Rachelle Ashcroft and co-authors publish “5 principles for action on primary health-care teams”

Associate Professor Rachelle Ashcroft co-authored a piece for The Conversation that outlines “5 principles for action on primary health-care teams.” Her co-authors include Jennifer Lake from U of T’s Leslie Dan Faculty of Pharmacy, Catherine Donnelly and Jordan Miller from Queen’s University’s School of Rehabilitation Therapy, and Clare Cruickshank, Patient Advisor, Ontario Health INSPIRE-PHC, Patient Expertise in Research Collaboration.

As the number of Canadians without a primary health-care provider grows, social workers, pharmacists, physicians, nurses and other health care professionals have come together to advocate for the development of primary health-care teams, which include professionals from different disciplines collaborating to provide patients with more comprehensive care. A team-based approach can also reduce the administrative burden on family doctors and others.

From the article in The Conversation:

Primary care is in crisis. Recent estimates indicate 6.5 million Canadians, including 2.5 million Ontarians, do not have a primary care provider.

Interprofessional primary care teams include a range of health professionals in addition to a family doctor or nurse practitioner, and are a key solution to improve access to primary care.

As of Dec. 1, 2024 family physician and former federal cabinet minister Jane Philpott is leading Ontario’s new Primary Care Action Team. Philpott states, “Our goal will be for 100 percent of Ontarians to be attached to a family doctor or nurse practitioner working in a publicly funded team, where they receive ongoing, comprehensive care.”

Her book Health for All articulates a vision of primary care, or what is being described as a “health home,” which would guarantee every person access to a primary care team close to where they live. The Primary Care Action Team has announced its plans to achieve this goal within five years.

A health home is the front door to the health system and includes a team of primary care providers that supports an individual’s health and wellness; co-ordinating care across the system and through every stage of their lives. Each health home would ensure you could receive primary care services based on where you live; ensuring that if you move to a new city you would have access to your local health home, just as you would have access to your local school.

Principles are needed to achieve these goals. These principles should build on successes and address historical challenges. Our team, comprised of primary care researchers and a community partner, has focused our work on understanding how primary care teams can support access and better outcomes.

Collectively we propose the following five principles for the Primary Care Action Team to consider, which emerged from our panel discussion at the 2024 Trillium Primary Care Research Day on Oct. 25, 2024.

Read the full article in The Conversation.

In addition to her role as Assistant Professor at the Factor-Inwentash Faculty of Social Work, Rachelle Ashcroft is chair of U of T’s InterFaculty Curriculum Committee, which is responsible for the University of Toronto’s Interprofessional Education (IPE) Curriculum, in partnership with the Toronto Academic Health Science Network, inclusive of 14 hospitals and 12 health and social care professional training programs.

Keith Adamson and Rachelle Ashcroft

Ashcroft is also involved in a Canada-wide strategy to accelerate transformative change in the way that primary health-care practitioners work together. In 2024, she and FIFSW Associate Professor Keith Adamson, in partnership with the Canadian Association of Social Workers (CASW), assembled a group of social work leaders to develop a national vision for social work in primary care. Together, they are not only charting a path for social work’s role in primary care, but also ensuring that the valuable skills and expertise that accredited social workers offer are recognized as integral to the system.

In September 2024, CASW published the report “Social Work and Primary Care: A Vision for the Path Forward.” Click here to read the full landmark report on social work and primary care.

Ashcroft, Adamson and colleagues have also launched a free, six-module e-learning program for social workers in primary care, and social work learners considering a future practice in primary care. The programs may also be used by health professionals and trainees from other disciplines to learn more about social workers’ roles in primary care.

Access the e-learning Social Work in Primary Care modules here!

New study by Carmen Logie and Andie MacNeil shows how climate change is linked with worse HIV prevention and care

New challenges in HIV prevention and care are emerging due to climate change, according to a review published earlier this month in Current Opinions in Infectious Disease.

Researchers from the University of Toronto analyzed 22 recent studies exploring HIV-related outcomes in the context of climate change and identified several links between extreme weather events and HIV prevention and care.

Climate change-related extreme weather events, such as drought and flooding, were associated with poorer HIV prevention outcomes, including reduced HIV testing. Extreme weather events were also linked to increased practices that elevate HIV risk, such as transactional sex and condomless sex, as well as increases in new HIV infection.

