Large Canadian City Research Articles

115 An Evidence-Based Model of Care for Newcomer Children with Special Health Care Needs

Abstract Background In 2018, Canada resettled the most refugees in the world, in response to the greatest migration crisis in global history. The refugee and resettlement experience at critical stages of children’s development places children at risk for a number of chronic illnesses. Newcomer children with chronic illnesses or special health care needs (NCSHCN) require services and care providers across many systems, but face greater barriers to healthcare access and are at an increased risk of unmet needs, yet no research has been done to identify best practices for this vulnerable population. Objectives To develop an evidence-based model for high-quality, patient-centered care for NCSHCN and identify areas of need in a large Canadian city with a high density of newcomers. Design/Methods Using formative research design, a literature review and thematic analysis was performed to develop a conceptual model of care for NCSHCN. Next, a local environmental scan was conducted to identify and evaluate current clinics serving newcomers in a large urban Canadian city. Variables collected included the constructs identified in the conceptual model, and information about population served, providers and services offered including access to paediatrics. Results 326 studies were identified, of which 43 studies underwent full-text review and 21 were included in the final synthesis. Six key components were identified to best support NCSHCN: access to interpreters and appropriately translated resources; delivery of culturally competent care; access to care coordination and system navigation; longer appointment times; family-centered care through medical homes and home-based services; and an enhanced knowledge and understanding of health insurance processes. The environmental scan identified 50 clinics and programs serving newcomers, with 88% providing referrals to paediatric services but only 12% with a paediatrician on-site. Eighty-eight percent offered some form of interpreter services and while 71% offered patient navigation/care coordination services, only one program was specific to navigating child health services and programs. Conclusion We propose a data-driven model of care for NCSHCN that can reduce the intersecting disparities these families face by promoting equitable access to health and community services, thereby improving child outcomes and quality of life. While many programs for newcomers exist, access to paediatric services remains elusive and training in cultural competency and insurance processes is variable. More programs that integrate paediatric services into the community to make quality care more accessible and family-centered are required.

Healthy built environment: Spatial patterns and relationships of multiple exposures and deprivation in Toronto, Montreal and Vancouver

BackgroundVarious aspects of the urban environment and neighbourhood socio-economic status interact with each other to affect health. Few studies to date have quantitatively assessed intersections of multiple urban environmental factors and their distribution across levels of deprivation. ObjectivesTo explore the spatial patterns of urban environmental exposures within three large Canadian cities, assess how exposures are distributed across socio-economic deprivation gradients, and identify clusters of favourable or unfavourable environmental characteristics. MethodsWe indexed nationally standardized estimates of active living friendliness (i.e. “walkability”), NO2 air pollution, and greenness to 6-digit postal codes within the cities of Toronto, Montreal and Vancouver. We compared the distribution of within-city exposure tertiles across quintiles of material deprivation. Tertiles of each exposure were then overlaid with each other in order to identify potentially favorable (high walkability, low NO2, high greenness) and unfavorable (low walkability, high NO2, and low greenness) environments. ResultsIn all three cities, high walkability was more common in least deprived areas and less prevalent in highly deprived areas. We also generally saw a greater prevalence of postal codes with high vegetation indices and low NO2 in areas with low deprivation, and a lower greenness prevalence and higher NO2 concentrations in highly deprived areas, suggesting environmental inequity is occurring. Our study showed that relatively few postal codes were simultaneously characterized by desirable or undesirable walkability, NO2and greenness tertiles. DiscussionSpatial analyses of multiple standardized urban environmental factors such as the ones presented in this manuscript can help refine municipal investments and policy priorities. This study illustrates a methodology to prioritize areas for interventions that increase active living and exposure to urban vegetation, as well as lower air pollution. Our results also highlight the importance of considering the intersections between the built environment and socio-economic status in city planning and urban public health decision-making.

Levers for Change and Unexpected Outcomes of a Participatory Research Partnership: Toward Fostering Older adults' Social Participation to Promote Health Equity.

