Addressing stigma, mistrust, and power within integrated care work: Example of an underserved vulnerable population in a Canadian city 

Background: Integrated care is about removing barriers to effective, coordinated, and person-centred care. Often, the language used to describe barriers revolves around fragmentation, for example, siloed care delivery or communication gaps. However, even the joining-up of services will not achieve the ideal of “the right care at the right time in the right place” without addressing other barriers to accessing care. These barriers include stigma, discrimination, mistrust, and power imbalances that operate at all levels (micro to macro), and directly and indirectly (via health inequity) contribute to poor health. In our project, we focus on an underserved vulnerable population living and working in a community-based congregate setting (residential care facilities; RCFs) in a Canadian city. RCF residents often have complex and multi-layered needs, which may include mental health and/or addictions, history of homelessness or precarious living, or both. As well, the majority of staff are personal support workers who are mostly women and among the lowest paid care workers in the health care system. Issues such as stigma affect the everyday lives of residents and staff. Despite the needs of this population, historically, RCFs have not been included in health system planning. Objectives: We are working on a three-year project in collaboration with the Greater Hamilton Health Network and a ~40-member group including health, social, and housing partners. The first phase is about comprehensively gathering information on the population health needs, system gaps, and opportunities. Ultimately, we seek to co-design, implement, and evaluate a model of integrated primary care across several RCFs. In this workshop, we will share our project journey from proposal development to present-day, including findings from two sub-studies: (1) Semi-structured interviews were conducted with 20 RCF operators and 20 organizations/individuals providing support to RCF residents, (2) Ethnographic fieldwork was used to understand resident and staff perspectives from several RCFs. We will utilize our project to highlight issues related to stigma, mistrust, and power as well as facilitators such as relationship building and joint working. Audience: Through this workshop, we hope to engage with health and social care organizations/providers, policymakers, administrators, people with lived experiences (i.e., living or working in congregate care settings), caregivers, researchers, and anyone who is passionate about health equity. The 90-minute workshop will be structured as follows: 5 minutes: Introduction 15 minutes: Project overview 10 minutes: Small group discussion - What does person-centred integrated care look like from your perspective? 15 minutes: Interviews (methods & findings) 10 minutes: Small group discussion - How do the issues we share from our findings resonate with your experiences? What is similar/different? 15 minutes: Fieldwork (methods & findings) 10 minutes: Small group discussion - How do the issues we share from our findings resonate with your experiences? What is similar/different? 10 minutes: Group reflection & closing Outcome: Using this Canadian example, workshop participants will consider and understand practical tips/approaches from different perspectives on how to identify and address barriers (e.g., stigma, power imbalances) and facilitators (e.g., trust, joint working) of equitable access to integrated care.