London Organizations Lead the Way in Trauma- and Violence-Informed, Equity-Oriented Services

This is Part 2 of our 4-part series, which explores the key dimensions of equity-oriented care (EOC) and how this can be supported by EQUIP’s Equity Action Kit. We examine how organizations in London have started taking up EOC.

In Part 1 we featured the EQUIP Pathways Project, featuring the EQUIP Equity Action Kit, and supports for better care for people facing substance stigma, which was developed with key input from the London InterCommunity Health Centre based on their expertise delivering Emergency Safer Supply.

The key dimensions of the Equity Action Kit aim to:

  • Reduce substance use stigma in health and social services
  • Promote Trauma and Violence and Informed Care
  • Ensure cultural safety and reduce racism and discrimination in health and social service settings
Key Dimensions of Equity-Oriented Care

The Equity Action Kit consists of the following resources:

  • Free e-learning modules describe equity-oriented care and guides providers during implementation at practice and policy levels
  • Planning tools, report cards and evaluation strategies
  • Resources and tools to address substance use stigma and reduce racism, especially towards Indigenous people

Stigma and discrimination make it very hard for people to seek care, particularly if they’re Indigenous, or are assumed to have a history of substance use”

Colleen Varcoe, UBC Professor Emeritus of Nursing (quote from UBC News)

Why Equity-Oriented Care

Equity Action Kit Road Map

The Equity Action Kit makes reaching for health equity simpler by laying out a roadmap of action steps based on implementation science and organizational change principles.

Steps 0 to 6 of the Road Map are iterative and adaptable to the needs and priorities of different organizations. The steps help organizational leaders and staff:

  • assess their needs and context to tailor tools and strategies accordingly
  • build momentum, assess success, and embed accountability
  • anticipate and confront barriers, resistance and pushback
  • continuously evaluate how to improve services and support equity outcomes

Are you ready to get started with the Equity Action Kit?

Step Zero in the Equity Action Kit asks you to critically assess your organization before you take action.

It is necessary to look through an equity lens to understand the point from which you are starting this journey.

Organizations can ask: What are the areas for growth? What are the problems to be solved? What does success” (broadly defined) look like?”

The Guiding Questions of Step Zero are:

  1. What are the inequities of concern in your setting? What are the barriers to, and resources for achieving greater equity?
  2. What are the motivations driving you and others toward equity?
  3. Where are you ‘at’ on each of the Key Dimensions?

To support discussions, EQUIP has created useful tools in the Rate your Organization Worksheets. These collaborative worksheets get organizations thinking about the Guiding Questions of Step Zero, with a focus on each of the 3 key dimensions of the Equity Action Kit.

Discussion tools can be found by clicking here.

Having the opportunity to contribute to the EQUIP Equity Action Kit demonstrates how equity-oriented care is an ever-evolving process. Our team is hopeful that our experience working in substance use health can help others build their skillset and feel more confident in working with this marginalized population by delivering high quality, trauma – and violence-informed care

Greg Nash, Director of Program Development and Complex Urban Health at London InterCommunity Health Centre (quote from Western Communications, 2022).

London, Ontario: Taking a Lead on Equity-Oriented Care

Several London organizations have taken up TVIC and health equity to better serve those who experience barriers to care. The work came together through the Gender, Trauma & Violence Knowledge Incubator, a collective of community leaders and academic researchers from Western with an interest in TVIC policy, practice and research.

Supported by the collective knowledge of EQUIP Pathways partners and Incubator members, the TVIC Foundations Curriculum was developed. Look for this in the soon-to be-released book Implementing Trauma- and Violence-Informed Care: A Handbook for Diverse Service Contexts (University of Toronto Press).

For more information on projects please visit the GTV Incubator click this link.

Written by Samantha Campanella, Hooria Haider, and Christine Garinger

This series was developed by Samantha Campanella and Hooria Haider, Western University, Health Sciences Students, Community Engaged Learning placement with CRHESI.

NEXT in the Series – Equity in Action: London InterCommunity Health Centre

EQUIPping London’s Health and Social Services for Equity

This 4-part series explores substance use stigma and the ways that health and social service providers can improve care. The series includes:

  • Substance Use Stigma and Discrimination & the EQUIP Pathways Project
  • Finding Pathways to Substance Use Health:  The EQUIP Equity Action Kit
  • Equity in Action: London InterCommunity Health Centre
  • Equity in Action: More local EQUIP implementation

Congratulation to the team behind EQUIP Pathways who recently launched the Equity Action Kit to support service providers!

The Harms of Stigma and Discrimination associated with Substance Use

Substance use is common. It is a complex health issue and has different impacts on people across a continuum of substance use. Substance use health recognizes that substance use ranges from no use at all, to beneficial and low risk use, to problematic and medically diagnosable substance use disorder.

Related to their substance use, people are viewed differently depending on intersecting factors such as socioeconomic status, race/ethnicity, and gender, and are stigmatized in different ways, often causing harm.

As well, specific substances are more susceptible to stigmatizing attitudes than others. Some substance use is criminalized (street opioids), while some is not (alcohol and most recently cannabis), which adds complexity to people’s lives.

Harms in the form of stigmatizing and discriminatory actions can be serious. People are disrespected, judged, have their challenges and problems dismissed, assumed to be drug-seeking. People are often denied health care or services because they are not deemed deserving of care.

The criminalization of specific drugs, such as opioids, leads to people using illegal drug supplies where what or how much is in the drug is unknown, resulting in a toxic drug overdose crisis that kills, on average, 21 people per day in Canada1.

EQUIP Health Care is a research and implementation program to enhance organizational capacity to provide equity-oriented care, providing pathways to better care, especially for people facing barriers to care.

The EQUIP model encourages people to ask

 “What’s happened, and is still happening, to this person and how can I help?”

EQUIP Pathways Project

The main goal of the EQUIP Pathways project, funded by the Public Health Agency of Canada, is to improve care by reducing the substance use stigma and discrimination that people face in health care settings.

The London InterCommunity Health Centre (LIHC) was a key partner. LIHC has deep knowledge, skill and competence in health equity and substance use health.

The Pathways team created evidence-based resources to support equity-promoting care specific to people who use substances.

“We partnered with health and social service providers and people with lived experience to develop guidance, strategies and resources to improve pathways to care for people who experience substance use stigma and related types of discrimination. A key goal is to help organizations, staff and providers to deliver care that is non-judgmental, and that will encourage people to seek help when they need it – not avoid seeking help”  

-Project co-lead Annette Browne, professor of nursing at University of British Columbia (quote from Western News)

The Equity Action Kit guides organizations to implement equity-oriented care and evaluate equity and change.

“The Action Kit encourages practitioners and organizational leaders to engage people with experiences of stigma and poor care in a way that ensures their voices are heard and prioritized”

Nadine Wathen, professor, Arthur Labatt Family School of Nursing at Western University and CRHESI Academic Director (quote from Western News)

Check out media coverage:

Written by Samantha Campanella & Christine Garinger

This series was developed by Samantha Campanella and Hooria Haider, Western University, Health Sciences Students, Community Engaged Learning placement with CRHESI

[1] Government of Canada (2022). Opioid and Stimulant related Harms in Canada

NEXT in the Series – Finding Pathways: The Equity Action Kit