evaluate current virtual care (or digital, hybrid/blended service delivery).
Why it's useful: "Understanding what has worked well, challenges and how these have been addressed will enable the sector, post-pandemic, to take planful and deliberate steps to adding virtual care options to their suite of mental health services for families."
The document is useful for any organization looking to evaluate their digital or hybrid/blended service delivery, regardless of the sector. It provides:
The guiding framework suggests that you conduct "evaluations of virtual care assess processes and outcomes across three levels:
Other factors in the larger environmental context are also important considerations (e.g. legislative and socio-cultural factors), but beyond the scope of work at any one agency."
The evaluation checklist they provide is a subtle, but powerfully important reminder that what you are evaluating is not technology, but the effectiveness of service interventions and client outcomes.
They also ran a webinar on the topic in October 2020:
[pdf-embedder url="https://km4s.ca/wp-content/uploads/Evaluating-and-improving-e-mental-health-services-a-guiding-framework-for-evaluating-e-mental-health-services-2020.pdf" title="Evaluating and improving e-mental health services - a guiding framework for evaluating e-mental health services (2020)"]
The Virtual Care Equity Matrix outlines key equity issues that must be addressed in the delivery of virtual care. It highlights the conditions necessary for everyone to access high quality, timely, equitable, and person-centred virtual care. The matrix is presented in the form of a pyramid, illustrating a hierarchy of needs and foundational conditions that must be built upon to create equity in virtual care or service delivery:
I think the matrix is valuable and useful for anyone providing digital or hybrid/blended service, whether in health care or not. In particular, if you're committed to digital inclusion and equity, this matrix appears to provide a measurable model to help you develop your interventions and services.
These foundations overlap or intersect to limit or facilitate access to virtual care.
The matrix was created to guide the work of the Ontario Mental Health and Addictions Virtual Care Collaborative. The goal is to ensure that health equity is centred in virtual care. The matrix is relevant to anyone looking to develop interventions, technologies, or projects that are digitally equitable and inclusive.
Webinar recording
On December 2, 2021, the Health Equity Impact Assessment (HEIA) Community of Interest and the Ontario Mental Health and Addictions Virtual Care Collaborative (the Collaborative) presented a webinar that discussed:
Presenters:
Paul Bailey - strategist, urban planner and Interim Executive Director at the Black Health Alliance. Paul has spent the last decade designing interventions focused on: health and well-being, community violence, mental health and addictions, and the social service sector as it relates to improving outcomes for Black children, youth and families. His work is currently focused on social planning, health equity, and addressing the causes of neighbourhood distress and inequality.
PhebeAnn Wolframe-Smith, PhD - queer, neurodivergent white Settler and psychiatric survivor based in Wiikwedong (Thunder Bay). She is an Equity Coach with the Provincial System Support Program at CAMH and co-chair of the Ontario Mental Health and Addictions Virtual Care Collaborative’s Equity and Lived Experience Working Group.
Allan Katz - has held progressively senior leadership positions in Ontario’s health care sector. Currently, Allan serves as a Board Director at Ontario211, Chair of the Stroke Network of Southeastern Ontario, and is a Board Director of Shared Support Services Southeastern Ontario. He is the principal of an independent health system planning consultancy and works with the Réseau des services de santé en français de l'est de l'Ontario. Allan has served in senior leadership roles at Riverside Health Care (Fort Frances, Emo and Rainy River in Northwestern Ontario). South East Community Care Access Centre, Health Care Network of Southeastern Ontario, Deep River and District Hospital, Northeastern Ontario Regional Cancer Centre and Muskoka/Parry Sound District Health Councils.
This 2020 NTEN guide provides a set of guidelines addressing the equitable use, creation, and funding of technology in the nonprofit sector. This "guide was created through a collaborative process with diverse community members who acknowledge it is merely the beginning. We anticipate it evolving as it mirrors changes in society. You’ll find that equity, particularly racial equity, is central to this document as a reflection on NTEN’s commitment to advancing equity as an intersectional issue. Our commitment acknowledges that the foundation of all equity work is antiracism due to white supremacy’s dominance in all oppression systems."
What's in the guide?
The guide is organized into 5 key areas.
As the guide outlines, this is an ongoing and evolving conversation. Use this guide to at least start the conversation in your organization and community. Connect with others doing similar work to continue to build an equity and inclusion approach to technology development and adoption in the nonprofit sector.