“Climate change impacts HIV prevention through several mechanistic pathways,” says lead author Carmen Logie, Professor at the Factor-Inwentash Faculty of Social Work (FIFSW) at the University of Toronto and the United Nations University Institute for Water, Environment, and Health. “Extreme weather events cause structural damage to health care infrastructure and increase migration and displacement, both of which disrupt access to HIV clinics for prevention and testing. We also see increases in practices that increase HIV risk due to climate change-related resource scarcity.”

The study also uncovered important implications for HIV care among those already living with HIV, such as reduced viral suppression, poorer treatment adherence, and worse physical and mental wellbeing.

“Extreme weather events present new challenges with access to HIV care and treatment adherence,” says co-author Andie MacNeil, PhD student at FIFSW. “Multilevel strategies are needed to mitigate the effects of climate change on HIV care, such as long-lasting antiretroviral therapy, increased medication dispensing supplies, and community-based medication delivery and outreach programs.”

The authors highlighted several important gaps in the existing literature, including the lack of research on specific extreme weather events (e.g., extreme heat, wildfires, hurricanes) and in geographic areas with high climate change vulnerability and increasing HIV rates (e.g., the Middle East and Northern Africa).

They also described a persisting lack of knowledge on extreme weather events and HIV among key marginalized populations, including sex workers, people who use drugs, and gender diverse persons, as well as how extreme weather events interact with intersecting forms of stigma.

The researchers are hopeful that these findings can help offer ways forward for research, policy, and practice.

“Innovative HIV interventions, such as long-acting PrEP, mobile pharmacies and health clinics, and interventions that reduce food and water insecurity may all contribute to improving HIV care during extreme weather events. More research and evaluation is needed to test climate-change informed HIV prevention and intervention strategies,” says Logie. “The integration of disaster preparedness and HIV care provides new opportunities to optimize HIV care in our changing climate.”

Source Article

Logie, C. & MacNeil, A. (2024). Climate change and extreme weather events and linkages with HIV outcomes: Recent advances and ways forward. Current Opinion in Infectious Disease. Advance online publication.

Media Contact:

Professor Carmen Logie, MSW, PhD
carmen.logie@utoronto.ca

How diverse perspectives and lived experiences strengthen our understanding of the policies and systems that affect health and mental health

How do policies, culture, historical legacies, and systems of care impact our health and mental health?  

The course SWK 4412H: The Context of Mental Health and Health Practice provides the opportunity for students to answer this question, drawing on readings, recent media, guest lectures, and invigorating class discussions. Throughout the course, students strengthen their capacity to identify and address how broader systems embedded within our institutions and communities affect one’s health and mental health – an essential skill that social workers bring to both their clients and the healthcare teams they work with. 

A report created by one of the classes in this multi-section course for students in the Mental Health and Health field of study highlights the collective wisdom and knowledge that the students both contributed to and gained from the course. Facilitated by Sessional Lecturer Sandy Rao, the online publication summarizes the diverse perspectives and reflections that the students shared in logs completed at the close of each class.  

“The report not only summarizes what the students learned in class, it also demonstrates their ability to learn from each other’s diverse perspectives and lived experience,” says Rao. “Students in the class gained a better understanding of their capacity to enact change. We explored how little steps over time can create something impactful.” 

Presented in an online flipbook, the report is now available to readers interested in learning about and reflecting on social work in the context of mental health and health practice. It can also be used to further dialogue, discussion and advocacy. 

As outlined in the first pages of the publication, the report is “a testament to the philosophy of ‘all teach, and all learn’.”  

“In this classroom, every voice contributed to the collective knowledge,” wrote the authors. “Learners did not simply absorb information – they analyzed it, critiqued it, and reshaped it through the lenses of their identities and experiences. Each reflection demonstrated the power of mutual learning: insights are shared and deepened through dialogue and interaction.” 

Topics covered include the role of policy in social work, Indigenous perspectives and decolonization, trauma-informed and culturally sensitive practices, social determinants of health and housing, relationship building and allyship, equity in access to healthcare, neoliberalism and social work values, and the role of public opinion in policy. 

“By documenting weekly reflections, learners collectively build a portfolio of insights, emphasizing the actionable wisdom inherent in the classroom, even amidst the maelstrom of local, provincial, national and global crises,” says Rao. “Together we learn that there are opportunities to act meaningfully, however small.” 