Promoting health equity in aging requires ensuring older adults' effective access to community-based services fostering their social participation. This study aimed to (a) identify levers for change in community-based services to foster older adults' social participation and (b) explore unexpected outcomes of stakeholder engagement. Based in a large Canadian city, a critical participatory research partnership was formed in a district experiencing considerable health disparities. Four focus groups and seven individual interviews were followed by a collaborative workshop with 28 community stakeholders. Participants identified mainly systemic and organizational levers for change. These levers comprised changing performance indicators and the institutional culture of homecare to value services fostering social participation opportunities. Other levers included supporting individual change agency through participatory research involving community members. Stakeholder engagement led to five unexpected outcomes: "Marking a new beginning," "Expressing ourselves," "Feeling better," "Working together," and "Influencing the community." Recognizing levers for change is essential to understand how to develop services fostering social participation to promote health equity, with whom and in which contexts.

Does Community Size Matter in the Settlement Process? The Experience of Syrian Refugees in Lethbridge in Alberta, Canada.

The article documents refugee experience in the first year of their settlement in a small city in Canada and then explores whether the size of the community matters in the settlement processes. This is based on an extensive study of Syrian refugee settlement experiences in one large Canadian city (Edmonton) and one small Canadian city (Lethbridge). The findings argue that contrary to existing scholarly literature, small municipalities such as Lethbridge were more creative, nimble, and efficient in settling Syrian newcomers. In small cities, however, lack of denominational and non-denominational organizations to complement government assistance, the onset of compassionate fatigue among the city dwellers, and limited retention of newcomers due to limited employment opportunity are real threats to the settlement process immediately after newcomers’ arrival and in the long term. A more substantial role of municipal governments in the refugee resettlement process is recommended to offset the disproportionate burden settlement sector carries.

An examination of older men’s body image: How men 65 years and older perceive, experience, and cope with their aging bodies

We examined how older men perceived, experienced, and coped with age-related changes to their appearance, body function, and health. Data from semi-structured interviews with 28 men aged 65–83 living in a large urban Canadian city and diverse in ethnocultural background (European, East Asian, and South Asian) and sexual orientation (heterosexual and gay) were analyzed through a reflexive thematic analysis. Four overarching themes were constructed from the participants’ accounts. Participants were ambivalent about their aging bodies; they were concerned about certain changes to their bodies, yet concurrently grateful for their retained health and body function. The men stressed the need to accept age-related body changes through pragmatism, awareness of challenging body-related cognitions and emotions without overidentification or suppression, and adjustments to expectations and activities. Participants engaged in upward and downward social comparisons to assess their aging bodies in relation to others and to their younger selves. Weight concerns were prominent. The men worried about their weight, with particular attention to their stomach, and were physically active and ate a healthy diet to manage their weight. This study contributes to body image theorizing by including older diverse men and can inform interventions aiming to enhance men’s later life psychological adjustment.

Aboriginal Family Services Agencies in High Poverty Urban Neighborhoods: Challenges Experienced by Local Staff

The purpose of the study was to describe the challenges of working in the community from the perspective of staff hired locally by culturally-based Aboriginal organizations in high-poverty urban neighborhoods. Locally staffed and culturally based Aboriginal family service agencies operating communities with high levels of poverty have emerged in large cities. Efforts of these agencies are consistent with community economic development practice aiming to improve local quality of life and skill development and promote economic capacity. There has been little research to date exploring the challenges faced by staff working in these organizations. Participants were residents of the local geographic community and staff of one of three Aboriginal family services agencies in a large Canadian city. They were asked “What are the challenges of working in your own community?” and their responses were analyzed using concept mapping methodology. Twelve concepts emerged from the analysis including: lack of privacy, being personally affected outside of work, keeping healthy boundaries, and knowing how to help. In addition participants described the high local need and meeting the range of needs given limited funding and influence of government on operations. As well, participants identified dealing with broader structural issues, such as substance abuse and gang problems. The results indicate that staff in Aboriginal family services agencies in high poverty communities experience living in the same community as service recipients, management of personal relationships with them, diversity of need within their service area, as well as potential for traumatic experiences as particularly challenging. Staff preparation, training and support for these issues are important for funders and administrators to attend to.

