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Category Archive: Medicare at 50: Our Healthy Future and the Role of CHCs

Social Work Students: If You Like Variety, a CHC Might be Right for You

A Medicare@50 blog post by
Marc Laferriere (Social Worker) – Follow @MarcLaferriere
Grand River Community Health Centre (Brantford, ON)

Bethany Deml (MSW candidate and Placement Student) 
Grand River Community Health Centre (Brantford, ON)


A question still being asked by many in North America is: “what is a Community Health Centre (CHC)?”. While CHCs have been around for decades, the short answer is simply this: if you have seen one CHC then you have seen one CHC.

The differences between CHCs are numerous. The creation and management of individual CHCs are rooted in grassroots community development and CHCs are designed in such a way that they form around their communities in a variety of ways. Some, for example, may offer more services related to addiction, while others may see a local uptick in homelessness and poverty in their area and seek to address that. Others still might focus on communities and individuals with common characteristics.

The result is that two CHCs no more than 50 miles apart might have significantly different programs based on the identified needs of their respective communities. One CHC might have a large focus on rural and migrant worker health because it is located in a community where this is relevant, while another might have a great deal of programs for youth who speak French. It all depends on the local community.

The CHC this article is being written from is the Grand River Community Health Centre in Brantford, Ontario, Canada. It is co-written by an MSW and an MSW student, at the culmination of her successful 6 month placement with the CHC. Both authors have come to realize that there is a lack of literature and information about the potential role for social work student learning at CHCs across Canada.

Completing a student placement within a Community Health Centre can allow for a diverse experience of social work practice. For those social work students who are equally interested in both the clinical and community side of social work practice, a CHC may be the perfect fit. To illustrate this, a student may spend part of her time counselling, part of her time sitting on local committees, and a part of her time participating in outreach activities. A student may also have the option to register for local training workshops, which could take the form of suicide prevention training or holistic healing practices. The versatility of a CHC placement allows students to experience social work and social justice at the macro, mezzo, and micro levels all at the same time.

In addition, this versatility often means that students can work with a variety of clients. Students may participate in seniors programs, LGBTQ projects, and multicultural initiatives. Considering the growing demand for culturally-relevant practices, working with diverse groups is valuable experience for new social workers.

Research can also be a component of a CHC placement, especially depending on which team of the CHC you are placed with. The activities carried out by the Social Work team and/or the Health Promotion team are likely to include a research component. Students may have a chance to write for a CHC’s blog or other publications; to research best practices; or to write an article for an external publication, such as The New Social Worker Magazine!

Research is an important part of social work practice. Whether assessing the usefulness of existing studies, evaluating programs, or conducting new research—social workers need to engage with research on a daily basis. It is important, then, that social work students get a feel for agency research, and a CHC may offer this opportunity. In short, CHCs are a great option for students completing their thesis, or for those students who wish to improve their writing and researching skills. The time for this is exciting, especially since the Canadian Association of Community Health Centres and its national Research Working Group are now focused on building a Canada-wide CHC research strategy and helping local CHCs to build in-house research capacity.

Over the course of six months with the Grand River CHC, our student was able to see a variety of clients in a clinical social work setting. This included individual and group work. She was also able to take part in mental health promotion programs in which literally thousands of community members engage with activities designed to help reduce mental health stigma. She was able to help the City and County with the development of their 10-year housing and homelessness strategy and also helped with various research projects and the creation of written materials that will be a part of the CHC long after the student has graduated.

Some placement students complain about limited experiential opportunities during their placements with other types of organizations. Counselling placements with only a very specific type of client (say youth age 6-12) may not allow for the generalist experience you were hoping for. In this turbulent job market you would probably like a variety of relevant experiences to pull from during future job interviews. During the six month placement, our student saw clients both young and old, and with a variety of presenting issues that these clients wanted to work on from a strengths-based perspective.

For students who have a variety of interests, the dynamic and multi-faceted environment of a CHC might be an excellent fit. Interested in clinical work AND policy development? Or perhaps you love community development AND research too? Working in an inter-professional health care environment means there are opportunities for a large variety of experiences. What an opportunity to have so early in your social work career!