Read the students’ online Reflection Report here. 

Related news on students, recent graduates and programs:

• Job posting: Assistant Professor or Professor and Lee Wu Kee Ming Chair in Indigenous Social Work
• The power of cultural connections: ITR student Folashade Kortee is now helping Indigenous students at U of T strengthen their wellbeing and sense of belonging
• New report on unregulated homestays in Canada uncovers adverse living conditions for international students from Kindergarten to Grade 12
• Meet spring 2024 graduate and Student Leadership Award winner Vithusan Arunakirinathan

Celebrating the holidays at FIFSW: View photos from our Winter solstice party

FIFSW students, faculty and staff gathered in the student lounge on December 3rd to celebrate the upcoming Winter Solstice with food and drinks. It was wonderful to be able to come together as the sun set in the afternoon to brighten to the day with colleagues and friends.

A reminder that the University of Toronto’s holiday break runs from December 24th to January 3rd. We hope that our students, staff and faculty have a joyous and restful holiday!

Below are some photos from the Winter Solstice event!

Photos by Jim Moore

Q & A: Meet Tin Vo, Assistant Professor, CLTA

Dr. Tin Vo’s longstanding interest in social justice and the social determinants of health first led them to a career in public health, where they focused on program planning, evaluation, and research. But they reached a point where they wanted to tackle the social determinants of health in a more direct, hands-on way. This led Vo to complete a PhD in social work at Wilfrid Laurier University. We asked Vo about the evolution of their career prior to joining U of T’s Factor-Inwentash Faculty of Social Work this summer, their past and current research, and what most excites them about teaching.  

Your undergraduate degree was in molecular biology and genetics. What were your early career aspirations?

Well, I wanted to help cure HIV. Just a small ambition! I worked my way through four years of lab bench research, and at the end of my degree realized that I enjoyed working with humans much more than with bacteria and proteins.

What made you choose public health next?

I debated between a master’s in public health and a master’s in social work. I wanted to address the social determinants of health through community development and social justice work, and I thought health might be the better route because my education so far had focused on human health.

Can you describe your career as a public health practitioner?

My master’s in public health focused on a social justice approach to health promotion, and through my studies I fell in love with program evaluation. After graduation, I went into the field designing and evaluating public health programs across the spectrum of public health, from infectious diseases and chronic disease prevention to substance use and mental health. It was fun and interesting, but after about five years I didn’t feel as challenged as I wanted to be.

What led you to a PhD in social work?

At the time, I was working closely with social service agencies and mental health providers, and I noticed that social workers were implementing concrete, tangible strategies to address the social determinants of health. I thought, “What if I merge social work and public health going forward?”

What was the focus of your PhD?

I chose a subject that related to my lived experience. I was interested in how homophobia, transphobia, racism, and other systems of oppression impact people’s wellbeing, so I looked at how discrimination in 2SLGBTQ+ leisure spaces affects individuals’ mental health and sense of belonging. These spaces – like queer sports leagues, social groups, clubs and bars, and virtual platforms – are often assumed to be inclusive. But they’re not always, and people can experience discrimination based on their gender identities, race and/or disabilities. I conducted a bi-national survey across Canada and the US of more than 500 people around their experiences of discrimination in these spaces, their mental health, and their social wellbeing. I also interviewed a little more than 20 participants to dive deeper into their experiences.

What were your main findings?

The research participants fell into three mains groups based on how they experienced the queer spaces: as welcoming, hostile, or somewhere in between these two. Not surprisingly, the people who felt welcomed had more positive mental health, and negative mental health for those who described the spaces as hostile. Individuals with disabilities tended to experience the most discrimination – often revolving around inaccessible queer spaces.

Why are queer leisure spaces important?

Queer and trans spaces are vital to the wellbeing of queer and trans folks, as it’s very unsafe for queer and trans folks in general society today with the harmful, discriminatory public policies alongside violent interpersonal incidents. They need places to escape, where they can find community and the social support that’s going to be helpful when they inevitably face challenging experiences.

How do you plan to build on this research at FIFSW?

