Why Social Change? PDF
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Summary
This document provides an overview of social change, emphasizing the role of community psychology in promoting social justice. It details different types of social change, approaches to community change and the instruments of social power.
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Why Social Change? - Social justice reasons - Community psychology’s commitment to social justice - How the “status quo” is not a level playing field - Marginalization perpetuates injustice - Psychology should not be “apolitical” - Inequity signals injustice - Injustice compels action Community and...
Why Social Change? - Social justice reasons - Community psychology’s commitment to social justice - How the “status quo” is not a level playing field - Marginalization perpetuates injustice - Psychology should not be “apolitical” - Inequity signals injustice - Injustice compels action Community and Social Change - A focus on approaches to promote change at the level of communities and societies, rather than individuals - Dofficults, complex, long-term, but possible Types of Social Change - Spontaneous and unplanned social change - Unintentional change - Ex. natural disaster - Causes stress due to the unknown and the uncontrolled - Planned social change - Limited in scope - Directed at enhancing quality of life - Provides a role for those affected by change - Guided by a social change agent - Identify issue - Research causes - Take action - Reflect Types of Change - First-order change - Only a proportion of a system is changed (person, clients, tool) - Broader system remains intact - Second-order change - Changes to the system - Changes in relationships among component parts of a system - Changes in the goals, structure or processes of a system Types of Community Change - Community betterment approach - Attempts to improve specific aspect of community functioning using a top-down approach - Community empowerment model - Uses bottom-up approach in which community members have primary control of change efforts - Can increase community capacity and strengthen sense of community Instruments of Social Power - Control of resources to bargain, reward and punish - Control of channels for citizen participation in community decisions - Ability to shape the definition of a public issue or conflict Approaches to Community and Social Change - Consciousness raising - Social action - Community development - Community coalition - Organizational consultation - Alternative settings - Policy research and advocacy Continuum of Community Change Strategies - Community coalition → policy research and advocacy → community development → social action Consciousness Raising - Emphasizes increasing citizen’s awareness of social conditions that affect them - Conscientization - when people become aware of their oppression, and the forces that maintain it - Focuses on influencing how community problems are defined and explained - Grassroots, bottom-up approach to community change Social Action - Identifies obstacles to empowerment of disadvantaged groups, and creates constructive conflict to remove these obstacles through direct, nonviolent action - Focus on power and conflict - Based on gaining control of resources - Conflict strategy because cooperation is viewed as being ineffective Dynamics of Social Action - The purpose of the Haves is the keep what they have - Thus, the Haves want to maintain the status quo and the Have - Not want to change it - The haves want to keep, the have-nots to get Alinky’s Principle - Power is not only what you have, but what the enemy thinks you have - Ridicule is the most potent weapon - Make enemy live up to his or her own rules - A good tactic is one that people enjoy - The threat is usually more terrifying than the thing itself - The price of a successful attack is a constructive alternative - Pick the target, freeze it, personalize it, and polarize it Community Development - Process of strengthening relationships among the community members to define community problems, resources, and strategies for solutions - Cooperative strategy intended to broaden opportunities for participation and influence in community decision-making Objectives of Community Development - Personal - Empowerment - Community - Citizen participation - Sense of community - Social learning - New services or resources - Societal - Social justice (redistribution of resources) Community Coalition - Outgrowth of community development - Broad representation of citizens to address a community problem - Can involve: - Citizens, community organizations, businesses, media, grassroots groups - Typically involve community and organization leaders - Coalitions - Develop a mission - Write and implement action plans Organizational Consultation - Professional working as consultants with workplaces, for profit, or non-profit, to make changes in the organization’s policies, structure, or practices Alternative Settings - Outgrowth of dissatisfaction with mainstream services - Ex. consumer/survivor initiatives, street health clinics, alternative schools - Sage haven and support for individuals experiences