Racialized Migrant Women in Canada: Essays on Health, Violence and Equity
Canadian CHWs had been disconnected from each other, but have recently formed the Community Health Worker Network of Canada — the first organization of its kind in the country. Among the concerns discussed by network members include the lack of recognition and the unregulated status of CHWs; the need to organize the workforce at the local, regional, provincial and national levels; the search for a single definition for their work; the need to conduct research on the workforce's composition and competencies; and the potential for adopting a set curriculum or standardized training for CHWs.
Network members are also reflecting on how the two CHW practice models independent or integrated, described below affect their capacity to remove access barriers to health and other services in marginalized communities, or to serve as cultural brokers. In this model, independent organizations, often established by CHWs themselves, offer services that target marginalized communities. These organizations and the CHWs working within them obtain contract funding to deliver their services independently of public healthcare institutions, but often in collaboration with them. When funded, organizations retain complete autonomy in the work's conceptualization and programming.
The wages and hours to deliver the services are not equivalent to those of CHWs, who may be working within the formal healthcare system; typically, funding allows for a mixture of part-time and full-time CHW employment. Independent models are marked by high levels of health promotion activity, as distinct from a focus on specific service delivery. The main health system's concern with independent models is that they may have less accountability and supervision, and that the CHWs may have less training, than CHW program delivery through integrated models.
Furthermore, given the lack of resources, it may also be more difficult to evaluate service outcomes in independent models. In this model, CHWs are staff within public health or primary care institutions, which have as part of their mandate the delivery of programs targeting populations experiencing marginalization. These workers are usually well-paid with good benefits, as well as reasonable work hours and caseloads, which is often not the case for CHWs operating in independent models. Generally, CHWs and their professional allies in public health units reach out to marginalized communities with specific programs and key health messages.
In situations of pandemics, they orchestrate campaigns to ensure that contagious diseases do not spread among these populations. One concern with the integrated model is that its responsiveness to marginalized community concerns may be constrained by requirements for bureaucratic approval that is often needed for new initiatives. Another concern with this model is that CHWs are more and more focused around fulfilling technical activities and practices traditionally performed with the scope of health services rather than focused on intersectoral actions, community development and social participation Rodrigues Fausto et al.
Data for this paper are a subset of a case study conducted for the first author's doctoral research. The investigation applied an instrumental case study design Stake to examine issues that went beyond the case itself Stake Finally, the study examined the MCHBs' practice to understand their role as part of a health human resource workforce that operates independently of the healthcare system. Data also included descriptive and analytical field notes taken throughout the course of the onsite research.
This paper centres on the analysis of 23 of the 44 qualitative interviews conducted for the study 16 of these interviewees were MCHBs working for the Health Co-Op and seven were health professionals within AHS , as well as data from the MCHBs' client caseload database. Interviews were conducted between July and May Depending on the program, an MCHB case was defined as a mother with a child or children 0 to 6 years old, a family with a child with a disability, the parents whose children are experiencing abuse or neglect, or a senior experiencing isolation see Figure 1.
Hand-coding and the qualitative analysis software QSR Nvivo8 were used in coding and data management. Inductive analysis was conducted for the interviews, and descriptive analysis was performed on the MCHBs' client caseload database. The Health Co-Op's independently run programming has been offering culturally responsive services ever since its founding in MCHBs provide culturally and linguistically appropriate services to immigrant and refugee families from at least 18 different cultural backgrounds, and collectively are able to speak 29 languages MCHB Co-op a.
One MCHB explained the need to provide services that are culturally relevant to women, even if that includes bringing "cultural food" to a new mother in the hospital:.
Sometimes, like, you know, she had a baby at 6 o'clock … at night, or 7, or 8, 9, 10 o'clock at night … she has nobody, she has no language … she's in the hospital, and she's calling you. MCHBs do home visits to pregnant women and new mothers, accompany patients to doctors' appointments, take mothers and children to vaccination clinics and accompany women during child labour and delivery. MCHBs also do group work, undertake community development initiatives and provide educational outreach on chronic disease prevention and management, as well as offer family intervention programs to address child abuse and neglect.
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As an independently run Health Co-Op, MCHBs control and manage their time to meet the needs of their clients, sometimes making themselves available to help clients in the evenings or on weekends, which mainstream health service providers typically do not do.
These types of services, however, are not fully financed by AHS, and MCHBs often use their "own time," as they describe it, to support immigrant and refugee women and their families, effectively subsidizing the publicly funded program. Indeed, being available to support mothers in times of need is what often makes it possible for MCHBs to do their perinatal work. As one MCHB stated:. Figure 1 illustrates the MCHBs' caseload, including health and other related programs.
