Services In Canada Research Articles

30 Access to Autism Spectrum Disorder services for marginalized families in Canada: A scoping review

Abstract Background In Canada, despite universal healthcare, immigrant and racially marginalized families face unique barriers when accessing Autism Spectrum Disorder (ASD) services for their children. Exploring these experiences is critical to inform the federal government’s efforts to create a national autism strategy that serves children and families with ASD in Canada. Objectives We conducted a scoping review of immigrant, refugee, and racially marginalized families’ access to, utilization, and experiences with ASD services in Canada. Design/Methods The Joanna Briggs Institute scoping review methodology was used. A literature search in MEDLINE, EMBASE, CINAHL, APA PsycINFO, Scopus, and Web of Science was conducted in August 2023. English and French-language qualitative studies describing the experiences of marginalized families in Canada with accessing and/or using ASD services for their child <18 years were included. To assess eligibility of search results, title, abstract, and full-text screening were conducted independently by two reviewers. For included studies, two reviewers extracted data and appraised articles using the Critical Appraisal Skills Programme qualitative checklist. Results There were 4,489 search results. After de-duplication, 3,804 studies remained. Of these studies, 12 met inclusion criteria – representing 320 immigrant caregivers living in Ontario (n=167), Quebec (n=151), and British Columbia (n=2). Caregivers immigrated from Africa (n=55), Latin America (n=43), Europe (n=25), Asia (n=13), North America (n=11), the Middle East (n=4), and unreported (n=169). Of note, no studies focused on refugees. Common barriers when accessing ASD services were related to: difficulties navigating the health system (wait times, limited resources in the public system, high costs for private services, lack of collaboration between school and healthcare providers), challenges interacting with service providers (feeling unheard, discrimination, lack of continuity of care), and cultural differences (regarding ASD, language barriers, social isolation). In contrast, families identified supportive healthcare and school personnel, provision of culturally-specific multilingual resources, and parent-led peer support networks as key facilitators to ASD service access and use. Conclusion These results highlight gaps in existing research, especially around the experiences of refugee families. Our findings reiterate the importance of greater caregiver involvement in informing evidence-based recommendations to improve Canadian service provision, policy, and research. This national focus is especially relevant, given that 23% of Canadians in the most recent 2021 census are landed immigrants – representing the highest proportion of immigrants in Canada to date and emphasizing the growing need for culturally competent care.

“Increasing Demands and Competing Priorities”: How Organizational Structure Affects Worker Well-Being in the Victim Services Field

ABSTRACT This study examined the impact of organizational structure on worker well-being in victim services in Canada. With data collected from 915 survey respondents, 24 semi-structured interviews, and 19 focus group participants, we found that although there are many aspects that negatively affect worker well-being (e.g. lack of funding, inadequate compensation, understaffing, large caseloads), positive aspects helped ameliorate the negative (e.g. a positive team environment, support from supervisors, flexibility and autonomy within the position, and witnessing client resilience). Given the increases in workload and stress stemming from the COVID-19 pandemic, it is essential to understand the current landscape of worker well-being.

Landscape of healthcare transition services in Canada: a multi-method environmental scan

BackgroundPoorly supported transitions from pediatric to adult healthcare can lead to negative health outcomes for youth and their families. To better understand the current landscape of healthcare transition care across Canada, the Canadian Health Hub in Transition (the “Transition Hub”, established in 2019) identified a need to: (1) describe programs and services supporting the transition from pediatric to adult healthcare across Canada; and (2) identify strengths, barriers, and gaps affecting the provision of transition services.MethodsOur project included two iterative steps: a national survey followed by a qualitative descriptive study. Service providers were recruited from the Transition Hub and invited to complete the survey and participate in the qualitative study. The survey was used to collect program information (e.g., setting, clinical population, program components), and semi-structured interviews were used to explore providers’ perspectives on strengths, barriers, and gaps in transition services. Qualitative data were analyzed using the Framework Method.ResultsFifty-one surveys were completed, describing 48 programs (22 pediatric, 19 bridging, and 7 adult) across 9 provinces. Almost half of the surveyed programs were in Ontario (44%) and most programs were based in hospital (65%) and outpatient settings (73%). There was wide variation in the ages served, with most programs focused on specific diagnostic groups. Qualitative findings from 23 interviews with service providers were organized into five topics: (1) measuring transition success; (2) program strengths; (3) barriers and gaps; (4) strategies for improvement; and (5) drivers for change.ConclusionsWhile national transition guidelines exist in Canada, there is wide variation in the way young people and their families are supported. A national strategy, backed by local leadership, is essential for instigating system change toward sustainable and universally accessible support for healthcare transition in Canada.