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Beyond Dispensing: The Voice of a Pharmacist Working as a Member of an Interdisciplinary Primary Health Care Team

A Medicare@50 blog post by:
Susan Troesch – Clinical Pharmacist
Mid-Main Community Health Centre (Vancouver, BC)
Follow them @Mid_MainCHC

As fall rolls around, I find myself stopping to give thanks for my great fortune. I am grateful to be able to say I love what I do. Not all pharmacists I talk with today tell me that they can say the same, and many often report that they would love to have a job like mine. Many pharmacists are becoming increasingly frustrated at not being able to practice in a way that utilizes the knowledge and skills that they received during their university training. As Canadian Universities’ Faculties of Pharmacy move toward an entry to practice PharmD program, it will become even more important that health care professionals learn to practice collaboratively in the interest of providing the best care for Canadians. Sadly, though I was one of the first pharmacists in a primary health care family practice (in the late 1990s) in Canada, I remain one of very few currently working in British Columbia.

Despite ongoing attempts to expand the scope of pharmacy practice across Canada, and particularly in the atmosphere of shrinking health care budgets, change is slow. In BC, integration of pharmacists into community-based primary health care practice has been especially slow. We look with some envy to our Alberta colleagues who can now obtain prescribing authority and our colleagues in Ontario who have greater opportunities to work on interdisciplinary teams in numerous primary care practices, some in Community Health Centres (CHCs).

Imagine my surprise at being invited to Mid-Main CHC some 15 years ago to chat with the clinicians about a potential integration of pharmacy services into the primary care team. After working for 28 years in a pharmacy with a significant Long Term Care (LTC) and mental health practice, in addition to a neighborhood community practice, my dream was to work on an interdisciplinary primary health care team full-time. My LTC work had allowed me to be involved in the building and workings of some interdisciplinary teams at my LTC practice sites. Through this work, I was able to not only experience the feeling of satisfaction, but also see the benefits in patient outcomes. This was the direct result of team members from different disciplines learning to collaborate and work together. I was hungry for more.

At our first meeting at Mid-Main CHC, I learned that the clinicians were looking for access to cheaper drugs for their clients and were hoping to open a dispensary on site, which would allow for some clinical support as well (a model being used at Vancouver’s REACH CHC at the time). Still in “recovery” from the 1995 Pharmanet roll out in BC, I was looking for a more clinical focus. I did, however, volunteer to help Mid-Main CHC write some proposals for a funding source for a dispensary on-site, but also asked what other clinical activities might be helpful for the practice – nobody knew. Following further discussions, the practice agreed to allow me to provide “volunteer” clinical services for one-half day each week for the next year. I felt that this might allow all of us the opportunity to explore and experience the potential benefits of the pharmacist contribution to the primary care team within a community-based primary health care setting. It was a bit scary walking into the unknown but simultaneously, I was excited about the prospects. Although it took us a while to get to know each other and to begin to work well together (evidence as per EICP is 2 years) we succeeded and have never looked back.

My role at Mid-Mid Main CHC has evolved over time. I began by: providing refill authorization for patients (under a delegated authority); doing medication reviews; answering drug information questions; making evidence-based recommendations regarding pharmacotherapy; and providing smoking cessation support for patients at the health centre. Today my responsibilities includes Chronic Disease Management (CDM) support for the practice (review and proactive recall); wellness promotion and self management support; anticoagulation support; continuity of care support for complex patients; shared care of the frail elderly population; and facilitation of group medical visits. With the encouragement and support of my team, I have attained Certified Diabetes Educator (CDE) status, which also allows me to support our patients with diabetes, especially those who need to start or who are currently using insulin as a part of their management strategy.

I have seen the power of working face-to-face with the other members of the primary care team in a client-focused care environment. When my dispensing colleagues tell me that they would like a job like mine, I encourage them to call a CHC or a physician practice in their area who they feel they might be able to work with, and see if they might be willing to meet over coffee. Working and collaborating together begins with getting together, face-to-face.

 

 

 

 

 

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Health Care’s Real Iceberg

A Medicare@50 blog post by:
Russ Ford (@RussJamesFord) – Executive Director
LAMP Community Health Centre (Toronto ON)

Ryan Meili does not wear a beret. In fact, I doubt he even owns a Che tee-shirt. He does not  emphatically wave his arms while speaking. Some revolutionary?! Ryan Meili does wear a suit, speaks softly and is a doctor from Saskatoon. With no political experience he ran for the leadership of the Saskatchewan NDP, the province’s natural governing party and finished second. His campaign was based on the social determinants of health. Yes, some revolutionary.

Dr. Meili is the founder of a new organization called Upstream: Institute for a Healthy Society, launched on September 27 at the national Community Health Centres conference — Medicare@50 – in SaskatoonThe purpose of Upstream is to change the way you and I think about health care.  He uses an analogy of a river to explain it:

“One day you are on the bank of a river and you see a child drowning.  You jump in and save the child. Soon another child comes down the river, whom you also save, and the more you save the more that come down the river. Eventually you go up the river to see why so many children are falling in the water.”