Qualitative analysis of perceived impacts on childhood food allergy on caregiver mental health and lifestyle

BackgroundApproximately 8% of children have food allergy. Yet, little is known about how parents cope with the burden of this disease. ObjectiveThis study aimed to describe the perceptions of food allergy–related mental health issues of parents of children with food allergy. MethodsParents of children with pediatric allergist–diagnosed food allergy were recruited through allergy clinics and education centers in a large Canadian city. We used content analysis to identify overarching themes. ResultsWe interviewed 21 parents with children (boys [13/21; 62.9%]) aged younger than 12 months to 16 years. Interviews averaged 47 (range 33-82) minutes. Most children were diagnosed as infants, and few (7/21; 33.3%) were monoallergic. About one-half (7/16; 43.8%) had a history of anaphylaxis. Parents of children with a single food allergy spoke of “accommodation and adaptation.” In contrast, parents of children with multiple food allergies described “anxiety and isolation” and spoke of being “depressed” and “terrified” about leaving their children in the care of others who may not be equipped to handle food allergy. Many parents felt “overwhelmed and alone,” especially if they lacked support from extended family and/or their social circle. “Fear for today, fear for the future” was commonly described by parents, although a tenuous symbiotic coexistence was developed, with parents stating “Food allergy management has become our normal.” Finally, a small group of parents reported that “Bullying happens, but we are alone to cope with it.” ConclusionMultiple food allergies negatively affect the mental health of parents, in a variety of well-being domains.

‘Don't take a poo!': Worker misbehaviour in on‐demand ride‐hail carpooling

Workers actively negotiate contradictions between discourses of flexibility and entrepreneurialism and actually existing conditions of risk and precarity endemic to online self‐employed work. This article examines how ride‐hail drivers counter‐branded UberPool—a carpool ride‐hail service—as ‘UberPoo’. While marketed as a solution to congestion, UberPool created risky and coercive working conditions for ride‐hail drivers. Our analysis is from a study on ride‐hail driver experiences of health and safety risks in a large Canadian city. We engage the concept of organisational misbehaviour to explore how drivers mocked and avoided carpool rides despite the threat of penalties. We characterise misbehaviour as a struggle over lack of control and lack of autonomy in self‐employed work, providing evidence that despite their structural powerlessness, some ride‐hail drivers do set limits around the work they are willing to accept. Algorithmic management and ambiguously classified ride‐hail work are thus subject to some degree of subversion.

Are fluorometric, taxonomic, and functional indicators of phytoplankton community structure linked to environmental typology of urban ponds and lakes?

ABSTRACTPhytoplankton bioindicators were used to assess environmental conditions in urban aquatic systems in a large Canadian city. Sampling was conducted during summers 2010 and 2011 in 20 urban waterbodies on the Island of Montreal (Quebec, Canada). We evaluated 4 indicators: (1) fluorometric estimates of the chlorophyll concentration of the total phytoplankton and of 4 spectral groups, (2) species richness, and (3) biovolumes of taxonomic and (4) functional groups of the microphytoplankton. We assessed how these indicators changed among types of urban waterbodies and determined the limnological features and/or management practices driving their spatial variation. Principal component analysis captured 48% of total environmental heterogeneity, and K-means clustering analyses defined 5 relevant types of waterbodies. Overall, 96 microphytoplankton species (γ diversity) were recorded, and species richness (α diversity) per waterbody varied from 1 to 27. Chlorophyll concentration of the total phytoplankton and the green algae spectral group, as well as the total biovolume of microphytoplankton, dinophytes, and of 2 functional groups (large flagellates, large colonies of green algae, and cyanobacteria) differed among waterbody types. Phytoplankton indicators based on in situ fluorometry and microphytoplankton biovolume of functional and taxonomic groups were fairly coherent and showed potential for monitoring. Implications of our findings are discussed in light of guiding future management practices to sustain biodiversity, ecological integrity, and water quality of urban waterbodies.

Occupational Safety and the City: Licensing Regulation and Deregulation in the Taxi Sector

Many large cities in North America have jurisdiction over licensing rules that shape the employment and health conditions of ride-hail and taxi drivers. Yet there is a lack of research on the role of licensing agencies relating to the occupational health and safety (OHS) of taxi drivers. Most taxi and ride-hail drivers in Canada are self-employed workers and are, by default, exempt from OHS and worker compensation laws. Additionally, municipal licensing regimes in Canada and the US have undergone various changes as a result of pressures from new platform-based ride-hail services, like Uber and Lyft.The analysis is part of a larger study on the health and safety conditions faced by ride-hail drivers. The research approach adopted a multi-level sampling and analysis strategy with the aim of connecting taxi drivers’ everyday work experiences to company and sector practices, and with various regulatory arenas, including municipal licensing, taxation and car insurance. In this paper, the analysis draws from in-depth interviews at these different levels: with taxi and ride-hail drivers, with taxi and ride-hail managers, and with key informants in government, law, insurance, tax and elsewhere.The paper identifies features and impacts of municipal deregulation in the era of on-demand taxi services, focusing on a large Canadian city in a province where municipal authorities regulate the vehicle-for-hire sector. The research identified regulatory changes that included removing centralized taxi vehicle inspections, cancelling mandatory driver training, and instigating rapid changes to competition in the taxi workforce by issuing unlimited numbers of ride-hail licenses. Our analysis indicates that regulatory changes adopted by the city administration have compounded work vulnerabilities and hazards for taxi drivers, while extending hazardous conditions to ride-hail drivers. These hazards suggest the need for interventions at a range of levels, actors and agencies, rather than solely by city licensing officials.