Exploring contexts for using digital food retail services in Canada: A qualitative study

This study aimed to understand contexts for buying food online with food delivery apps, meal kits, and online grocers in Canada. A total of 34 participants (24% identified as men) between the ages of 16 and 60 were interviewed over the phone. The participants were recruited through personal and professional networks, electronic word of mouth, and paid social media ads. The interviews were transcribed verbatim and thematic analysis was used to generate major themes: convenience, food literacy, and cost-effectiveness. Convenience was multifaceted, including protecting time, minimizing food preparation effort, and facilitating food access (without a vehicle, during illness and isolation, during bad weather, with mobility challenges, or while consuming drugs or alcohol). It was found that regardless of age, gender, or lifestyle, the contexts for using digital food retail services were similar. These services made food acquisition and preparation easier; however, the benefits may be at the detriment to food literacy. The added value that digital food retail services provided made up for any additional costs. This study highlighted the need for public health practitioners to consider different facets of convenience and the added value that digital food retail services offer when making healthy food shopping and preparation recommendations. Additionally, further investigation into the impacts of digital food retail on food literacy is warranted. Results from this study will be integrated into a larger survey exploring the relationship between online food purchasing behaviors and diet quality among Canadians.

Equity in home care use in Canada: a cross-sectional analysis of the Canadian longitudinal study on ageing

BackgroundAlthough home care is an essential service that enables older adults to age at home, there are concerns that not all populations have equitable access to home care services in...

“I feel like it should be but I know it’s really not”: exploring physical fitness priorities at the correctional training program in Canadian federal corrections

ABSTRACT The correctional training program (CTP), composed of three stages, includes a 14 week in-person component that Correctional Officer Recruits (CORs) must complete prior to their employment as a federal Correctional Officer (CO) for Correctional Service Canada (CSC). The CTP prepares recruits for a plethora of CO responsibilities, some dependent on physical fitness, such as responding to codes being called, physical altercations, or violent situations. Unlike other public safety positions (e.g. policing, border services, or coast guard) CSC does not require occupational fitness testing. In the current article, we use data from a multiyear longitudinal study of federal COs from across Canada to unpack how CORs manage physical fitness expectations at CTP; CSCs’ expectations of COR physical fitness; and outline what types of physical fitness (e.g. weightlifting, cardiovascular, self-defence) are taught, thus valued most, during CTP. We situate the voices of CORs regarding physical fitness within the broader “body” literature and discuss policy recommendations tied to physical fitness, specifically COs’ interest in reinstating pre-employment physical fitness screening.

Environmental and Economic Analysis of Reusable and Single‐Use Food Packaging Formats in University Campus Food Services

ABSTRACTThe purpose of this study is to assess the environmental and economic impacts of the various food packaging systems offered in university food services in Canada. Toronto Metropolitan University's food service was chosen as a test case. Three systems exist in this setting: single‐use polypropylene (PP) containers, reusable PP clamshells and compostable bagasse clamshells. The goal is to understand which system has the most favourable impact regarding the Tool for the Reduction and Assessment of Chemical and other environmental Impacts' (TRACI 2.1) 10 impact categories and which system is the most financially viable through a cost analysis. The scope includes a cradle‐to‐grave life cycle assessment (LCA) consisting of raw material extraction and production, transportation, usage and end‐of‐life disposal. This study investigates the environmental impact of each packaging system for 10 000 meals consumed by students. This research follows two ISO standards, 14044:2006, and 14040:2006. These standards involve defining the goal and scope, completing a life cycle inventory (LCI) analysis, completing a life cycle impact assessment (LCIA) and interpreting the life cycle. LCI information is extracted using SimaPro v9.0. The study results reveal that the reusable PP clamshell has the least environmental impact when compared to the two other single‐use packaging alternatives for nine of the 10 environmental impact categories. The single‐use PP container has the most significant environmental impact due to its harmful material extraction, production processes and end‐of‐life emissions. The sensitivity analysis determined that if reused a minimum number of 37 times, the reusable clamshell (RU) remains favourable to the single‐use formats in nine of the 10 impact categories. Furthermore, the cost analysis reveals that the reusable packaging format is the most financially favourable when reused 16 times or more. This research concludes that single‐use food packaging options have a more significant environmental impact than reusable PP clamshells. Based on the research findings, purchasing a less harmful detergent, sourcing the packaging locally and reducing the loss rate of reusable PP clamshells could produce an even more favourable environmental impact for the reusable food packaging system.

