The occupational health and safety vulnerability of recent immigrants accessing settlement services.

OBJECTIVE: To compare occupational health and safety (OHS) vulnerability of recent Canadian immigrants and workers born in Canada. METHODS: Recent immigrants (n = 195) were recruited at four settlement agencies in Southern Ontario, and non-immigrants in Ontario (n = 1030) were contacted by phone and email by a third-party survey provider. The questionnaire measured OHS vulnerability using a 27-item measure and collected sociodemographic and workplace information. Responses were used to evaluate one overall and three specific (policy and procedure, awareness, and empowerment) measures of OHS vulnerability. Log-binomial models compared the overall and policy and procedure-, awareness- and empowerment-related vulnerability of recent immigrants to non-immigrant workers. Models were adjusted for demographic and workplace characteristics. RESULTS: New immigrants experience statistically elevated levels of overall (adjusted risk ratio [ARR] = 1.60, 95% CI 1.23-2.07) and empowerment-related vulnerability (ARR = 1.54, 95% CI 1.09-2.17). Compared to workers born in Canada, immigrants also report elevated levels of policy and procedure vulnerability (ARR = 1.37, 95% CI 0.98-1.92), although this estimate did not meet traditional criteria for statistical significance. CONCLUSIONS: This study uses a novel multi-dimensional measure to identify how differences in workplace context place recent immigrant workers at increased risk of work-related injury or illness. Recent immigrant workers experience increased risk of OHS vulnerability. In particular, this vulnerability results from exposure to hazards in combination with inadequate levels of empowerment to protect themselves in the workplace. Policy-makers, advocates, and employers should implement strategies that not only build workplaces where occupational hazards are minimized but also ensure immigrant workers are empowered to act on their workplace rights and engaged to improve workplace safety.

Building flexibility and managing complexity in community mental health: lessons learned in a large urban centre.

BACKGROUND: Across many jurisdictions, adults with complex mental health and social needs face challenges accessing appropriate supports due to system fragmentation and strict eligibility criteria of existing services. To support this underserviced population, Toronto's local health authority launched two novel community mental health models in 2014, inspired by Flexible Assertive Community Team principles. This study explores service user and provider perspectives on the acceptability of these services, and lessons learned during early implementation. METHODS: We purposively sampled 49 stakeholders (staff, physicians, service users, health systems stakeholders) and conducted 17 semi-structured qualitative interviews and 5 focus groups between October 23, 2014 and March 2, 2015, exploring stakeholder perspectives on the newly launched team based models, as well as activities and strategies employed to support early implementation. Interviews and focus groups were audio recorded, transcribed verbatim and analyzed using thematic analysis. RESULTS: Findings revealed wide-ranging endorsement for the two team-based models' success in engaging the target population of adults with complex service needs. Implementation strengths included the broad recognition of existing service gaps, the use of interdisciplinary teams and experienced service providers, broad partnerships and collaboration among various service sectors, training and team building activities. Emerging challenges included lack of complementary support services such as suitable housing, organizational contexts reluctant to embrace change and risk associated with complexity, as well as limited service provider and organizational capacity to deliver evidence-based interventions. CONCLUSIONS: Findings identified implementation drivers at the practitioner, program, and system levels, specific to the implementation of community mental health interventions for adults with complex health and social needs. These can inform future efforts to address the health and support needs of this vulnerable population.

Implementation and impact of an online tool used in primary care to improve access to financial benefits for patients: a study protocol.

OBJECTIVES: Addressing the social determinants of health has been identified as crucial to reducing health inequities. However, few evidence-based interventions exist. This study emerges from an ongoing collaboration between physicians, researchers and a financial literacy organisation. Our study will answer the following: Is an online tool that improves access to financial benefits feasible and acceptable? Can such a tool be integrated into clinical workflow? What are patient perspectives on the tool and what is the short-term impact on access to benefits? METHODS: An advisory group made up of patients living on low incomes and representatives from community agencies supports this study. We will recruit three primary care sites in Toronto, Ontario and three in Winnipeg, Manitoba that serve low-income communities. We will introduce clinicians to screening for poverty and how benefits can increase income. Health providers will be encouraged to use the tool with any patient seen. The health provider and patient will complete the online tool together, generating a tailored list of benefits and resources to assist with obtaining these benefits. A brief survey on this experience will be administered to patients after they complete the tool, as well as a request to contact them in 1 month. Those who agree to be contacted will be interviewed on whether the intervention improved access to financial benefits. We will also administer an online survey to providers and conduct focus groups at each site. ETHICS AND DISSEMINATION: Key ethical concerns include that patients may feel discomfort when being asked about their financial situation, may feel obliged to complete the tool and may have their expectations falsely raised about receiving benefits. Providers will be trained to address each of these concerns. We will share our findings with providers and policy-makers interested in addressing the social determinants of health within healthcare settings. TRIAL REGISTRATION NUMBER: Clinicaltrials.gov: NCT02959866. Registered 7 November 2016. Retrospectively registered. Pre-results.