discrimination and injustice - Potential fertile ground for social change Policy Research and Advocacy - Speaking out in some form to influence decisions, policies, and laws - Participation in public decision-making and influencing how an issue is defined or understood in the political area - Persuasion based on research findings and reasoned arguments - Often a top-down method of social and community change Professional Change Agents - Community Psychologists as consultants in social change - Skilled in - Community needs assessment - Community organizing - Group problem solving - Action research - Likely to focus on social systems and institutions rather than individuals Professional Change Agents - Private consultants - cost $ - University affiliated consultants - Need $ - May be limited by academic reward structure funding/project timelines may not fit community timelines Lecture 10 Stress and Coping in Community Psychology - The aim of community psychology is undermining the process whereby stress generates psychopathology - CP considers both community-contextual and clinical-individual perspectives as intertwined in stress and coping An Ecological-Context Coping Framework Risk and Protection - Risk process - factors correlated with problematic individual outcomes - Distress, mental disorders, behavioural problems - Protective processes - strengths or resources associated with positive individual relationships - Coping, treatment, supportive relationships - Risk and protection exist at multiple ecological levels from individual qualities to macrosystem forces Distal Factors - Predisposing processes that indirectly shape stressors, resources, coping processes and outcomes - Personal factors - gender, personal temperament, genetic or other biological factors - Contextual factors - economic trends, neighborhood characteristics, family conflict, racism, poverty Stressors and Resources - Definitions - Stressors - circumstances that represent a threatened or actual loss of scarcity of resources - Resources - material, social, and personal factors that promote health and personal well-being - Material - money, employment, housing - Social - support from friends, social status - Personal - competencies or skills Proximal Stressors - Precipitating, relatively direct relationship to stress and coping - Directly trigger or contribute to a problem - Represent a threatened or actual loss or scarcity of resources - May arise from distal factors Types of Stressors - Major life events - Ex. job loss, death of a friend - Life transitions - Ex. entry to college, retirement - Daily hassles - Ex. traffic gridlock, family conflict - Microaggressions - brief, commonplace, daily indignities that communicate negative or derogatory slights - Microassault - explicit racial belittling remark or action, telling racist joke - Microinsult - racial insults, arguing against affirmative action - Microinvalidation - denying one’s experiences - Ex. I don't believe racism exists today - ambient/chronic stressors - Ex. poverty, pollution - Disasters - Ex. hurricanes, floods, nuclear accidents, terrorism and war Stress Reactions - The personal experience of stress may include physiological, emotional, behavioral, cognitive, and social components - These are interdependent and often cyclical - Appraisal - The process of constructing the meaning of a stressful situation or event - Involves the extent to which the situation is seen as challenging, expected or unexpected, controllable or uncontrollable - Also involves our assessment of our available resources to combat the stressor Appraisal - Assessing Stressors and Resources - Primary appraisal - Estimation of the strength or intensity of the stressor - Secondary appraisal - Estimation of the resources and coping options for responding to the stressor - Reappraisal - Changing perception of stressor’s intensity, identifying unrecognized resources, or finding remaining meaning in the situation Coping Resources - Individuals activate resources for coping with stressors, often from many ecological levels - Material resources - Money, employment, housing, food, transportation, etc - Social-economic competencies - Connect with others to make use of resources they offer - Social, cultural, and spiritual - Cultural traditions, rituals, beliefs, meaning Coping - Efforts, both intrapsychic and action-oriented to manage (i.e. master, tolerate, reduce, minimize) environmental and internal demands and conflicts among them Types of Coping - Emotion-focused vs Problem-solving focused coping - Emotion focused - lessen or strengthen the emotion - Problem focused - change the environment - Active vs avoidant coping - Active - try to solve the problem - Avoidant - try to escape the problem Coping Outcomes - Distress - Dysfunction - Clinical disorders - Resilience Resilience - The achievement of positive adaptation despite exposure to significant threat or severe adversity - Good outcomes in spite of serious threats to adaptation or development - 2 key criteria need to be satisfied - Positive adaptation, including development of competence - Significant risk or adversity - Protective processes (environmental and individual) that allow