In real terms, however, the latter program is more demanding because victims of family violence require intense support over a long period. MCHBs who work in violence prevention and child intervention receive training in these areas from Alberta Children Services to make sure that MCHBs are aware of their legislative responsibilities as workers.
Finally, MCHBs developed their own multicultural health brokering theory to guide their practice Ortiz Multicultural health brokering is a relationship-based practice based on trust and confidence established between MCHBs and the women and communities they help Torres The practice standards of MCHBs' daily activities embody both the principles and the values of health brokering theory Ortiz These standards are:.
The practice standards are codes of conduct that will help support decisions and actions of the worker in an ethical and appropriate manner MCHB Co-Op b They are based on a dedication to empowering people and communities; are rooted in the wisdom, knowledge and culture ways of people; and are based on principles of social justice, equity and democracy MCHB Co-op b.
MCHB interviews revealed their commitment to responding to health and social needs of the communities, whether or not the Health Co-Op received funding to service those needs. MCHBs viewed this situation as reflecting a growing gap in access to health and social services, which would require multi-ministry and multi-stakeholder support to address. Alberta's health system has undergone several rounds of restructuring in the past two decades, although the funding for the MCHB program has been maintained.
Firstly, MCHBs helped the health unit to meet its mandate to serve immigrants and refugees, and the health unit's staff and managers to learn about immigrant and refugee communities from the MCHBs.
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Well, I don't think we could do our work without them … I think that they're hugely influential in the outcomes … I mean certainly there's a role for both of us [public health] within helping that family with health outcomes, but … the brokers … we really depend on them. Secondly, MCHBs understood different cultures, provided culturally appropriate services and were able to help clients in different areas:. I'm completely convinced that every single newcomer to the country should have a health broker, I mean, I have no doubts about that … immigrant families manage fairly well in comparison to the refugee families, but the refugee families really struggle and should, do need that kind of support, I feel quite strongly.
Thirdly, MCHBs have helped most health services providers in the city to understand the need to look at "culture" when serving immigrants and refugees. One professional explained:.
Introduction and summary
Finally, MCHBs are not interpreters, they are cultural brokers. When they accompany patients to medical appointments, they help health professionals to understand clients' issues better, especially when the client does not speak English fluently. One health professional referred to MCHBs' contributions to the health system as "saving lives. Most health professionals thought that the health system was responding well to the perinatal care needs of existing immigrant and refugee communities, but was not providing adequate funding to provide for new cultural groups arriving in the city.
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The collaboration between an independent MCHB model and AHS' public health unit in Edmonton reveals the complementary role that MCHBs can play in meeting the health system's mandate to reduce barriers to marginalized populations' access to services. The MCHB model illustrates the importance of addressing health needs of immigrants and refugees through culturally and linguistically appropriate services that target issues linked to social determinants of health.
This article focused on the uniqueness of the MCHB Edmonton model because of its relevance to other cities and provinces in Canada that may wish to improve access to health and other services by working with CHWs operating independently of the formal healthcare system. We believe, however, that both independent and integrated CHW models have a role to play in improving the effectiveness of the Canadian health systems.
These standards are minimal criteria to ensure that barriers to accessing public health programs and services, such as language, economic circumstances and discrimination MOHLTC , are reduced. Barriers can include, but are not limited to, lack of education, low literacy levels, language, cultural differences, geography, economic circumstances, discrimination e. This paper, based on empirical research, described the collaboration between MCHBs in Edmonton and the local public health unit's maternal child health area to remove barriers to accessing perinatal health for immigrant and refugee women and their families.
It also illustrated the strategies used by MCHBs to address the complex realities of these families, owing to other needs linked to social determinants of health, and highlighted the linguistically and culturally appropriate nature of their work. The collaboration model described in this paper and the linguistically and culturally appropriate nature of MCHB work are part of their commitment to building a new community of practice to address the perinatal health and other social needs of immigrant and refugee families Torres et al.
This community of practice is based on MCHBs' ability to articulate, reflect on and monitor their practice; to operate and sustain an independent organization; to develop and maintain and seek intersectoral, cross-governmental collaboration; and to develop programs that address the social determinants of health Torres et al.
Doing so will benefit the workers, the population they serve and the healthcare system. Une telle reconnaissance serait aussi avantageuse pour les TSC et les populations qu'ils desservent. Denise L. Andrews, J. Felton, M. Wewers and J. Armstrong, P. Don Mills: Oxford University Press. Rosenthal, J. Brownstein, C. Rush, S. Matos and L. Beiser, M. Black, M. Campbell, B. Carpio, J. Crawford, A. Frisina, T. Hack et al. Women's Health Educators: Pilot Project: — Retrieved February 22, Hack and B.