Women Offenders Under Community Supervision: Comparing the Profiles of Returners and Non-Returners to Federal Prison.

As a key indicator of correctional performance, returns to custody are a topic of much empirical inquiry, yet there remains considerable debate regarding questions around who returns and why, as well as the factors that support or impede successful post-release outcomes. Research examining the post-release trajectories of federal releasees in the Canadian context, particularly in the case of women, is necessary to identify opportunities for more responsive case management practices. Drawing on the case files of 43 formerly-federally-incarcerated women referred to a day reporting centre in a large Canadian city, we explore the profiles of women who returned to federal custody from those who did not, considering factors related to demographics, personal history, specifically mental health and mental health needs, static risk and dynamic need. In general, we found that those who returned to custody tended to have more needs and more complex needs relative to non-returners. Notable differences were evident in relation to criminal history, reintegration potential, dynamic factor needs, the presence of a mental health condition, the presence of substance addiction and institutional adjustment (as measured by institutional charges and segregation placements). While not attempting to present causal relationships, we shed light on the case management needs of this particular group and identify areas in need of further inquiry.

Taming anger and trusting others: Roles of skin conductance, anger regulation, and trust in children's aggression.

Proactive and reactive aggression subtypes are distinguishable as early as the preschool years. However, their early physiological and social-emotional correlates have not been examined simultaneously. We tested whether children's skin conductance level, anger regulation, and trust in others were differentially related to their proactive and reactive aggression. Four-year-olds and their primary caregivers were recruited from a large Canadian city (N=150). Controlling for reactive aggression, higher trust was associated with lower proactive aggression, but only for children with low anger regulation or skin conductance level. Controlling for proactive aggression, lower anger regulation was related to higher reactive aggression, and higher trust was related to higher reactive aggression for children with high skin conductance level. Findings highlight the unique and collective relations of physiology, emotion regulation, and trust to different forms of aggression in early childhood. Statement of contribution What is already known on this subject Proactive and reactive aggression subtypes are distinguishable as early as the preschool years. Unique physiological and social-emotional correlates of each subtype have been studied in middle and late childhood. Trust is a critical milestone for positive social interactions in early childhood and has been linked to aggression. What the present study adds Physiological and social-emotional correlates are uniquely linked to subtypes of aggression already at age 4. Trust is differentially linked to aggression subtypes as a function of anger regulation and skin conductance level.

Community Policing in Schools: Relationship-Building and the Responsibilities of School Resource Officers

Abstract School resource officers (SROs) have become nearly ubiquitous in North American schools in the last three decades. Most research on SROs has examined their impact on violence and disorder at school, yielding mixed results; however, it is widely accepted that traditional law enforcement responsibilities comprise only one element of SROs’ triad of responsibilities, which also includes teaching and counselling. Although their responsibilities are based in community policing models, little research has explored the place of community policing principles within the work of SROs. Drawing upon mixed methods data collected from school administrators and SROs in a large Canadian city, this study examines relationship-building within the context of SROs’ triad of responsibilities. The results suggest that SROs follow a community policing approach and strategically foster mutually beneficial relationships to support their law enforcement, teaching, and counselling objectives. Further, as a result of their established relationships, SROs are positioned as key sources of support for school administrators.

