Work Yordanos Woldemariam

Social Prescribing: Building toward a national framework

Problem

The Canadian Institute for Social Prescribing and the Social Prescribing Community of Practice sought to understand the current state of social prescribing in Canada, and enlisted Bridgeable to co-design early building blocks for advancing social prescribing nationally.

Solution

We defined the current state of social prescribing in Canada through interviews with social prescribing experts. We synthesized our findings to create a high-level social prescribing experience map and identify relevant insights. Our research findings enabled us to create five building block recommendations for advancing social prescribing in Canada.

Impact

The social prescribing experience map enables practitioners and other stakeholders to demonstrate the value of their programs using a visual of a complex system. Our research gives stakeholders, policymakers, and funders an accessible way to understand the current state of social prescribing in Canada, and the building blocks identify key areas of opportunity in future efforts to develop a national framework.

We are proud to share our full findings and recommendations through an interactive microsite.

For a summary of our initial phase of this work, please read: Social Prescribing: A holistic approach to improving the health and well-being of Canadians.

Watch our hybrid project readout: Social prescribing: Building toward a national framework with CISP.

 

In collaboration with multi-sectoral stakeholders, the Canadian Institute for Social Prescribing (CISP), anchored by the Canadian Red Cross, has begun a project to create a national framework for social prescribing. Working with CISP and the Canadian Social Prescribing Community of Practice (CoP), Bridgeable was tasked with understanding the current state of social prescribing in Canada and co-creating the early building blocks for advancement at the national level.

Bridgeable delivered this work in three phases:

In the first phase, we captured the current state of social prescribing in Canada through a multi-faceted research approach, including desk research, public perception interviews, and expert interviews with social prescribing practitioners and implementers. We were able to synthesize our research findings into a clear social prescribing referral pathway and show stakeholders across five key stages: enter, connect, attend, follow-up, and exit. We also learned about the presence of a “link worker” across most initiatives: someone to assess client needs, create care plans, and connect clients with community resources. This role may also be called a community connector, navigator, social worker, seniors connector, or other titles, and may be a volunteer or staff member where funding is available. Understanding the needs and challenges faced by link workers became a point of exploration in our second phase.

To complement our social prescribing pathway map, we also identified six key insights to inform the next phases of our project. For a full summary of this initial phase, please read our article Social Prescribing: A holistic approach to improving the health and well-being of Canadians.

In the second phase, we hosted co-creation sessions with the CoP to generate the ideal parameters for a unified link worker role, and identify the support required to build out this role. Through validation interviews with policymakers and funding experts, we uncovered healthcare system complexities to consider when trying to expand the link worker role and social prescribing practices as a whole.

In this second phase we also collected video reflections from social prescribing practitioners including physicians, link workers, and community partners. In these videos, our participants spoke about the value of social prescribing, and what they’d like to see in terms of advancing social prescribing in Canada. These first-hand accounts also helped our team in understanding the challenges and successes of working as a service provider in this practice space. They can be viewed in our interactive microsite.

Voices of Social Prescribing videos thumbnail

Voices of Social Prescribing, interviews viewable on our interactive microsite.

In our third phase, we developed five building block recommendations for CISP and the CoP to consider when developing a national framework for social prescribing in Canada, accompanied by an interactive microsite that outlines our complete project work and process. The full description of the second and third phases of Bridgeable’s work are detailed below.

Co-creation with the Social Prescribing Community of Practice

Bridgeable facilitated two co-creation workshops with 17 individuals from the CoP including link workers, program directors, and community partners. We explored the core components and characteristics of a unified link worker role. We also discussed the challenges experienced by individuals in these roles currently and the resources needed for their advancement.

We learned that the core attributes required of a link worker include the ability to build trust-based relationships with clients; an understanding of the social determinants of health; and a trauma-informed, anti-racist, and culturally safe approach to care. We also learned that link workers need support in the form of ongoing training and professional development, mentorship and administrative support, collaboration with healthcare and community service providers, the ability to collect and share client information, and access to a database of available resources.