Chiu, Y. Ortiz and R. Edmonton: Metropolis. Clark, P. Crighton, E. Elliott, P. Kanaroglou, R. Moineddin and R. Federal Register. Retrieved September 30, Green, M. Weir, W. Hogg, V. Etches, K. Moore, D. Hunter and R. Hodnett E. Fredericks and F. Javanparast, S. Baum, R. Sanders, G. Heidari and S. Jezewski, M. Johnson, C. Noyes, A.
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Haines, K. Thomas, C. Stockport, A. He is working on a book about reflective practice and education. Is Canada a Safe Haven? A member of the Ryerson community for almost 30 years as sessional instructor, lecturer and professor in the Department of Politics and Public Administration, Anver has earned a number of teaching awards including Ryerson Professor of the Year.
Anver has an extensive record of service including a number of roles at the Canadian Association of University Teachers including vice-president as well as chair, equity committee. A panel discussion on refugee inclusion in policy making and economic empowerment. As a civil rights lawyer, she has advocated for accountability and reform in policing for many years, representing community organizations. She was a regular commentator on current and legal affairs for CTV News and has appeared as a spokesperson on a variety of issues.
She is co-author of the book Politically Speaking. She has addressed audiences across Canada and in the United States on issues of anti-racism, feminism, and progressive change. Panel discussion on the role settlement services have in the lives of newcomers, particularly the need for support to be oriented towards newcomer empowerment and self-determination.
The importance of training workers on being responsive to the diversity and intersectionalities of clients and their needs are also emphasized, as well as the accessibility and quality of services. The paper will discuss the representation of racial difference in the archive, and about the ways visual culture tells both a story of migration and of belonging to the nation.
Will Straw and Dr. Charmaine Nelson. Second Day. Denise O'Neil Green. Green has a deep-rooted passion for the advancement of diverse classrooms and inclusive campus climates and has championed organizational change on university campuses, both in the USA and in Canada, for over 25 years. She holds extensive academic and administrative experience and has served as Associate Vice President for Institutional Diversity, a professor, and director for student success programs.
She has published and presented many book chapters, journal articles, papers, and is the Executive Editor of InstitutionalDiversityBlog. She is the co-author of Accomplished Black Canadian Women — He is also the founder of the Ryerson Centre for Immigration and Settlement. Senator Ratna will engage in a fireside chat moderated by Sara Asalya around diversity, inclusion, migration and refugee empowerment. Audience will have the opportunity to engage in this discussion and ask any questions.
Prior to joining Ryerson, John led community based outreach programs for Samara Canada. He has also worked as an educator and served on the board of the organization that successfully campaigned for the first system of public financing for state elections in the United States. Since immigrating to Canada in , John led the development of national tutoring initiatives for Pathways to Education.
He also served as founding board member and chair of Park People. Panel and guest information. Shahrzad Mojab Dr. After completing her degree she moved to the Northwest Territories where she taught at Elizabeth Mackenzie Elementary School in Behchoko for 3 years before teaching at Alexis Arrowmaker School in Wekweeti for an additional year. After 4 years up north Rachel decided to move back to Ontario to be closer to her family and pursue her masters degree.
She is currently completing her masters in immigration and settlement studies at Ryerson University. She has recently completed her Major Research Paper on how settlement services can build relationships with Indigenous organizations and people. She is also actively involved in the St. James Town community as she volunteers at the St. James Town Community Corner, teaching english language to adults and providing a leadership program for youth in the community.
She is an award-winning short story writer, and a newly published Author opening and closing Indigeniety and Decolonial Resistance: Alternatives to colonial thinking and practice an Educator's textbook , edited by George J. She used her poetry as a powerful way to politize her Identity and to challenge academia's ways of teaching and learning. Alfredo Barahona : is originally from Cuzcatlan, a Maya — Pipil territory part of what is also known as El Salvador, moved to Canada as refugee in the mid-eighties.
Currently Alfredo is working on Indigenous Rights issues focusing on the development of meaningful relationships and solidarity between Indigenous peoples and newcomers to Canada. She joined the Department of Criminology in She received her Ph. Her research interests include irregular migration, refugee protection, and international and European human rights law. He holds a B. His doctoral studies focused on the impact of international and comparative human rights on the Canadian security certificate regime.
Ritika Goel: is a family physician and activist in Toronto. Ritika has been involved with organizing around various social justice issues including access to healthcare for uninsured migrants, defending our public healthcare system, and upstream policy change on the social determinants of health. In the past two years after the Canadian government decided to welcome 25, Syrian Refugees, D r. Fakih made headlines in Canadian News when he travelled to Lebanon to visit the Islamic Relief Camps for Syrian Refugees to gain a deeper understanding of current relief efforts.