I’m in the early stages of building my research program. I’m interested in continuing to explore how we create inclusive queer and trans spaces of care in community and postsecondary settings. I’m also building on my postdoctoral research, which focused on the sexual health of queer and trans men in Canada and Australia. I am also working with community partners to develop a project that explores how intergenerational engagement between queer and trans youth and older adults shapes identity formation, loneliness, and belonging in northern Ontario.

What made you take this full-time role at FIFSW after all your years of practice?

This position is focused on community-based social work research and practice, something that’s been important to me throughout my career. In program evaluation, I always prioritized program users’ perspectives. I do the same thing in my research – involving the people that are directly affected by the research at every stage. Also, I fell in love with teaching during my doctoral studies. I started my PhD thinking that I’d go back into public health practice, but it really excited me to see the light bulb moments happen in the classroom. It brought me a lot of joy.

What do you enjoy most about teaching?

Most of my teaching will be about program evaluation and research methods. I’m a research nerd, and I love getting learners to think about how to work with communities in research and how to choose and use the best methods to answer their questions. To make the learning meaningful, I attempt to integrate more practical, case-based learning to allow learners to build useful research skills that they can apply in their future career. A lot of students enter social work with the mindset of being a clinician, and so research may not be top of mind. I hope that I can help them see, by the end of their degree, how valuable research is, especially as we think about evidence-informed practice. Even if they choose not to engage in research activities, I want them to understand where it comes from, and how to use it.

Q&A by Megan Easton; Photo by Jim Moore

Q&A: Meet Amar Ghelani, Assistant Professor, Teaching Stream

Dr. Amar Ghelani worked in shelters, addiction programs, mobile crisis intervention, prisons and various mental health settings for nearly two decades before joining U of T’s Factor-Inwentash Faculty of Social Work this year as an assistant professor in the teaching stream. In many ways, it’s been a smooth transition because Ghelani sees social workers as natural educators. He completed his PhD at the Wilfred Laurier University Faculty of Social Work, where his research examined cannabis use in youth who have experienced psychosis. We asked Ghelani about his time on the frontlines, his current research and how he’ll ground his teaching in his rich field experience.

What led you to social work?

I was always interested in social issues and mental health, and I was looking for an opportunity to help people, learn from people, and contribute to social justice movements. But there was one interaction I had on the street with a couple experiencing homelessness and addiction when I was a teenager that really opened my eyes to the kinds of problems people face. I didn’t really know what social work was then, but I knew I wanted to work with unhoused populations, wherever that took me.

So where did this interest take you, after you earned your undergraduate degree in social work?

I started at a shelter in Ottawa working the overnight shift and on the street outreach team, then moved to an addictions treatment centre for homeless men. Then I decided to do my MSW at UBC, where I focused on trauma and addictions and did a placement in Vancouver’s Downtown Eastside with Indigenous populations. Later, I was a youth and family counsellor in a community service, did mental health crisis intervention with Peel Regional Police, worked in an early psychosis intervention program, was a DBT therapist, and spent four years as a prison social worker with the Centre for Addiction and Mental Health. I also spent a few years here at U of T’s Health and Counselling Centre as the mental health care coordinator. My last position was in forensic assessment at the Centre for Addiction and Mental Health.

These all sound like challenging frontline roles. What kept you going, and how did you avoid burnout?

I’ve always really enjoyed all the jobs that I’ve done, including working with complex populations. In most of my jobs, it hasn’t even felt like work. I think it helps a lot if you’re open to continuous learning and consulting with people who’ve been doing the role for a while. Also, I just like hearing people’s stories and being helpful to them. It energizes me. Seeing people overcome addiction or trauma and grow really drives me. 

What prompted you to do your PhD? 

It was the legalization of cannabis, actually. I’d worked with cannabis users for my whole career, and it was the most complicated drug to me in some ways. Often, people don’t see it as a problem, but it does contribute to certain issues and plays an important role — sometimes positive, and sometimes not so positive — in people’s lives. I worked with youth who’d had a psychotic episode, and I wanted to understand cannabis use in this population from the users’ perspectives.

What made you take this full-time role at FIFSW after all your years of practice?

Well, this is my dream job. It’s in the teaching stream and I’ve always loved teaching. Social work, to me, is teaching. So I’ve always been kind of a teacher, especially early in my career at the homeless shelter, where I was leading addictions groups. I’ve also facilitated anger management groups for youth involved in the criminal justice system. I really learned how to keep people’s attention and make learning practical for people struggling with life problems. Apart from my teaching skills, I feel like after more than 18 years of practice I have some useful insights for social work students.

