RxCommunity: Social Prescribing in Ontario | Final Report

#EXECUTIVE SUMMARY

#Social prescribing in context

For over 50 years, Community Health Centres and other community-led primary healthcare organizations in Ontario have been united in their commitment to community development, health equity, and social justice. We know that as much as 80-90% of our health outcomes are driven by the social determinants of health. , For a person to thrive in health and wellbeing, they must have access not only to appropriate clinical care and material supports, but also to meaningful social support and a community where they feel they belong. Social prescribing is a healthcare tool that can help ensure that clients are supported to connect with appropriate social and material supports. The Alliance for Healthier Communities embarked on Canada’s first social prescribing initiative because it offered an opportunity to demonstrate and deepen members’ work.

#Developing the Rx: Community pilot

Eleven community health centres (CHCs) across the province participated in Rx: Community. Using client- and community-centred design thinking, they identified non-clinical interventions, built a structured referral pathway, and tracked the impact of their work.

Social prescribing may look different in different communities, depending on local needs and capacity. However, these five essential components have emerged as the foundation of an impactful model of social prescribing:

1. A person or client who is experiencing social and health barriers and challenges, and who has unique goals, interests, and skills;
2. A prescriber who recognizes the impact of social determinants on a client’s health and refers them using social prescribing;
3. A navigator who receives the referrals and works collaboratively with the client to connect them to appropriate non-clinical, community-based supports;
4. Social prescriptions, non-medical and co-created supports in the community;
5. A data pathway that enables continuous incorporation of meaningful data and lessons learned to ensure quality of delivery and monitor outcomes.

Rx: Community began with a health and wellbeing grant in May 2018 and was launched at our pilot sites in late 2018. Data were collected throughout. This report was prepared in March 2020 to share findings and make recommendations for scaling up social prescribing across Ontario and beyond.

#Evaluation findings

We used a mixed-methods implementation evaluation that combined qualitative and quantitative research approaches to examine how social prescribing was implemented; clients’ and providers’ perceptions of the initiative; its effects on clients’ health; and its impact on systems within healthcare organizations.

During the year-long pilot, over 1,100 clients across 11 CHCs were provided a total of nearly 3,300 social prescriptions. Seventy-one of the clients who received social prescriptions were supported to become volunteer Health Champions who co-created and delivered social activities and programs.

• Finding #1: Clients reported overall improvements to their mental health and a greater capacity to self-manage their health, as well as decreased loneliness and an increased sense of connectedness and belonging.
• Finding #2: Healthcare providers find social prescribing useful for improving client wellbeing and decreasing repeat visits. They recognized the value of the navigator role, and, where it was not in place, they felt a need for more support.
• Finding #3: Social prescribing enabled deeper integration between clinical care, interprofessional teams, and social support; and it enhanced the capacity of the community through co-creation.

The project team, local social prescribing implementers, health providers, and clients provided insights into the challenges, lessons learned, and key enabling factors of implementing social prescribing with a health equity lens.

Participating centres identified the following as significant, common challenges:

• Lack of dedicated staff capacity;
• Stretched organizational capacity;
• Barriers in data tracking;
• Lack of community infrastructure to support social prescriptions;
• Early lack of clarity in defining the social prescribing model in Ontario.

We learned that the following are essential to a successful social prescribing program:

• Organizational culture change toward innovative, person-centred ways of working;
• Dedicated staff and organizational commitment to support practice change;
•  A Learning Health System approach to data collection and utilization;
• Clarity in social prescribing terminology and model;
• Supportive social prescribing navigators;
• Inviting clients to define their own goals;
• Enabling volunteers of all abilities to contribute.

Participating centres observed and reported the following as enabling factors:

• Implementation within the context of a team-based, community development oriented healthcare setting;
• The spirit of innovation and persistence at pilot centres;
• Provincial coordination support.

#Recommendations for scaling

Social prescribing is gaining momentum in Canada among healthcare providers, community partners, researchers, funders, and policymakers. This report concludes with a series of recommendations as to how each of these groups can contribute:

Policymakers, funders, and Ontario Health Teams can create fertile ground for social prescribing by investing in primary health care and social supports. They can further advance social prescribing initiatives with direct financial, material, and/or policy support.

Health care, cross-sectoral, and social support organizations can build and strengthen local partnerships, adapt social prescribing to the needs and assets of their communities, embrace culture change, and develop strategies for data collection and use.

Researchers and academic institutions can contribute screening and evaluation tools, conduct data analysis, and provide research support to health care and social support organizations.