someone to adapt to adverse contexts Protective Factors Promoting Resilience in Children & Youth - Within the child - Good cognitive abilities, including problem-solving and attentional skills - Easy temperament, adaptable personality - Positive self-perception, adaptable personality - Faht and good sense of meaning in life - Positive outlook on life - Good self-regulation of emotional arousal and impulses - Talents valued by self and society - Good sense of humor - General appear or attractiveness to others - Within the family - Close relationships with caregiving adults - Authoritative parenting (high warmth/responsiveness and monitoring/supervision) - Positive family climate, including low discord between parents - Organized home environment - Postsecondary education of parents - Parents with protective qualities listed above - Parents’ involvement in child’s education - Socioeconomic advantages - Within interpersonal environment (within or outside family) - Close relationships to competent, prosocial and supportive adults - Connections to prosocial and rule-abiding peers - Within the community - Effective schools - Ties to prosocial organizations (schooles, clubs, scouting, etc) - Neighborhoods with high “collective efficacy” - High levels of public safety - Good emergency social services (ex. 911, child protection) - Good public health and health care services Interventions to Promote Resilience - Varying in timing, ecological level, and content - Social policy and advocacy - Organizational consultation - Alternative settings - Community coalitions Prevention and promotion programs Crisis intervention Case management Social Support - Definitions - Social support as a meta construct - A collection of social, emotional, cognitive, and behavioural processes occurring in personal relationships that provide aid that promotes adaptive coping Types of Social Support - Emotional - Expressing compassion - Instrumental - Physical or substantive assistance is provided - Informational - Helpful information is provided Specific Support - Enhanced support - Behavioural help provided to people coping with a particular stressor - Emotional encouragement, information, advice, tangible assistance - Support is tailored to a specific stressor Generalized Support - Occurs in interpersonal relationships sustained over time - Provide a secure base for living and coping - Does not necessarily involve behavioral helping in a specific situation - Perceived support Social Support - Specificity Hypothesis - Social support will be effective in so far as it is matched to the particular needs for support which exist - Ex. material support in the face of poverty or catastrophic loss of resources - Ex. informational support in the face of uncertainty such as new situations What is the Relationship Between Specific and Generalized Support? Social Support - Direct Effect Social Support - Buffer Effect Link Between Social Support and Health - The breadth and consistency of the research and beneficial effects of social support are impressive - Either through direct protective effects, or by buffering the adverse consequences with a decreased likelihood of developing a disorder Relationship Context of Support - Social support occur within the context of relationships - Families - Sources of both generalized and specific - Involve greater commitment and personal knowledge - Can be limited by greater obligation for reciprocity and potential for conflict Natural Helpers, Mentors - Sources of informal support in a community - In positions were conversations can become personal and emotional - Mentors - older, more experienced person who provides support and guidance - Naturally occurring or available through programs Relationships as Stressors - Relationships as sources of stress - Conflict, criticism, misunderstandings - Can mitigate support that is expressed Social Support Network Map - Heavy lines represent multidimensional relationships - Unidimensional relationships between focal person and others are not drawn Lecture 11 Rationale for Health Promotion and Prevention - George Albee - Limitations of one-on-one therapy - Insufficient resources - Instead of treating disorders, why not prevent them from occurring to begin with Definitions - Prevention - reduction of problems of living, mental disorders, distress, etc - Prevent new causes from occurring - Focus on populations, not individuals - Intentional (theory driven) - Promotion - enhancement of well-being in populations Health Promotion - Enabling people to increase control over, and to improve their health - To reach a state of complete physical mental and social well being - An individual or group must be able to identify and to realize aspirations, to satisfy needs, and to change or cope with the environment - The fundamental conditions and resources for health are peace, shelter, education, food income, a stable ecosystem, sustainable resources, social justice and equity Characteristics of Promotion - Proactive - Focus on populations not individuals - Multidimensional - an integrated set of activities at multiple ecological levels - Ongoing, not time-limited Health Promotion Action Means - Build healthy public