A Cluster RCT Study Exploring Stigmatization and Recovery-Based Perspectives Regarding Mental Illness and Substance Use Problems among Community Health Centre Staff across Toronto Emily Lentinello Project Coordinator / Special Advisor Mark van der Maas Post-Doctoral Fellow, CAMH CAMH Webinar September 19, 2017
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A Cluster RCT Study Exploring Stigmatization and Recovery-Based
Perspectives Regarding Mental Illness and Substance Use Problems
among Community Health Centre Staff across Toronto
Emily Lentinello
Project Coordinator / Special Advisor
Mark van der Maas
Post-Doctoral Fellow, CAMH
CAMH Webinar September 19, 2017
+ Learning Objectives
1. To provide an overview of a three year anti-stigma
project
2. To summarize a five-pronged intervention for
reducing stigmatizing attitudes and behaviours
among Community Health Centre (CHC) staff
toward people with mental health and substance
use problems
3. To learn the results of how CHCs that received the
intervention compare with those that did not and
what the next steps should be.
+ Defining the Problem
+ Stigma & Discrimination in MH&A
• Stigma & discrimination towards MH&A is
widespread and a major public health concern
• Health professionals are no less susceptible to
stigmatizing beliefs and behaviours than members
of the general public (Schulze, 2007; Corrigan, 2004)
• Stigma and discrimination prevents clients/patients
and families to seek mental health care (WHO)
• Clients/patients often report that MH&A stigma is
more difficult to bear than the actual
illness/condition (Angermeyer, et al, 2003)
+
Why Primary Health
Care?
+ Why Focus on Health Care
Professionals?
• Primary care settings are often the first point of
contact for people with mental health and/or
substance use problems
• Primary care settings, such as community health
centres, offer a wide range of services and tend to
work with people that are most marginalized and
vulnerable
• CHCs provide services to people who do not have
OHIP or other means of payment
• Working within an interdisciplinary and non-
discriminatory framework is key to CHC mandates
and core values
+ Why Focus on Health Care
Professionals?
There is a knowledge gap
• Scarcity of studies examining mental health related stigma
in primary health care (PHC)
• Even fewer studies focus on implementing interventions
aimed at reducing stigma among health care professionals
working in PHC
+ The Pilot Project
• Funded by CAMH’s Development and
Dissemination Grant in Primary Health
Care and MHCC Opening Minds
• In collaboration with three CHCs (Unison,
Central Toronto, and South Riverdale)
• Developed a comprehensive,
organizational-level intervention based on:
a) Participatory action research
b) Feedback from a knowledge-translation
symposium
c) Development of tailored implementation plans
for each CHC
+
• Initial results were positive,
BUT • There was no comprehensive
evaluation conducted to
determine the effectiveness of
the intervention in addressing
stigmatizing attitudes and
discriminatory behaviours and
the impact on individuals with
MHSUP.
The Pilot Project
+ The Anti-Stigma Intervention
+ What is the CIHR Anti-Stigma
Intervention?
Purpose:
To determine the effectiveness of a
(RCT) comprehensive recovery-
oriented anti-stigma intervention in
reducing stigmatizing attitudes and
behaviours among PHC providers
towards individuals with MHSUP in
the Canadian context, using
Community Health Centres (CHCs)
as a point of intervention.
+ Participating CHCs Using an RCT model, three CHCs in the GTA were randomly
selected to be experimental (intervention sites).
Three CHCs in the GTA were selected to be controls.
+
Specific hypotheses:
1. Participation in experimental group will
result in a significant decrease in
stigmatizing and discriminatory attitudes
among PHC providers towards clients
with MHSUP compared to control group.
2. Participation in the experimental group
will result in a significant decrease of
clients’ experiences of MHSUP stigma
conveyed by CHC staff compared with
control group.
What is the CIHR Anti-Stigma
Intervention?
+ What is the Intervention?
Team of Champions
Innovative Contact-
Based Trainings
Raising Awareness
Analysis of Internal
Policies and Procedures
Recovery-based Arts
+ Component 1: Team of Champions
• Involves the identification and formation of
Team of Local Champions (staff at CHCs)
• Champions provide input and leadership
in the project and assist with logistical
support
+
Innovative Contact-
Based Trainings
Raising Awareness
Analysis of Internal Policies and Procedures
Recovery-based Arts
Team of Champions
+
• Half-day educational
workshops for CHC
providers designed to
increase knowledge and
share information on anti-
stigma and discrimination
for people living with
MHSUP
• Facilitated by experts in
the field, along with
consumer-survivors
Component 2:
Innovative Contact-Based Training
+ Training session data
• According to the final survey, approx.
76% of respondents attended at least one
training session and approx. 33%
attended all four.
• Staff generally reported high satisfaction
with the training sessions (4.1/5 for
overall of training 4)
• Staff tended to appreciate the clients with
lived experience the most (4.3/5)
• Staff rated that the sessions would
change their practices the lowest (3.7/5)
+
Raising Awareness
Analysis of Internal
Policies and Procedures
Recovery-based Arts
Team of Champions
Innovative Contact-Based
Trainings
+ Component 3: Raising Awareness
• Involved the use of various forms of
media to increase awareness about
stigma and discrimination as well
as to showcase recovery
• Posters were developed with the
direct guidance and participation of
CHC staff and clients
• In collaboration with the Team of
Champions from the intervention
sites, a brand and logo was
developed and used for materials
such as pens and buttons.
+
Analysis of Internal
Policies and Procedures
Recovery-based Arts
Team of Champions
Innovative Contact-
Based Trainings
Raising Awareness
+ Component 4:
Analysis of Internal Policies & Procedures
• Evaluation of CHC policies and procedures using an
anti-stigma approach to identify strengths and areas
for improvements in service delivery
• Team of Local Champions identified relevant policies
• Used a collection of validated policy assessment tools
to determine whether policies and procedures can be
improved to better serve clients living with MHSUP
• CHCs were provided with recommendations and
implemented a select number
+
Recovery-based
Arts
Team of Champions
Innovative Contact-Based
Trainings
Raising Awareness
Analysis of Internal
Policies and Procedures
+ Component 5: Recovery-based Arts
• The Team of Champions helped identify a staff
facilitator and an artist to lead the art program
• Over 10 weekly sessions, clients with MHSUP (10)
and CHC staff (3-4) participated
• CHCs showcased the art during an event they
organized. Audience members were made up of
staff, other clients, Board members, and the
community.
• This was followed by participating in a focus group
to learn more about the impact of the program and
the experience of staff and clients working
together.
+ Art Program Focus Group Overview
• Overall, participants enjoyed the program and
found the discussions and artistic creativity
engaging
• Participants used a variety of art media including
paint, encaustic wax, and clay
• Some client participants expressed concern that
staff were there as they did not realize staff
participants were part of the program. Clients
expressed feeling observed and disconnected at
times
• CHC staff that attended the art event found it
informative and appreciated seeing the art
+ Evaluation
+ Data Collection - Staff
• All CHC staff completed a survey at 4 different
time points
• Three of the four were completed online while the
first was completed with paper/pencil.
• Interviews were conducted with a random sample
of 18 staff at baseline
• Staff completed evaluations at the end of each
training session
• Staff that participated in the Art Program were
engaged in a focus group following the program
+ Quantitative Tools (Staff)
1. Opening Minds for Health Care Providers (Opening Minds, MHCC)