For more information, watch this NTEN community discussion about how the guide was created and how you can use it in your organization:
[pdf-embedder url="https://km4s.ca/wp-content/uploads/NTEN-Equity-Guide-for-Nonprofit-Technology_September_2020_v2.pdf"]
"As part of the second phase of the ACS-WES project Envisioning the Future of the Immigrant-Serving Sector, four focus groups were conducted with experts in the settlement sector. Through our newcomer and service providing organization (SPO) surveys, we uncovered key challenges within the sector from the perspective of settlement agencies and their clients. The focus groups centered around finding solutions to these key challenges faced by clients and service providers, which have been exacerbated by the onset of COVID-19.
The topics of solution-focussed discussion included
These focus groups will inform the next phase of our project, in which we will further explore solutions for the sector with a broader range of stakeholders by conducting key informant interviews...
The four focus groups were conducted between September 14-17 2021 and ranged in size from 6 to 10 participants. In total, 34 participants attended one of four 90 minute sessions. No attendees were permitted to participate in more than one focus group. Participants received a $50 honoraria for their engagement. The focus groups were conducted over Zoom with one of our project team members as a facilitator for each. All participants belonged to a newcomer settlement service providing organization in an array of professional capacities. Some participants were newcomers as well as settlement service workers. The participants were selected through a number of applicants due to their knowledge of and/or experience with the topics covered, as well as to maintain diversification of region, size, and longevity of organization.
Participants were regionally dispersed across Canada from settlement agencies located in Nova Scotia, Manitoba, Alberta, British Columbia, Ontario, Saskatchewan, Prince Edward Island, and Québec. The size of participants’ settlement organizations ranged from 1-250+ employees. As an introduction, each participant was asked to introduce themselves, their organization and reason for joining the selected focus group."
[pdf-embedder url="https://km4s.ca/wp-content/uploads/ACS-Focus-Group-Narrative-Report-2021.pdf" title="ACS Focus Group Narrative Report (2021)"]
Abstract
Social media usage has been recognized as an integral part of immigrants’ acculturation experiences, yet research on social media is just emerging, and more detailed understanding is needed. In this report, researchers sought to understand how Chinese immigrants’ social media use influences their acculturation experiences. They looked at which social media platforms Chinese immigrants use and for what purposes, as well as what influence social media use has on their acculturation process in Canada. Their findings echo and reinforce what we have heard and know about newcomer use of social media and information practices, offering additional evidence and practical tips for immigrant and refugee-serving organizations.
The report authors discussed their findings in this November 2021 Pathways to Prosperity Canada conference session:
Research questions
Social media has become an integral part of immigrants’ adaptation. The types of social communication immigrants engage can impact acculturation. The authors write:
"Past research has found that different immigrant groups use social media for different purposes. Some studies have found that Facebook is one of the most frequently used platforms among immigrants, including Chinese international students, for host cultural communication (Hofhuis, Hanke, & Rutten, 2019). Other studies have found that immigrants use Facebook mainly to connect with family and friends at home or to express their ethnic cultural identity (Lim & Pham, 2016). Of relevance to the current project, other researchers have suggested that, for Chinese immigrants, WeChat is most prevalent for both host and ethnic communication (Chen, Butler, & Liang, 2018). These findings highlight the importance of focusing on specific immigrant groups to understand how each group uses social media differently, including what platforms they use and how they use those platforms. This is particularly important given the current transition to
providing settlement services in virtual formats (Helps, Silvius, & Gibson, 2020). A greater understanding of social media use will help settlement agencies deliver targeted settlement programs."
"... past studies have demonstrated inconsistent findings about the effects of social media on acculturation. One possible explanation is that most studies failed to recognize the intricate nature of social media communication. Social media can transcend the boundaries of interpersonal and mass communication, as well as ethnic and host communication. For example, although Facebook is generally considered a host communication platform, ethnic communication occurs on Facebook as well. Immigrants connect to other individuals through social media; however, they also consume information and news on social media. To understand the impact of such complex communication platforms, we must consider the different types of communication happening on social media."
Based on these and other literature findings, researchers explored these questions:
What did researchers do?
They conducted "two studies using a mixed-method approach. Study 1 used focus groups to seek qualitative information that describes Chinese immigrants’ experiences of using social media in the acculturation process. Built on the results from Study 1, Study 2 used a survey to explore the relations between specific social media use and acculturation outcomes."
Three focus groups (90 minutes each) with a total of 24 participants were conducted in Mandarin. Participants were recruited through an organization that provides services to Chinese immigrants.