What are some of those insights?

A widespread mental health crisis is happening right now, and social workers are vital to supporting individuals and families through that crisis. Social work students need to develop practical skills, including applying evidence-based interventions and measuring their effectiveness. That’s one of the things that I really want to get across to students: we have to set goals and know how to evaluate progress so that, when clients reach out for help, social workers know that they’re being effective and competent.

You’re in the teaching stream, but you’ll also be conducting some research. What are your current projects?

Something I’ve noticed throughout my career is that one of the most challenging things that social workers do is help people who have signs of psychosis or active psychotic symptoms. There isn’t much education and not a lot of opportunities to practice social work skills with people who are acutely psychotic. This faculty has a lot of excellent simulation opportunities for developing clinical skills, but not for psychosis. So part of my research right now is doing a scoping review to understand how other health fields have incorporated psychosis-focused simulations, and how social work can adopt them. I’m also working on a grant proposal to develop materials to train actors to portray people with psychosis using the advice and guidance of people with lived experience of psychosis.

What are you teaching this year? 

I’m teaching Elements and Lab, which focuses on foundational practice skills, mental health and social work, advanced mental health practice, and crisis intervention. I have pretty varied experience in all these areas, and I’m really looking forward to sharing it.

Q&A by Megan Easton; Photo by Jim Moore

Recent publications by Amar Ghelani

Ghelani, A. (2023), Perspectives on cannabis risks and harm reduction among youth in Early Psychosis Intervention programs: a qualitative study, Mental Health and Social Inclusion,  Vol. ahead-of-print No. ahead-of-print. https://doi.org/10.1108/MHSI-06-2023-0064

Ghelani, A. (2023) Perspectives toward cannabidiol (CBD) among youth in Early Psychosis Intervention programs: A qualitative study. Early Intervention in Psychiatry, 18 (1), 10-17

Ghelani, A. (2022) Knowledge and Skills for Social Workers on Mobile Crisis Intervention Teams. Clinical Social Work Journal, 50, 414–425 . https://doi.org/10.1007/s10615-021-00823-x

Ghelani, A., Douglin, M., & Diebold, A. (2022). Effectiveness of Canadian police and mental health co-response crisis teams: A scoping review. Social Work in Mental Health, 21(1), 86–100. https://doi.org/10.1080/15332985.2022.2074283

Improved services and supports are needed to help youth transition out of foster care, say co-directors of the Fraser Mustard Institute for Human Development Policy Bench

Ashley Vandermorris (left) and Barbara Fallon are Co-Directors of the Fraser Mustard Institute for Human Development Policy Bench.

On October 28, Co-Directors of the Fraser Mustard Institute for Human Development Policy Bench, Barbara Fallon and Ashley Vandermorris, testified to the Senate Committee on Human Rights on the topic of youth aging out of foster care.

A professor at the Factor-Inwentash Faculty of Social Work, Fallon holds the Canada Research Chair in Child Welfare and has spent the past 25 years researching the needs and trajectories of children and families in the child welfare system. Vandermorris is a staff paediatrician in the Division of Adolescent Medicine at The Hospital for Sick Children (SickKids), where her work focuses on youth confronting intersecting structural vulnerabilities. She also serves on the board of directors of the Canadian Coalition for the Rights of Children.

“Children in foster care do have an equal right to access the supports they need to thrive and succeed,” said Professor Fallon in her opening statement. “This is even more important during the critical period in which they transition into adulthood.”

Fallon and Vandermorris’ testimony drew on a 2020 Policy Bench report on children aging out of care [PDF]. Commissioned by the Ontario Ministry of Children, Community and Social Services, the report included a literature review with a focus on policies and programs that might improve outcomes for children and youth in foster care.

Canada does not have a national standard or guidelines for youth leaving care, stated Fallon and Vandermorris in their joint testimony. Moreover, there has been little research on culturally informed, evidence-based interventions to support them. As a result, Canadian youth transitioning out of foster care are at risk as they continue to confront challenges and hardships on the road to full independence.

“Access to supports and services for youth leaving care is based on legislated age cut-offs regardless of the individual’s developmental readiness and financial or emotional ability to make the transition to independence,” said Vandermorris. “A more flexible approach to aging out that is not based on specific age cut-offs would be more developmentally appropriate.”