Association between child sexual abuse and infectious disease diagnoses

BackgroundThough many studies have linked child sexual abuse (CSA) to psychological health problems, little is known regarding the relationship between CSA and children and adolescents’ physical health. ObjectiveThe objective of this study was to assess the relationship between CSA and infectious disease diagnoses. ParticipantsOf the 955 eligible children and adolescents who had a substantiated report of sexual abuse between 2001 and 2010, medical data was retrieved for 882 individuals, who formed the sexually abused group. These 882 participants were matched to 882 participants on age, gender, and administrative healthcare region to form the general population group. Setting and methodsThis matched-cohort study, conducted in a large Canadian city, compared the number of infectious disease diagnoses between the date of the substantiated sexual abuse report and August 1, 2013, between the two groups. ResultsResults indicate that sexually abused participants had 1.27 times more (95% CI – 1.13 to 1.42) infectious diseases diagnoses than those from the general population. They received 1.83 times more genitourinary infection diagnoses (95% CI – 1.43 to 2.33), 1.31 times more diagnoses for other types of infections (95% CI – 1.11 to 1.55) and 1.21 times more respiratory and ear infection diagnoses (95% CI – 1.05 to 1.40). There was no statistically significant difference regarding skin infection diagnoses. These results indicate an association between CSA and more frequent infectious diseases diagnoses.

Sociodemographic and geospatial associations with community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) infections in a large Canadian city: an 11\u2009year retrospective study

BackgroundThe first Canadian outbreak of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) was identified in 2004 in Calgary, Alberta. Using a novel model of MRSA population-based surveillance, sociodemographic risk associations, yearly geospatial dissemination and prevalence of CA-MRSA infections over an 11 year period was identified in an urban healthcare jurisdiction of Calgary.MethodsPositive MRSA case records, patient demographics and laboratory data were obtained from a centralized Laboratory Information System of Calgary Laboratory Services in Calgary, Alberta, Canada between 2004 and 2014. Public census data was obtained from Statistics Canada, which was used to match with laboratory data and mapped using Geographic Information Systems.ResultsDuring the study period, 52.5% of positive MRSA infections in Calgary were CA-MRSA cases. The majority were CMRSA10 (USA300) clones (94.1%; n = 4255), while the remaining case (n = 266) were CMRSA7 (USA400) clones. Period prevalence of CMRSA10 increased from 3.6 cases/100000 population in 2004, to 41.3 cases/100000 population in 2014. Geospatial analysis demonstrated wide dissemination of CMRSA10 annually in the city. Those who are English speaking (RR = 0.05, p < 0.0001), identify as visible minority Chinese (RR = 0.09, p = 0.0023) or visible minority South Asian (RR = 0.25, p = 0.015), and have a high median household income (RR = 0.27, p < 0.0001) have a significantly decreased relative risk of CMRSA10 infections.ConclusionsCMRSA10 prevalence increased between 2004 and 2007, followed by a stabilization of cases by 2014. Certain sociodemographic factors were protective from CMRSA10 infections. The model of MRSA population-surveillance and geomap outbreak events can be used to track the epidemiology of MRSA in any jurisdiction.

Stressful by design: Exploring health risks of ride-share work

IntroductionFor-hire driving work, such as taxi driving, is characterized by long hours of sedentary behaviour, passenger assault, lack of benefits or support, and isolating working conditions that jeopardize good health. The for-hire driving industry has recently expanded to include a new group of ride-share drivers from digital platforms such as Uber and Lyft; this has substantially increased the number of people engaged in for-hire driving. However, there is very little existing research on ride-share drivers’ health and safety in relation to their work, and no research on the Canadian context. MethodsThis paper draws from a qualitative study consisting of in-depth interviews and focus groups with ride-share drivers and passengers, taxi drivers, taxi and ride-share managers, and other industry key informants in a large Canadian city. This paper focuses on ride-share drivers’ health risks on the job. ResultsThis study finds that ride-share drivers face physical and mental health risks resulting from ride-sharing work that are distinct to ride-share work, as well as ones similar to taxi driving and other transportation work. We find that the nature of the work is stressful by design: ride-share drivers face regular stressors and pressures from passengers, such as to speed and drive young children without proper booster seats. They also describe weight gain and muscle pain. ConclusionAs greater numbers of passengers opt for ride-share transportation and more people take up ride-share work, understanding potential short- and long-term health implications is an important area of inquiry. Understanding the working conditions of ride-share drivers can support the development of appropriate policy and practice tools to improve ride-share drivers’ health and safety.

Heterogeneous Trajectories of Delayed Communicative Development From 12 to 36 Months: Predictors and Consequences.