Applying that analogy to our health system the obvious question is: why do we continue to direct all our efforts at treating people rather than spending some resources on trying to figure out why they got sick in the first place?

Seems to make sense, but we do not do it. The current direction in Ontario, for example, is to see if we can address the needs of those that use the services the most. The belief is that if the care received by these people was better managed it would result in savings to the system.

While there is certainly nothing wrong  with trying to spend your resources in a more efficient manner, it is an example of short-term, downstream thinking.  It is an approach an economist would prescribe, not a healthcare provider. It is just like pulling the child from the river.

Upstream thinking is about redirecting the emphasis from treatment to the causes of ill health. To use a cliché, it is a paradigm shift.

So what are the causes of ill health? Well for that we go to that leftist organization the Canadian institute for Health Information. They concluded that the five leading causes of ill health are:

  1. poverty
  2. lack of education
  3. lack of social support networks
  4. employment and working conditions
  5. early childhood development

The holy trinity of health promotion —  “don’t smoke”,  “get some exercise” and “watch your weight” do not appear on the list. Yet, the majority of the meager dollars we put into health promotion stress these narrow lifestyle issues.

The truth is that it is much easier to get someone to stop smoking than it is to get them out of poverty. It is much easier to give a person a pill for high blood pressure than to teach them to read.  But like our “tough on crime agenda” it is totally useless.  I doubt there is anyone who does not know by now the perils of smoking and there is not much more we can do to discourage it, but we still pump money into anti-smoking programs.

As a doctor, Meili is trained to go by evidence not hunches or gut feelings. So what is his evidence?

If you live in the centre if Saskatoon where Meili practices,  you are living in one of the most impoverished areas in Canada.  If you live there, the  research shows that you are fifteen times more likely to contract a sexually transmitted infection; fifteen more times likely to commit suicide; thirty-five times more likely to get Hep C and thirteen times more likely to have type-two diabetes. The infant mortality rate is three times higher and a resident of this community  is 2.5 times more likely to die within the year. The evidence is there.

So if addressing poverty and the issues that accompany it like racism would make people healthier and reduce costs in a much more significant way, why are we not doing anything about it?

To do that we would  have to change the way we “do politics” and the way we think about it.

The way we currently do politics is a disservice to this country. We are more interested in scandals, especially if sex is involved. We dumb down debate to attack ads and the issues that many face no longer seem to be relevant to our political masters. Scoring debating points in question period seems to be what is important. Getting elected is more important than telling the truth, especially if the truth is what the polls tell you the people do not want to hear.

So let’s change it. Meili almost became leader of the Saskatchewan NDP by not succumbing to the tired old approach. Let’s start by making evidence-based decisions and challenging those that are not based on evidence.

Take crime as an example. There is not one shred of evidence to support the “get tough on crime agenda”. Yet the government initiates it and the opposition parties, fearful that the public will see them as “soft on crime” if they oppose it, meekly accept it. Perhaps the opposition should have more faith in us and present the evidence.  It is not hard to find. It is one Google search away.

Mike Harris, former Premier of Ontario, would often say that the best social program is a job. In other words, a strong economy will cure most if not all that ails us. He was wrong, or to be more charitable, he way out of date.

The new global economy has only increased inequity, even during times of growth. An increase in GDP historically meant that most members of society prospered. We now know that is no longer true. A strong GDP now means nothing to the lives of most Canadians

Many have argued that our future health care system will find itself in crisis largely because people are living longer.  We have moved from a system that previously addressed episodic illnesses to one that is now focussed on chronic disease management.  But to suggest that chronic disease will be the iceberg that derails our health system is simply nonsense.

The money is there, or at least it was there until governments started cutting our taxes, especially those of corporations, literally taking billions out of the public treasury. The lost tax-cut money can easily finance those costs and there will be even money left over to buy the military all the toys it wants.

No, chronic disease will not be our undoing. Our undoing will be a failure to acknowledge and address the fact that our new economic order is causing more and more Canadians to be sick by creating more inequality.

The easy solution would be to enter our political parties into a rehab program in order to end their addiction to public opinion polls. Can you imagine how politics would be different if our parties stood for something, and acted on principle rather than focussed on what the polls tell them we want to hear?

Doing politics differently means starting  to say what needs to be said.

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