policy - Create supportive environments - Strengthen community action - Develop personal skills - Reorient health services Health Promotion in Practice - A focus on encouraging individuals to adopt or to drop health practices - Participation Prevention - Tends to be more focused, intentional, and theory-driven than health promotion - Interventions designed to prevent the occurrence of a particular disease - Developed based on association between the link between risk or protective factors, and disease - Developed based on assumption that intervention can decrease risk or increase protective factors Types of Prevention - Primary prevention - Entire populations, that does not have the disorder or problem - Lower rates of new cases (incidence) - Vaccinations, skill-building programs - Secondary prevention (or early intervention) - Populations showing early signs of disorder or problem (at risk) - Children who are having academic difficulties - Risk of stigmatization - Tertiary prevention - Populations that have a disorder or problem - Reducing intensity or duration of disorder or problem - Rehabilitation focus (though difficult to differentiate from treatment) Prevention Continuum Types of Prevention - Universal - directed at everyone in a population - People are not in distress, like primary prevention - Selective - directed at groups of people at above average risk due to environmental or personal factors - Risk ≠ symptoms - Indicated - directed at individuals who are at high risk of developing problems (presence of early signs) Risk, PRotection, and Resilience Risk Factors - Features of individuals and environments that reduce the biological, psychological, and/or social capacities of individuals to maintain their well being and function adaptively in society - Individual risk factors - Ex. premature birth, divorce, maltreatment, motherhood in unwed teenagers, parental psychopathology, poverty, homelessness - social/environmental risk factors - Ex. family stress, poor housing, resource poor neighborhoods or settings Protective Factors - Definitions - Features of individuals and environments that operate in ongoing ways to increase or enhance the biological, psychological, social, and emotional capacities of individuals to maintain well being and function adaptively in society - Individual protective factors - Ex. social support, coping skills, self-esteem, temperament, sense of community - social/environmental protective factors - Ex. family cohesion, resource rich neighborhoods, competent communities Strategies for Prevention - Incidence - the number of new cases that arise in a population during a specified period of time - Usually one year - Prevalence - the number of cases in existence at a specified point in time Reducing Prevalence - Prevalence (P) is reduced if incidence (I) is reduced and duration (D) of disorder is reduced - P=IXD Prevention Equation - Incidence of behavioural and emotional disorder in populations = - 𝑆𝑡𝑟𝑒𝑠𝑠 + 𝑝ℎ𝑦𝑠𝑖𝑐𝑎𝑙 𝑣𝑢𝑙𝑛𝑒𝑟𝑎𝑏𝑖𝑙𝑖𝑡𝑦 + 𝑒𝑥𝑝𝑙𝑜𝑖𝑡𝑎𝑡𝑖𝑜𝑛 𝑐𝑜𝑝𝑖𝑛𝑔 𝑠𝑘𝑖𝑙𝑙𝑠 + 𝑠𝑜𝑐𝑖𝑎𝑙 𝑠𝑢𝑝𝑝𝑜𝑟𝑡 + 𝑠𝑒𝑙𝑓 𝑒𝑠𝑡𝑒𝑒𝑚 Lecture 12 Community Psychology and Community Mental Health - Community mental health - the broad array of services and programs oriented to supporting people living with serious mental illness in the community - Community psychology has made significant contributions to the development and study of community mental health programs, and key concepts Overview of the Community Mental Health Movement Deinstitutionalization - The process of relocating people with serious mental illness from institutions to the community - Ex. psychiatric hospitals - In Canada, primarily 1960s-1970s - Arguably still ongoing Contributors to Deinstitutionalization - Criticism of institutions - Spiraling costs of institutions - Rise of outpatient services - Psychoactive drugs - Environmental models in vogue - Legal and legislative forces/shifts in funding Problems with Deinstitutionalization - Insufficient supports and resources in the community - Reliance on substandard housing - Increased pressure on families without support Leading to - Negative contact between public and people with serious mental illness - People falling between cracks - Revolving door process - Reliance on acute care services Objectives of Community Mental Health Services - General - Facilitate and support successful living in the community - Specific - Community integration with non-disabled individuals - Assume normal roles in the community - Experience quality of life similar to general population Changing Directions in Community Mental Health Services - Downsizing of system - Reallocation of resources to outpatient and community focused programs - Increase in funding for community mental health programs - Implementation of consumer/survivor non-service alternatives Current Mental Health System in Ontario - General Hospital Psychiatry Departments - Psychiatric hospitals (or mental health centers) - Community agencies - Ex. Assertive Community Treatment, case management, crisis intervention, self-help initiatives, housing, vocational and social rehabilitation Current Mental Health Services - There is no comprehensive system for mental health - Some but limited coordination