The Policy Bench co-directors argued that early evidence shows that extending support to youth until they are actually developmentally ready to live independently may result in better outcomes — not just for the youth themselves, but for society as a whole.

“Improved services and supports are needed to help youth successfully navigate this process, promoting more positive trajectories into adulthood,” Fallon said.

A joint initiative between the Factor-Inwentash Faculty of Social Work at the University of Toronto and SickKids and housed in the Edwin S.H. Leong Centre for Healthy Children, the Fraser Mustard Institute for Human Development Policy Bench brings together leaders with transdisciplinary expertise to support optimal human development and health equity across the life course. Its work strives to ensure that policies relevant to child development are based on the latest evidence across a multitude of disciplines – including health, psychology, social work, education, economics, and medical sciences.

• Learn more about the Policy Bench.
• View a video of Barbara Fallon and Ashley Vandermorris’ testimony to the Senate Committee on Human Rights and the official minutes from the meeting.
• Read the Policy Bench report on Children Aging Out of Care.

Amanda Grenier aims to spark action to address rising homelessness among older people

To improve services and meet community needs, policy makers and other professionals need a clearly defined and comprehensive understanding of what late life homelessness entails

Homelessness among people over the age of 50 is on the rise, a phenomenon formal housing strategies often overlook — but researchers from the University of Toronto and McGill hope to prevent this oversight in the future.

A new study published in The Gerontologist now provides a clear definition of late life homelessness informed by the lives and experiences of older adults. Drawing on interviews with older people who are unhoused and community workers in Montreal, Canada, the researchers aim to spark action and changes in policy and practice.

“We became interested in late life homelessness in 2011 when local service organizations told us that they were witnessing increasing numbers of older people in shelters and that they felt ill prepared to address their complex needs,” says Amanda Grenier, a social work professor at the University of Toronto’s Factor-Inwentash Faculty of Social Work and researcher at Baycrest Hospital (pictured, left). “We soon realized that the experiences of older people were absent from Canadian housing initiatives.”

The researchers’ definition of late-life homelessness points to a host of interconnected systemic issues that restrict access to support and contribute to increased inequalities, exclusion, and unmet needs. For example, the configurations of service for seniors are organized based on age, but people who are unhoused may experience reduced mobility or health concerns in their 50s. At the same time, community services without age criteria can overlook needs that are typically associated with aging.

The accumulation of disadvantage over time is another factor that defines late-life homelessness. Intersecting forms of oppression are well documented in research on homelessness among younger people, but often overlooked when it comes to older demographics. The researchers point to policy strategies that focus on physical health but ignore the cumulative impact of disadvantages experienced by an individual over time — due to racism, colonialism or sexism, for example — making the ability to bounce back from income, housing, or care setbacks a bigger challenge.

Space and place or the built form of our buildings and cities is a third component of what makes late-life homelessness unique. Older people without a residential address face challenges accessing community-based homecare programs. Additionally, programs for those who are homeless often take place in inaccessible settings. Changing mobility needs can impact the physical endurance needed to travel to shelters and safely navigate between spaces of support, leaving older people to age in places that most would consider ‘undesirable’.

The final characteristic of late-life homelessness includes patterns of non-response or inaction on the part of programs and policy that leave older people with histories of homelessness to suffer unmet needs. This includes examples of health and social systems that require clients to have an address and the practice of shuffling older people who are homeless between different programs because those programs aren’t able to address their intersecting needs.

Grenier and her co-author, Tamara Sussman from McGill University’s School of Social Work, argue that to effectively address late-life homelessness, policy makers and other professionals need a clearly defined and comprehensive understanding of what late life homelessness entails. To this end, they propose the following definition based on research with older people and in community settings:

Late life homelessness is an experience of unequal aging produced through age-based structures and social relations that restrict access to supports, reflect disadvantages over time, is lived in places that are not conducive to aging well and result in exclusion, non-recognition and unmet need.

“While attention to late life homelessness is starting to increase, older people still often remain overlooked in official  strategies and policy response,” says Grenier. “Recognition and inclusion will require continued vigilance.”

Amanda Grenier is the author of the book Late-Life Homelessness: Experiences of Disadvantage and Unequal Aging. 