What did the researchers learn?
Unsurprisingly, WeChat is the most frequently used social media platform/channel/tool. YouTube and Facebook were used moderately frequently: "Many participants indicated that they use YouTube fairly frequently, particularly to learn English, to get local news and information, and for entertainment. Though Facebook was used less frequently, it emerged as a means of connecting with host country individuals. However, no meaningful themes emerged for WhatsApp and Twitter because participants used these platforms infrequently."
Chinese immigrants find a wealth of settlement information on social media, which has helped with social and psychological adaptation: "WeChat groups help us a lot when we first came. For new immigrants, if they don’t know anyone here, their life will be very difficult. Very difficult. Since I have a relative who has lived here for about 20 years, he helped me a lot. He recommended many WeChat groups, such as the house group, the vehicle maintenance group, the house or the apartment renting group."
Facebook is a way, particularly for younger participants, to connect with people outside of their community. YouTube is a useful tool to watch news and learn English.
Social media is seen, as outlined above, as both good and bad for acculturation: "In my opinion, social media has two sides. The positive side is, particularly, when we first
arrived, everything was new for us; WeChat groups helped us to know a lot of people. WeChat groups also let us know a lot of activities. These activities gave us an excellent opportunity to communicate with different people. So, we knew many neighbors. Then, we could often connect with them. Yet, the negative thing is that to some extent, the groups limit my view. I tend to learn about local life from the WeChat groups instead of communicating with Canadians." Some described WeChat as "a cultural bubble that limits connections outside the Chinese immigrant
community."
The follow up survey underscored "the importance of social media use in predicting and explaining acculturation of immigrants."
How can you use this research?
"The COVID-19 pandemic has forced settlement agencies to quickly pivot their programs online (Esses et al., 2021). In this context, findings from this project can inform future settlement programming. Because using WeChat to learn English was negatively associated with English skills, immigrant-serving agencies can encourage newcomers to avoid this platform for language acquisition. Moreover, given that newcomers turn to social media to acquire receiving-country language skills, agencies can leverage this trend to create their own virtual language platforms or virtual language channels on YouTube.
Results from the current study suggest that finding resettlement information using social media platforms is positively associated with psychological adaptation. This builds on previous studies demonstrating that newcomers rely heavily on social media for resettlement information (Ahmed, Veronis, & Alghazali, 2020). Prearrival information programs and postarrival resettlement programs are encouraged to harness the power of social media for providing newcomers with valuable information. It is important to ensure that such information is accurate and helps to foster realistic expectations about life in the receiving country."
Overview
This series highlights digital divides across Canada, in hopes that by recognizing the interrelated issues of internet access, adoption and quality, a clearer path toward meaningful digital inclusion and equity can better shape our technology governance and digital policies.
The Overcoming Digital Divides workshop series engaged people living in Canada, industry, academia and policymakers to advance a deeper, more nuanced understanding of the conditions that shape digital inequities in Canada. Through expert panel discussions and thoughtful participatory dialogue, the series generated and drove toward innovative policy solutions to greater digital inclusion across Canada. The series built on intersectional connections across themes while identifying new issues and impacted communities.
The series captured innovative policy solutions, engage public discourse, and raise awareness about the common urgency to expand internet access and digital services. We hope that by bringing to the forefront the intersectional nature of Canada’s digital divide, we can help amplify the disparate, but often ignored voices of underserved groups. Moreover, directly engaging people in Canada will provide policymakers and advocates with first-hand access to Canadians’ digital experience. Bridging the gap between people living in Canada and decision-makers will be invaluable to producing digital inclusion policies that are informed by evidence and lived experience.
The series was presented in six parts, each tackling a specific theme with unique concern. Backgrounders for each theme are outlined in the series framing paper/report, outlining the specific concerns for each theme/community.
Webinar recordings are embedded below.
Indigenous, Rural and Remote Communities
Low-Income Communities
Older Adults and Digital Literacy
People with Disabilities and Accessibility
Public Internet Access
Youth and Digital Skills
[pdf-embedder url="https://km4s.ca/wp-content/uploads/DigitalDivideFramework-March-2021.pdf"]
This report introduces the Engagement, Governance, Access, and Protection (EGAP) Framework, developed by Black health sector leaders and health equity experts in Ontario to guide the collection, management, analysis, and use of race-based data from Black communities in ways that advance health equity.
