Academic journal article International Public Health Journal

Driving Equity at a Community Level: Case Studies of Community-Based Peer-Delivered Health-Care Services and Programs

Academic journal article International Public Health Journal

Driving Equity at a Community Level: Case Studies of Community-Based Peer-Delivered Health-Care Services and Programs

Article excerpt


The Wellesley Institute, based in Toronto, Ontario, Canada is a non-profit and non-partisan research and policy institute focused on developing research and community-based policy solutions to the problems of urban health and health disparities. Wellesley commissioned this Case Study Series, Driving Equity at a Community Level: Case Studies of Community- Based Peer-Delivered Health-Care Services and Programs, in 2010 to complement a Literature Review it conducted, "The Potential of Community-Based Peer-Delivered Healthcare Services and Programs" (1). The series was envisioned in several phases, with Phase 1 focusing on peer workers in health programs and services located in the Greater Toronto Area (GTA).

Interest in peer health workers, and evidence of their practice and its outcomes among health and social service providers and their clients in the Greater Toronto Area, developed out of a series of Health Equity Roundtables facilitated by The Wellesley Institute in 2009. These Roundtables brought together about 30 service providers, policymakers, and community- and academic-based researchers as "key informants" to create an informal best practices and advocacy network in the GTA around health disparities or inequities, socio- economic determinants of health, promising directions and gaps, and enablers and barriers to change.

The emerging philosophy and practice of peer workers was one area of discussion. At the suggestion of the Roundtables, The Wellesley Institute collaboratively developed this project to "dig deeper" into how and why peer workers provide health and social services in the GTA through a parallel and complementary Literature Review/Case Study approach that looks at three key lines of experiential inquiry: how the peer-based program or service works, why it works (facilitators, success conditions or best practices), and what challenges working with this model presents (barriers). This paper reports on Phase 1 of the project.

Two notes about terms and definitions used in this project. "Peer" is a flexible term as currently used in both the literature and in practice. This project adopts the definition suggested by the literature: "the term 'peer' is defined loosely as someone from the community being served. Such a loose definition allows for varying levels of expertise, from laypersons to professionals, so long as the person possesses the identifying traits of the community" (1). Similarly, when speaking of community, the literature suggests that:

'Community' refers to a group of people sharing identifying common traits such as ethnicity, race, religion, location or neighbourhood, sexual orientation, past or present health concern, educational status, age, lifestyle, and life-stage. To be community-based, a service or program must take place as close to the community as possible (1).

Where necessary, this paper refers to the broader term "health and social service providers" to reflect the reality that the health and social service sectors do cross over, both in policy and practice; and that many service providers are, in fact, multi-service agencies that work across sectors, disciplines and areas of practice. Several of the eight specific programs or services studied are multi-service agencies.

A comment about the project's scope. The terms of reference were highly focused for several reasons. The project had limited resources to access and collect data among communities of practice whose existence, location, size and client reach were relatively unknown among health and social service providers in the GTA, or known primarily through ever-changing networks of community-based contacts.

As a result, Phase 1 was envisioned as a preliminary, exploratory or "pilot" research project, a starting-point to explore the discussions, promising directions and recommendations from the Health Equity Roundtables and suggest next steps for Phase 2. The case study findings reported in this paper are therefore based on data gathered from a relatively small number, eight, of community-based peer- delivered healthcare services and programs that constitute field work component of the project. …

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