Study reference:

Grenier, A., and Sussman, T., Late life homelessness: A definition to spark action and change, The Gerontologist, 2024;, gnae123, [Open Access First View] https://doi.org/10.1093/geront/gnae123

Related:

• New book co-edited by Amanda Grenier offers a thought-provoking overview of precarity and ageing
• Can AI be ageist? Professor Amanda Grenier is part of a research team now working to find out

The power of cultural connections

Inspired by her own experience, Fall 2024 graduate Folashade Kortee is now helping Indigenous students at U of T strengthen their wellbeing and sense of belonging by connecting with their culture

Associate Professor Jane Middelton-Moz and Folashade Kortee

When Folashade Kortee discovered just how much her wellbeing increased when she connected to her roots and culture, she became passionate about giving other young people the same opportunity. The Master of Social Work – Indigenous Trauma and Resiliency (MSW-ITR) program gave her the skills and knowledge she needed, and today the new graduate is doing exactly what she set out to do.

Kortee recently started in her role as the Indigenous Wellness Counsellor and Coordinator at the University of Toronto, a job that draws on both her lived experience as a person with Métis-Cree and Nigerian heritage and the expertise she gained as an ITR student at U of T’s Factor-Inwentash Faculty of Social Work. “I’m so excited to be supporting Indigenous students with culturally relevant wellness programming,” she says.

Not long ago, Kortee believed that she was destined for a career in traditional healthcare. As a teen, she worked as a lifeguard and swim instructor and was interested in all things related to physical wellness. Then she gained a whole new perspective from a course on the social determinants of health during her undergraduate health sciences degree.

“It got me thinking about how so many people in my community are affected by how easy or hard it is to access education, healthy food, social services and culture,” says Kortee. At the same time, she was becoming more curious about her own identity. “Growing up, I sometimes found it hard to embrace my culture, even though I was interested,” says Kortee. “Often I’d be the only Indigenous and Black person in the room at school or work, so I focused a lot on fitting in.”

In 2018, Kortee’s sister invited her to join a hand drumming group with other young Indigenous women. “I felt at ease and was able to find my voice,” she says. “It affected every part of my life in a positive way.”

As she continued to explore her culture and find strength in community, one of Kortee’s mentors told her about the MSW-ITR program, which prepares graduates to help individuals, families and communities affected by historical and intergenerational trauma in culturally relevant ways. Wisdom from global Indigenous peoples and the latest scientific knowledge inform the program’s approach.

“I immediately felt that it was what I’d been looking for, since I had a background in health sciences and was getting more and more interested in Indigenous healing practices,” says Kortee, who received support from the Fu Hui Education Foundation for her MSW studies.

During the two-year program, she completed two field placements working alongside Indigenous social workers delivering mental health care to Indigenous clients at the Centre for Addiction and Mental Health and Weaving Wellness Centre. ITR students come from across Canada and beyond and can complete their placements in their home communities. There are five week-long intensive sessions where students gather in person to learn together and participate in ceremonies, community building, and deep reflective learning, but the rest of the program is online.

“I had amazing placements where I learned so much, and I formed a lot of strong bonds with my classmates,” says Kortee. “An important part of the ITR program is looking at our own wellbeing and the impact of trauma, and creating a support network around each other.”

Now she’s providing support to Indigenous students at U of T as a registered social worker collaborating with a multidisciplinary health team and U of T’s First Nations House. “I’m bridging Western and traditional healing methods, just as the ITR program does,” she says.

Working in partnership with advisors and the elder-in-residence at First Nations House is a crucial part of Kortee’s role. “Getting in touch with their culture can be so integral to Indigenous students’ health and wellbeing,” she says. “It helps them recognize and use the coping skills that were always in them.”

Outside of her job, Kortee runs wellness programs for Black and Indigenous youth in the Toronto community. “Sometimes I think about how much it would have changed my life to have accessed my culture at an earlier age,” she says. “It motivates me to keep doing what I’m doing.”

Shortly before convocation, Kortee ran into Jane Middelton-Moz, a co-founder and professor in the MSW-ITR program. “I thanked her and told her how much it changed my life, giving me the confidence to take on the kinds of roles where I’m empowering other Indigenous students to improve their wellness and sense of belonging.”