Overview
"Ideas about health data governance may not readily provoke interest for those not already immersed in them. Of more immediate concern for many Black communities are daily lived experiences of anti-Black racism, overt displays of violence, and discrimination within the health system. But data shapes all aspects of contemporary existence, informing policy development and determining what the world around us looks. Our aim here is to address where these two issues meet, for anti-Black racism runs through the realm of health data, with consequences for people’s lives. The Engagement, Governance, Access, and Protection (EGAP) Framework seeks to ensure that data from Black communities is properly collected, protected, and used to promote equity."
Framework
"The Black Health Equity Working Group, made up of Black health sector leaders and health equity experts, began meeting early in the pandemic to develop a governance framework for health data collected from Black communities in Ontario. The objective was to address concerns from Black communities about the continued extraction of data from them without the return of tangible benefits.
After creating a draft framework, the working group carried out a series of stakeholder consultations with Black community members, researchers and academics, public health professionals, and health system organizations in Ontario to gather critical feedback and inform revisions.
This report introduces the Engagement, Governance, Access, and Protection (EGAP) Framework, which outlines guiding principles in four areas of focus:
This document was authored by the Black Health Equity Working Group (Paul Bailey, Corey Bernard, Ahmed Bayoumi, Andrew Boozary, Cynthia Damba, Sané Dube, Ryan Hinds, Kwame McKenzie, Sume Ndumbe-Eyoh, Onye Nnorom, Camille Orridge, Andrew Pinto, Gideon Quaison, Angela Robertson, and Arjumand Siddiqi).
This report reviews vaccine hesitancy among Indigenous Peoples, Black people, immigrant, and native-born populations in Canada and the U.S.
Overview
"In both countries, our research is showing a high level of mistrust of government and health care organizations including the manufacturers of vaccines. These findings suggest that the general public mistrusts the vaccine development process, believing that the current COVID-19 vaccines have not been thoroughly tested and thereby having unknown side effects, especially in the longer term." Other explanations given for vaccine hesitancy include:
Hesitancy among immigrants
"Immigrants in both countries are more likely to report concern about the newness of the COVID-19 vaccine and concern about the development timeline than the general population (38.1% in Canada; 30.1% in the USA). Misinformation is less prevalent (5.6% and 5.5% respectively).
Political reasoning for declining a COVID-19 vaccine is lower in both countries for the immigrant population (6.2% in the USA), however it is significantly lower in Canada (2.4%).
The anti-vaccination population (those who refuse all vaccines or prefer to rely on their immune system to fight sicknesses) is also lower among immigrants in both countries (5.5% in the USA, 7.9% in Canada).
Immigrants in Canada are more likely to show general mistrust for the COVID-19 vaccine (19%) while in the United States, 20.5% have a mistrust for the COVID-19 vaccine, lower than the general population (22.9%)."
Hesitancy among Black people
"Black people in both Canada and the USA reported far higher COVID-19 mistrust than the general populations (25.0% in Canada, 31.0% in the USA). Black people in Canada were more likely to report concerns about the newness of the vaccine and development timeline (40.0%)."
[pdf-embedder url="https://km4s.ca/wp-content/uploads/COVID-Impacts-Vaccine-hesitancy-in-Canada-and-USA-MAR2021.pdf"]
Abstract:
This paper explores the COVID-19 crisis with a focus on immigration and migration in Canada using a political economy lens.
Findings
"Neoliberalism has played a major role in shaping pandemic impacts and the responses to it. We critically assesses the deep structural inequalities that have caused disproportionate COVID-19 impacts on migrants and immigrants. Migrants and immigrants carry the unequal burden of COVID-19 because of racialization, labour precariousness, and exposure to health risks on job sites and in the poor neighborhoods and over crowded housing in which many live in. Mobility and borders have also been cast as a particular threat during the pandemic even though domestic sources are the main sources of contagion. We examine the use of borders as filtering mechanisms during COVID-19 and the negative impacts this has had on migrant populations. While crises like pandemics pose many dangers they also open up policy windows through which progressive change may be realized. We reflect on these possibilities."
[pdf-embedder url="https://km4s.ca/wp-content/uploads/The-Political-Economy-of-a-Modern-Pandemic-Assessing-Impacts-of-COVID-19-on-Migrants-and-Immigrants-in-Canada.pdf" title="The Political Economy of a Modern Pandemic - Assessing Impacts of COVID-19 on Migrants and Immigrants in Canada"]
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