among psychiatric hospitals, general hospitals psychiatric units, and community mental health programs - Weaknesses and pressures - Limited integration and coordination - Significant regional variation in availability of programs/services - Inappropriate mix of institutional care and community services - High readmission rates/inappropriate use of services Approaches to Community Mental Health Serious Mental Health - 3 Ds - Diagnosis - Disability - Duration Models of Mental Illness - Medical model - Assumption - dysfunction is primarily due to internal, biological processes - Focus on illness and defect - Role of professional - psychiatrist diagnoses and prescribes treatment (ex. medication) - Role of individual - patient who is expected to follow treatment - Rehabilitation model - Assumption - dysfunction is primarily due to inadequate knowledge and skills - Role of professional - professionals identify deficits and develop programs to address these deficits - Role of individual - client who is expected to set rehabilitation goals and work with professionals to achieve these goals - Recovery Model - A person, unique process of returning to a satisfying, hopeful and contributing life even with limitations attributing to mental illness - Assumption - dysfunction is primarily due to loss of meaningful social roles - Role of professional - support the individual in working toward personal goals - Seek support and resources in community - Role of individual - person who identifies personal goals and assumes normal roles in the community Limitations of the Recovery Model - Suggests a never-ending process - Focus on individual-goal setting, to direct services - Overly individualistic and personal view - Ignores how individual and personal struggles are shared by virtue of group membership - Leads to individual-level programming rather than systems change - Toward a citizenship and social justice approach Outcomes of the CMH Movement - Dramatic reductions in long-stays in institutions - The vast majority of people with serious mental illness living (more or less) independently in the community - Programming and services increasingly responsive to individual choice - Complementarity of pharmaceutical and psychosocial treatments/support - By any perspective, most people with serious mental illness live in poverty - Those relying on income support programs live below the poverty line - They have difficulty meeting their basic needs - Ex. housing, food, transportation, mobile phones, internet - Lower life expectancy, lower literacy rates, higher rates of unemployment Limitations of the CMH Movement - Limited interest in policy beyond mental health policy - Ex. housing, employment, income - Limited links between mental health strategies and other strategies - Ex. housing, poverty reduction - Evidence-based interventions are individual-focused with limited scalability - A focus on narrow specialization and professionalization - Limited cross-sectoral collaboration - Need reorientation to concept of citizenship and a social justice orientation Consumer/Survivor Movement - Beginnings in early 1970s - Formal residents of psychiatric institutions began to meet on their own to offer mutual support - Evolved to include advocacy to improve programs and services and change policy Consumer Run Organizations - Organizations with consumers of mental health services in charge of operations and which have principles of choice and self-determination as elements of their basic philosophy - Drop-in centers, residential programs, advocacy organizations, businesses, self-help groups - Goals - improved coping skills, advocacy, support, improved recovery Ontario’s Consumer/Survivor Development Initiative - Influenced by the Vancouver Mental Patients Association, On Our Own founded in Toronto in 1974 - 1984 - only 4 initiatives in Ontario - 1984 - CMHA released its national policy framework identifying consumer/survivor initiatives as a key element - A Framework for Support Community Resource Base Ontario’s Development - CSDI - - Consumer/Survivor Initiative developed in 1991 - Designed to counterbalance the existing service paradigm - Check on existing service structure - Alternative source of support Key elements - Nonservice - Independence - Member-driven Longitudinal, mixed-methods, quasi-experimental study led by Geoff Nelson at Laurier demonstrated significant benefits for participants in CSIs as well as system level change activities Lecture 13 Homelessness in Ottawa - Best guess - Ottawa’s Point-in-Time count 2021 - 1340 people surveyed - 55% using shelters, others in transitional housing (13%), couch surfing (11%), on the street (9%), institutions (6%) - 32% of people identified as indigenous - 55% people racialized - 27% had been in a foster home/group home - Reasons for homelessness - 14% COVID - 26% insufficient income - 16% substance use - 13% conflict with landlord - 12% conflict with partner/spouse - 10% unfit/unsafe housing - Shelter users in Ottawa - From 2014-2017 - 16% increase in overall use of shelters - 12% increase in length of stay - 21% increase in chronic homelessness (6 months+) - For families, 33% increase in shelter use and 23% increase