Validation interviews with policy and funding experts

We validated our co-creation findings in eight interviews with policy and funding experts. Our interviewees included provincial government directors, Community Health Centre executive directors, community-based health service managers, health policy advisors, and private funders. These experts identified a number of health system complexities that need to be addressed in order to scale a unified link worker role.

We found three distinct areas of complexity:

  1. Variations in existing patient navigation models. The differences between existing methods for patients to navigate the healthcare system create a challenge in the application of a unified link worker role. Further assessment is needed to learn how this role fits into varying models.
  2. Distinct community and population needs. Unique populations require specific link worker knowledge or resources to address their particular needs. A standardized link worker role would need to adapt and respond to individual population needs. Our experts expressed concern that the flexibility of the link worker may be limited if the role is defined too rigidly.
  3. Current strain on primary and acute care services. The Canadian healthcare system is currently under pressure due to high demand for primary and acute services and challenges to healthcare funding. The policy and funding experts we spoke to identified this as a challenge to the introduction of a unified link worker role within the healthcare system. We heard that it will be necessary to promote the value of social prescribing among different sectors and levels of government to garner necessary support for a link worker role.

Building block recommendations

In consideration of the above complexities and of our research and co-creation discoveries, we developed five building block recommendations for CISP. Each of these building blocks can have an impact on furthering social prescribing in Canada. Our recommendations look at ways to promote awareness of social prescribing; support social prescribing practitioners; create partnerships between healthcare and community services; influence government support and policy for social prescribing; and gather impact data. These building blocks were delivered as the third and final phase of the work.

Social prescribing building blocks

Building Blocks for Social Prescribing, as seen on our interactive microsite.

The five building blocks we developed are:

  1. Amplify the voices of social prescribing. Share social prescribing success stories from practitioners and community members using various platforms including online campaigns, podcasts or radio, print media, and in-person events. Learn how existing social prescribing initiatives are raising awareness and how to best engage participants in telling their stories. Sharing experiences publicly can raise the profile of social prescribing and promote its value to individuals, population health, and the health system.
  2. Develop training, resources, and support. Create standardized training and resources that prepare the social prescribing workforce to meet the needs of diverse populations. These initiatives must prioritize building the skills necessary for complex social prescribing work with an emphasis on equity and anti-oppression approaches to care. Setting benchmarks for training adds credibility and improves client and social prescribing practitioners’ experiences.
  3. Create a friendly policy environment. Multi-sector awareness and support for social prescribing creates a broad commitment to population health. Develop best practices for partnership-building across sectors and government ministries (e.g., housing, education, food, and agriculture). Creating coalitions across these groups can foster shared accountability and a shared agenda when advocating for policy change. Discover the gaps in awareness of social prescribing to understand which sectors need further education.
  4. Build bridges between healthcare and community service by supporting healthcare provider awareness of social prescribing and building networks to foster collaboration. Enlisting “Physician Champions” and sharing information between social initiatives and healthcare practitioners strengthens the connection between primary and acute care, and community services. Increasing healthcare practitioner awareness of social prescribing will lead to increased referrals and improve their ability to address the medical and non-medical needs of patients. Of key importance will be learning how existing social prescribing initiatives have secured partnerships with primary and acute care and developing strategies for information-sharing that adhere to privacy legislation.
  5. Measure impact by developing best practices for data collection to support consistent impact measurement. Data tracking is crucial at both the individual and implementation level. Recording patient information leads to better outcomes and tracking overall program utilization and success is necessary to demonstrate value to funders and policymakers. To develop best practices, it will be necessary to understand cross-sectoral data collection methods and to learn how current social prescribing initiatives collect and share information.

Interactive site and next steps for CISP

We are proud to share our full findings and recommendations through an interactive microsite. There you can explore our process, view our research, watch video reflections from social prescribing practitioners, and see our ideas for how the above building blocks could be implemented.

Follow CISP’s Twitter and LinkedIn, or visit socialprescribing.ca to see their journey to share, celebrate, and advance social prescribing in Canada, and to enhance population wellbeing and support the Canadian health system.

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