Kortee says she was initially hesitant to apply to the ITR program, so she wants to encourage prospective students to take the leap. “I had imposter syndrome, thinking that U of T was so prestigious. But I know now that we need more people like me in these spaces. I hope people trust in themselves and realize they have nothing to lose and everything to gain in applying.”

By Megan Easton

The first of its kind in North America, the Factor-Inwentash Faculty’s Master of Social Work program in Indigenous Trauma and Resiliency is dedicated to preparing advanced social work professionals to work with individuals, families and communities who have been affected by historical and generational trauma. FIFSW is deeply grateful to the Fu Hui Education Foundation for its generous support to help sustain this important program and its students.

Admissions are now open for the Master of Social Work – Indigenous Trauma and Resiliency program. Learn more about the MSW-ITR field of study and how to apply.

Stigma has a profound impact on health outcomes and must be addressed, says Carmen Logie 

Investing in stigma reduction in health care systems will yield results across the care continuum, and should be supported by governments, health-care institution polices, and licensing bodies, say researchers 

A new article published in Nature Reviews Disease Primers underscores the profound role that stigma can play in health care — and how addressing stigma-related barriers can significantly improve health outcomes for individuals and communities around the world. 

“Stigma has harmful effects on health, equity and justice,” says lead author Carmen Logie, a professor at the University of Toronto’s Factor-Inwentash Faculty of Social Work (FIFSW). “And while we need more rigorous evaluation of interventions to reduce health-care stigma, we certainly know enough to begin to confront it.”  

Logie and her co-author Laura Nyblade, a fellow at the Social, Statistical and Environmental Sciences, Research Triangle Institute in Washington DC, argue that health-care providers need to be able to identify what drives stigma in health-care settings, so they can take action to address stigmatizing practices as well as internalized, anticipated or perceived stigmatization on behalf of those in need of care. 

Stigma can play a huge role in health outcomes, say the researchers. For example, health-care providers who view weight as a moral issue or lack of personal willpower, may use stigmatizing language in conversation with patients, contributing to their disengagement from care. People who use drugs may be deemed “junkies”, blamed for their substance use and denied services. In some regions, gender-based stigma has resulted in coerced sterilization and lack of informed choices around contraception and education for women living with HIV.  

The good news, say Logie and Nyblade, is that health-care settings are well positioned to identify what drives stigma and make changes to address it through evidence-based approaches. To start, health-care providers can examine misconceptions about disease transmission and infection control, and then make needed changes to institutional policies and practices. “Increasing health providers’ awareness of how stigma is appearing in the ways they deliver services is key,” says Logie, who is also Canada Research Chair in Global Health Equity and Social Justice with Marginalized Populations. 

In Ghana, for example, staff training and activities to reduce fear of HIV infection was shown to improve the caregivers’ willingness to provide services to people with HIV. In Tanzania, stigmatizing beliefs held by HIV clinic staff around substance use was reduced through interventions that addressed commonly held misconceptions. The interventions also successfully conveyed the impact that stigmatizing language used by health-care providers can have on their patients. 

The researchers argue that relationship building and partnerships between health care providers and communities can enhance the ability of both professionals and their clients to strengthen social cohesion, collective resilience and coping strategies. Social movements and dates of significance, such as weight inclusivity movements and World AIDS Day, are examples of ways that people have come together to advocate for awareness and promote change.  

“These approaches move beyond the focus on stigma victimization to recognize and celebrate the strengths of communities who have been marginalized, as well as social histories of mutual support and stigma resistance,” says Nyblade.  

Investing in stigma reduction in health care systems will yield results across the care continuum, and should be supported by governments, health-care institution polices, and licensing bodies, conclude the authors. 

“All types and levels of health-care providers need to be engaged in stigma reduction, through the training curriculums, continuing education programs, and more” says Logie. “The time to act is now.” 

In addition to her role at FIFSW, Logie is affiliated with the United Nations University Institute for Water, Environment and Health, and the Women’s College Research Insitute at Women’s College Hospital in Toronto. 

Related:

• Carmen Logie and her research team receive a 2024 Impact Award at the International AIDS Conference
• Now on YouTube: Carmen Logie highlights the connection between climate change and sexual health
• New song and music video launched on World AIDS Day highlights the importance of centering places of joy and reducing stigma for communities impacted by HIV
• Carmen Logie receives a CAHR-CANFAR Excellence in Research Award from the Canadian Association for HIV Research