in length of stay - Newcomer families represented 36% of families living in shelters (compared to 14% in 2014) - More recently, decrease in shelter use - In 2018 (City of Ottawa) - 7937 people used city shelters (6.5% increase since 2017 - 3228 single men (1.4% increase) - 934 single women (5.5% increase) - 222 in youth shelters (12.2% increase) - 1078 families (10.6% increase) - 3640 individual members - Average length of stay - 123 days - In 2021 - On average, 530 single men accessed the shelter system each night - On average, 191 single women accessed the shelter system each night - On average, 1153 family members accessed the shelter system each night - Single indigenous men account for 12.8% of all single men in the shelter system - Single indigenous women account for 18.6% of all single women in the shelter system - Single indigenous youth (18 and under) account for 10.7% of all single youth in the shelter system What Do We Know About Homeless People? - Great majority of people are 1 time users of shelters - 1-10% are chronic users - 3-11% are episodic users Diversity in homeless families in Ottawa - Newcomer families are more educated, more likely to be two-parent, have few diagnoses of mental illnesses, and alcohol and substance abuse - Single most important cause of homelessness is poverty Causes of Homelessness - Individual level - Unemployment, poverty - Mental illness - Substance abuse - Social isolation - Family - Single parent, female led, visible minority, violence and abuse, education - Structural causes - broader social and economic factors that create or foreclose opportunities - Income - Housing availability/affordability - Absence of prevention - Transitions from care - Discrimination - Is it variations in individual/family factors or structural factors that leads to variations in numbers of homeless people? - Whereas individual/family factors may create vulnerabilities, they do not determine extent of homelessness Consequences of Homelessness - Individuals - Mental health challenges - Chronic health challenges - Poor nutrition - Risk of injury and assault - Barriers to accessing health and social services - Higher mortality rates and shorter-life expectancies - Family - Family separations - Parent stress and mental health problems - Social isolation - Disruption of family routines and parenting practices - For children disruptions in school, stress and anxiety, loss of friends Homelessness Interventions - Prevention (Canadian OBservatory on Homelessness) - Universal prevention - Ex. adequate supply of affordable housing and poverty reduction strategies, such as greater access to affordable child care - Selected prevention - Ex. school-based programs and anti-oppression strategies for individuals facing discrimination, in particular the Indigenous Peoples - Programs aimed at low-income people (basic income) - Indicated prevention - Ex. support for families experiencing violence and individuals facing mental health and addictions challenges - Shelters - Conceived as an emergency response to homelessness - Have evolved into a management response to homelessness - Shift to integrating range of services - Ex. health, employment, housing, counseling, safe-injection - Life in shelters is stressful, over-crowded, regulated, and unhealthy - With shelters aging and overflowing, pressure is being placed to fund newer and larger shelters - For families - Most families will not need intensive support in order to leave homelessness Continuum of Service Needs of Homeless Families - - Tier 1 (10%) - all families regardless of their socioeconomic status, need the following basic combination of supports and services to survive and maintain their families - Affordable housing - Jobs that pay a living wage - Child care - Health care - Transportation - Basic child services - Ex. play groups Tier 2 (80%) - need all services in Tier 1, and additional ongoing, specialized services - Education and job opportunities - Services for traumatic stress and mental health - Family supports - Ex. home visiting - Services for children - Ex. mental health screening and treatment - Tier 3 (10%) - Require income supports as well as lifelong ongoing, often intensive, services and supports in order to maintain their families in housing and ensure the well being of all family members Homelessness Interventions - Family Options Study - 2015 - Hundreds of families across 12 communities in USA - Experimental design - 3 approaches - Permanent housing subsidy - Rapid rehousing - Transitional housing - Early findings appear to support housing subsidies as most strongly associated with more intact families and fewer returns to shelter - What are the prospects of extending subsidies to all families in need? Housing Interventions for People with Serious Mental Illness - In Ontario - A dedicated housing system funded by the Ministry of Health and Long-Term Care - Mix of private and non-for-profit providers - Mix of models - Custodial housing - First form of housing emerging post deinstitutionalization - Focus on treatment and rehabilitation (though little rehabilitation and support services available) - Mental health provider as expert - Often offered by