The objective of the study was to identify distinct trajectories of delayed communicative development from 12 to 36 months and examine differences in risk factors and developmental outcomes for each trajectory. Participants were 2192 children drawn from a prospective longitudinal pregnancy cohort in a large Canadian city. Maternal pregnancy medical records were used to determine perinatal risk factors. The Ages and Stages Questionnaire Communication subscale was administered at 12, 24, and 36 months. At 36 months, mothers reported on the child's health, cognitive, and behavioral development. Using growth mixture modeling, we identified 4 trajectories of communicative development. Most children (81.1%) were characterized by high and stable scores from 12 to 36 months. The remaining children fell into a low-increasing class (13.0%), a moderate-stable class (4.5%), and a low-decreasing class (1.4%). At 36 months, the low-increasing class had caught up to the high-stable group. However, by 36 months, the low-decreasing class fell under the recommended "referral" cutoff, and the moderate-stable class fell under the "monitoring" cutoff criteria. Children with continued communication problems at 36 months were more likely to have a congenital anomaly and lower family income than late-talking children who had caught up. Repeated assessments of a brief screening tool were able to differentiate patterns of communicative development over time, each with unique risk factors and developmental outcomes. Results highlight the potential for risk factors and repeated screenings to help identify children most at risk for persistent communication delays and in need of early support services.

The Concentration of Crime at Place in Montreal and Toronto

The identification of hot spots of crime – areas of high crime intensity – is of primary importance for crime prevention strategies. While the notion of crime hot spots is well accepted in Anglo-Saxon criminology, its empirical foundation is largely drawn from U.S. studies, and comparatively little literature is available for other countries, including Canada. Taking advantage of their respective “open data” initiatives, this study compares the spatial pattern of the two largest Canadian cities, Montreal and Toronto. The authors also review and empirically explore five propositions from the existing literature: (1) that a small proportion of places account for a large proportion of recorded criminal incidents; (2) that crime concentration is inversely correlated with the size of geographic units; (3) that crime concentration drastically varies whether all places or only places where at least one crime occurred are considered; (4) that different hot spots are identified at particular times of the day; and (5) that hot spots of different crime types do not overlap much. Both Toronto and Montreal appear to be very similar in terms of crime concentrations and hot spots. Additionally, this study provides preliminary support for the idea that findings from other countries can be generalized to the Canadian context.

Deep mapping gentrification in a large Canadian city using deep learning and Google Street View.

Gentrification is multidimensional and complex, but there is general agreement that visible changes to neighbourhoods are a clear manifestation of the process. Recent advances in computer vision and deep learning provide a unique opportunity to support automated mapping or ‘deep mapping’ of perceptual environmental attributes. We present a Siamese convolutional neural network (SCNN) that automatically detects gentrification-like visual changes in temporal sequences of Google Street View (GSV) images. Our SCNN achieves 95.6% test accuracy and is subsequently applied to GSV sequences at 86110 individual properties over a 9-year period in Ottawa, Canada. We use Kernel Density Estimation (KDE) to produce maps that illustrate where the spatial concentration of visual property improvements was highest within the study area at different times from 2007–2016. We find strong concordance between the mapped SCNN results and the spatial distribution of building permits in the City of Ottawa from 2011 to 2016. Our mapped results confirm those urban areas that are known to be undergoing gentrification as well as revealing areas undergoing gentrification that were previously unknown. Our approach differs from previous works because we examine the atomic unit of gentrification, namely, the individual property, for visual property improvements over time and we rely on KDE to describe regions of high spatial intensity that are indicative of gentrification processes.

Community-based participatory research remodelling occupational therapy to foster older adults' social participation.

Occupational therapists who provide community-based services are well positioned to foster older adults' social participation. However, community occupational therapists rarely address social participation and require support to change their practice. This study initiated a remodelling of community occupational therapy services by (a) selecting practices fostering older adults' social participation and (b) identifying factors that could affect their integration. A community-based participatory research study was conducted in a large Canadian city. Four focus group meetings and seven individual interviews were held with 28 key informants. A continuum of emerging practices was identified, including personalized, group-based, and community-based interventions. Potential enablers of these practices included clinical support, better communication, and user involvement. Organizational and systemic barriers were related to the institutional culture and performance indicators. These results point to innovative ways to foster older adults' social participation and identify potential enablers and barriers affecting their integration.