The Need for a Standardized Body-Worn Camera Policy

Based on a survey of all federal, provincial, municipal, and First Nations police services in Canada, 36 of 172 Canadian police services are using body-worn cameras (BWCs) as of 2022. Twenty-seven of these services shared their BWC policy with the researchers of the source article. Almost all BWC policies provided activation instructions, required subject notification of BWC use as soon as reasonably possible, did not allow BWC footage to substitute for other forms of evidence, and permitted users to view their BWC footage. However, some important topics were not consistently discussed in existing policies, including issues around camera buffering, victim-sensitive practices, and services publicly disclosing BWC footage in the public interest. Police services should work towards using a nationally standardized BWC policy to promote evidence-based practice, increase public confidence in police, reduce resource wastage in services acquiring BWCs, and decrease liability for services using a shared standard.

Computer-Based Training for Cognitive Behavioural Therapy for Substance Use Disorder: A Randomized Controlled Trial Including Quantitative and Qualitative Health and Economic Outcomes: Formation informatisée pour la thérapie cognitivo-comportementale pour les troubles liés à l'usage de substances : un essai randomisé contrôlé y compris les résultats quantitatifs et qualitatifs en matière de santé et d'économie.

Heavy alcohol and drug use is reported by a substantial number of Canadians; yet, only a minority of those experiencing substance use difficulties access specialized services. Computer-Based Training for Cognitive Behavioural Therapy (CBT4CBT) offers a low-cost method to deliver accessible and high-quality CBT for substance use difficulties. To date, CBT4CBT has primarily been evaluated in terms of quantitative outcomes within substance use disorder (SUD) samples in the United States. A comparison between CBT4CBT versus standard care for SUDs in a Canadian sample is critical to evaluate its potential for health services in Canada. We conducted a randomized controlled trial of CBT4CBT versus standard care for SUD. Adults seeking outpatient treatment for SUD (N = 50) were randomly assigned to receive either CBT4CBT or treatment-as-usual (TAU) for 8 weeks. Measures of substance use and associated harms and quality of life were completed before and after treatment and at 6-month follow-up. Qualitative interviews were administered after treatment and at follow-up, and healthcare utilization and costs were extracted for the entire study period. Participants exhibited improvements on the primary outcome as well as several secondary outcomes; however, there were no differences between groups. A cost-effectiveness analysis found lower healthcare costs in CBT4CBT versus TAU in a subsample analysis, but more days of substance use in CBT4CBT. Qualitative analyses highlighted the benefits and challenges of CBT4CBT. Findings supported an overall improvement in clinical outcomes. Further investigation is warranted to identify opportunities for implementation of CBT4CBT in tertiary care settings.Trial Registration: https://clinicaltrials.gov/ct2/show/NCT03767907.

Anarchists, Naturalists, Hippies, and Artists: Beliefs about Midwifery Care and Those Who Choose It

Although demand for midwifery services in Canada is increasing, research suggests that a low proportion of Canadians would consider midwifery care for their or their partner’s pregnancy. There is still a significant gap in knowledge about why Canadians prefer physician or obstetrician based care over midwifery care. In order to further understand these preferences, the current research employed a qualitative exploration of young adults’ commonly held beliefs about midwifery care and people who choose midwifery care. Discussions about midwifery care and people who choose midwives as their primary care provider during pregnancy and birth were elicited through seven focus groups consisting of 3-7 young adults each, for a total of 29 participants (20 women and 9 men). The discussions were audiotaped, transcribed, and analyzed using thematic analysis. Our analyses of the data suggested that participants seemed to believe that people who choose midwifery care value “the natural”, actively eschew the medical system, rebel against convention, value personal experience, and maintain alternative lifestyles. Midwifery care and midwife-assisted births were characterized as facilitating a positive prenatal and birth experience for the mother, but were also often characterized as risky for the pregnancy overall, and in particular for the baby, requiring a high degree of trust on the part of the mother. Midwifery care and midwife-assisted births were described as old-fashioned, and ultimately uncommon. Recommendations for marketing strategies, based on these findings, are suggested. This article has been peer reviewed.

