Trauma- & Violence-Informed & Equity Promoting Research & Knowledge Mobilization to Support London’s Whole of Community System Response to Health & Homelessness (February 16, 2024) 

 High Level Summary of Key Discussions & Next Steps

 On February 16th, 2024 CRHESI hosted an event on the importance of generating and mobilizing research and evaluation knowledge in ways informed by trauma-and violence informed care (TVIC) and equity principles. Panel discussions and small groups centered on the creation and implementation of rigourous and impactful evaluation methods, while also exploring strategic, respectful and effective approaches to knowledge sharing and use. 

This synthesis highlights the importance of building relationships, managing expectations, and effectively communicating narratives surrounding health and homelessness. It emphasizes the need for community involvement, TVIC approaches, and equitable representation in research and storytelling. Through respectful engagement, diverse perspectives, and transparent communication, efforts can be made to counter stigma, shift negative perceptions, and promote positive change in addressing health and homelessness in London. 

Trauma and Violence-Informed Care 

Trauma-informed care establishes a safe environment for service users by recognizing the effects of trauma and its close association with health and behaviour, focusing on understanding rather than eliciting or treating individual trauma. Expanding on this approach, trauma- and violence-informed care (TVIC) acknowledges the intersecting impacts of systemic and interpersonal violence, as well as structural inequities, on a person’s life. It emphasizes both historical and ongoing violence and their traumatic effects, shifting the focus to encompass a person’s experiences of past and present violence, including marginalized social circumstances. 

Embedding TVIC Principles in Producing & Sharing Evaluation Knowledge: Overarching Considerations

• Collaborate to design questions, and collect and use data efficiently, effectively and safely. 
• Evaluation questions and designs should focus on addressing structural and systemic violence and be analysed and interpreted to show the impact of these factors on individuals and groups. 
• Shift from identifying problems to understanding ongoing issues and traumatic impacts. 
• Acknowledge trauma’s complexity influenced by genetic, biological, and social factors and how it can look in research interactions – prepare all staff accordingly. 
• Recognize substance use as a continuum and address stigma as it often causes the most harm. 

What to Evaluate about London’s New Housing Support Interventions: 

(Hubs, Highly Supportive Housing, Encampment Strategy, etc.) 

• Emphasis on critical role of these supports in connecting with and meeting people where they’re at and moving them to the kind of housing they need:
  • describe and evaluate these pathways and outcomes across intervention types;
    • importance of individual and intersectional experiences, and collective action;
    • use data purposefully and transparently;
  • demonstrate (cost-)effectiveness of interventions to influence public policy and to highlight barriers.
• Examine the impact of new approaches and spaces on staff transitions, wellbeing and job satisfaction.
• Initial Hubs (youth, women, Indigenous) aim to fill most pressing needs exacerbated by the COVID-19 pandemic – include this framing in interpretation of findings.

Managing Expectations, Hopes and Fears: 

• Manage expectations about what can and might be found by maintaining communication.
• Collaboration between academia and the community to address biases in data interpretation.
• Concerns about political manipulation of data and importance of honesty in evaluation.
• Significance of telling accurate stories to reflect realities of marginalized communities.

Specific Strategies for Safe & Inclusive Participation: 

• Use existing relationships to help recruit; ensure fair payment, though people should not feel they can’t afford to decline to get money or service (i.e., recruitment arms’ length from staff but using their advice).
• Address concerns about privacy and confidentiality during recruitment; build data protection into all practices and strategies.
• Let participants tell their stories but ensure support is available during data collection, interpretation (e.g., member checking) and when data are made public (anticipatory guidance to avoid surprises).
• Train all research staff in TVIC, cultural safety & humility, and inclusive and respectful communication with all participants; emphasize (e.g., role play) strategies to build trust and comfort.

Sharing and Mobilizing Knowledge: 

• Emphasize inclusivity, respect, timeliness and collaboration in communication and engagement efforts.
• Use clear, concise and destigmatizing language and point to systems and structures that need to change (i.e., don’t use data to blame staff or service users for their individual circumstances or behaviours).
• Use data enhanced with narrative and share in multiple formats (including photos, art, poetry, videos, song, etc.) to tell the story of the work in ways accessible and safe for all involved.
• Proactively understand public concerns and expectations and develop a communications plan to prepare the public (and politicians) for various types of findings.
• Continuously evolve and iterate knowledge-sharing strategies.
• Actively create and “field test” de-stigmatizing, equity-promoting messages for the London community, particularly regarding health and homelessness, regardless of study findings.

Engaging Indigenous & Racialized People and Groups Across Activities: 

• Listen, build relationships, and support people and groups (as they’re willing) in decision-making.
• Include diverse perspectives, decolonizing approaches, and ensure benefit for those facing most harm.

Next Steps for CRHESI’s H&H Facilitators

1. Convene first 4 research/evaluation teams and outline key evaluation questions with input from Tables:
   • Experiences and Outcomes of Defined Groups
   • Experiences and Outcomes of Direct Service Workers
   • Systems, Structures, Processes, and Cost of Care
   • Overall WCR Process Review
2. Support each team in developing research/evaluation plans, ethics protocols, funding applications, etc.
3. Support London CARES and LHSC to document their outcomes in the new Dundas St. highly supportive housing site.
4. Develop templates, guides and trainings for researchers/evaluators to ensure safety, consent, privacy, confidentiality, and community engagement in research, evaluation and knowledge sharing processes.
5. Continued efforts towards inclusive and respectful communication and engagement, especially with local Indigenous partners and the new Indigenous Reference Table