for profit providers - Board and care style housing - Replication of the institution in the community - No research evidence in support of benefits from this type of housing - Supportive (single-site, congregate) housing - Non-profit housing - People share house or apartment building - Support provided on-site by trained, professional staff (linked to housing residency) - Greater emphasis on psychosocial rehabilitation - Expectation of graduation to more independent forms of housing (which was rarely realized) - Supported (scattered-site, independent) housing - People receive housing subsidies and choose the apartment where they want to live - Often independent apartments which are scattered throughout the city - Portable support provided to the individual - Focus on individual empowerment, recovery, and community integration - Research evidence of a range of positive outcomes - Housing First - Linked to supported housing, though may be any form of housing chosen by individual - Housing people with no pre-conditions - Housing as a right - Used to house people who have serious mental illness and experiences of chronic homelessness - Intensive, individualized support (ACT or Intensive Case Management) At Home/Chez Soi Project - In 2008, federal government of Canada allocated $119 million to the Mental Health Commission of Canada to conduct a multi-city research demonstration project testing the effectiveness of Housing First - A pragmatic RCT in 5 cities - Vancouver, Toronto, Winnipeg, Montreal, and Moncton - HF condition - 1198 individuals access to housing and support (ACT or Intensive Case Management) - Treatment as usual - 950 received standard care and support available to individuals with serious mental illness and who are homeless or precariously housed - Outcomes over 2 years - HF participants spent 73% of their time in stable housing, compared with TAU participants spending 32% of their time in stable housing - In the last 6 months of the study, 62% of HF participants were housed all of the time, compared with 31% of TAU participants - HF participants also showed greater improvements on average, in community functioning and QoL than TAU participants, though differences were not all sustained over the 24 month period - Implications - HF is effective in promoting housing stability - This finding has been replicated across numerous studies - HF is not sufficient to produce sustainable significant improvements in QoL, community functioning, community integration, and substance use - Why? Poverty, stigmatization, long process of extrication self from street life, and working toward new life in housing - Additional intensive and/or specialized services are required to compliment HF - Ex. leisure, education, employment - Sustainability - Nine of 12 HF programs successfully obtained provincial funding to continue - Discontinuation of the program at one site-transition to other programs - At another site, changes in support and loss of subsidy if they changed or lost housing At 3rd site, continuation of ACT but loss of ICM Lecture 14 Community Mental Health Association Who is CMHA Ottawa? - A community-based non-profit organization providing services for individuals with severe and persistent mental illness and/or substance disorder and trauma - Supporting individuals aged 16-64 years old in the Ottawa area who are living with severe and persistent mental health challenges - Promoting good mental health, developing and implementing sustainable support systems and services Funding - Province of Ontario - City of Ottawa - Other programs Programs and Services at CMHA Ottawa - Direct service - Case management - Familiar faces - Youth in transition - Systems navigation - Housing - Outreach services - Housing outreach - Court outreach - Hospital outreach - Specialty services - Nursing - Dual diagnosis - Peer support - Counseling services - Concurrent disorders (CD) program - Dialectical behaviour therapy (DBT) What is Community Development? - OCHC came into being when City Living merged with Ottawa Housing in 2002 - OCHC provides ~15,000 homes to more than 32,000 tenants, including seniors, parents, children, couples and singles - OCHC houses a diverse population of varying languages, ethnicities, cultures and ability levels - OCHC is the largest community housing provider in Ottawa, managing ⅔ of the City’s community housing portfolio, and is the second-largest in Ontario - We are also the largest of 52 non-profit community housing providers in the city Community Development Definition - Community development is a process where people come together to take action on what is important to them - At its heart, community development is rooted in the belief that all people should have access to health, wellbeing, wealth, justice and opportunity Resident Engagement is Key - When people discover what they have, they find power - When people join together in new connections and relationships, they build power - When people become more productive together, they exercise their power to address problems and realize dreams Some Bumps Along the Way - Turnover - Resident leadership or volunteer burnout - Community conflict - Critical incident responses