Gender Roles in Corrections: How Gendered Expectations Impact Female Correctional Officers

Compared to other organizations within the criminal justice system, the world of corrections is hidden from public view, and therefore, quickly forgotten. However, like many of these male-dominated organizations, there are significant issues regarding gender and women's roles in the job. With the considerable lack of research regarding correctional officers within Canada and the relatively small percentage of women in the correctional workforce, it is vital to expand this topic to understand the complication of a gendered role. Research has shown gendered issues among female correctional officers and the lack of the support they may receive. With all these persistent issues, we ask ourselves, why do women continue a career path that appears to be working against them? More specifically, how does gender influence women's experience in long-term careers in corrections? To answer this, I conducted in-depth qualitative interviews with women who maintained long-term roles in Correctional Service Canada (CSC). This presentation will discuss these women's gendered experiences working within a masculine organization, how their gender affected their relationships and job expectations, and how CSC may view them.

Ukrainian refugee women’s experiences of settlement and navigating health and social services in Canada

Ukrainian refugee women’s experiences of settlement and navigating health and social services in Canada

Feminization of equity deserving work in the third sector

Non-profit work plays a vital role in connecting policy and community, as well as providing essential services in Canada. However, evidence suggests that despite being often engaged in equity seeking work, many non-profit organizations remain sites of inequity and marginalization among service provider staff. In this qualitative study, researchers conducted interviews with representatives from 60 organizations across the province of Alberta, Canada. Using intersectionality and thematic analysis, the study identified three key themes across issues related to the feminization of gender-equity seeking work in the third sector. First, economic exploitation, including low pay across the non-profit sector, and pay discrepancies across positions within non-profit work, impact staff in gendered and racialized ways. Second, uneven labour expectations compound exploitation through failures of performative Equity, Diversity, and Inclusion (EDI), unpaid labour expectations, and gender bias both within and outside of organizational structure. Third, service provider capacities are being restricted through staff mental health challenges and burnout, staff use of the services they provide clients, and challenges with worker retention. Organizations and funders may address these inequities by demanding transparency in promotion policies to ensure women and gender-diverse people, particularly those who are racialized, have fair access to management and leadership positions, as well as by reforming funding structures to encourage more equitable pay.

Pursuit of Equity: Women on a Low Income Navigating Access to Health and Social Services in Canada.

Existing research highlights the role of social determinants of health, such as education and housing, in predicting health outcomes and the challenges that arise from deficiencies in these areas, often linked to societal inequities. Gender and income are recognized as social determinants of health, yet the complexities of their interplay, particularly for women with low income seeking health and social services in Canada, need more exploration. This study investigates how gender and income intersect to affect access to health and social services for Canadian women with low income. Employing a participatory action approach with arts-based and interpretive methodologies, the study partnered with a non-profit organization to engage five women through photovoice, interviews, and a focus group, aiming to capture their experiences in accessing services. The analysis revealed three primary themes: the labyrinth-like complexity of navigating health and social service systems, the importance of mental health sanctuaries, and the value of supportive networks. Participants reported difficulties and frustrations in system navigation, often feeling ignored by service providers. Contrarily, community agencies provided essential non-judgmental support, including daily necessities and emotional care, with the companionship of pets also being a notable source of comfort. The findings advocate for a shift towards more person-centred care in health and social service systems to better serve women in vulnerable positions, emphasizing the need to simplify the process of accessing services and ensuring that service providers recognize and address the unique challenges faced by equity-deserving groups.

Recommendations to Improve Services and Supports for Domestically Sex Trafficked Persons Derived from the Insights of Health Care Providers.

Health care providers are highly likely to encounter persons who have been domestically sex trafficked and, therefore, possess valuable insights that could be useful in understanding and improving existing services and supports. In-depth interviews were conducted with 31 health care providers residing and working in Canada's largest province, Ontario. Results were analyzed using Braun and Clarke's analytical framework. Across providers, a key theme was identified: "Facilitators to improve care", which was comprised of two sub-themes, "Address needs in service provision" and "Center unique needs of survivors". From these results, eight wide-ranging recommendations to improve services and supports were developed (eg, Jointly mobilize an intersectoral, collaborative, and coordinated approach to sex trafficking service provision; Employ a survivor-driven approach to designing and delivering sex trafficking services). These recommendations hold the potential to enhance services in Canada and beyond by reducing barriers to access and care, facilitating disclosure, aiding in recovery, and empowering those who have been domestically sex trafficked.

International Tax Planning: Taxation of Professional Athletes—Stickhandling Through the Maze

Recent changes in Canadian tax laws have important implications for many professional athletes relocating to Canada from the United States or other countries. At the federal level, proposed changes to the alternative minimum tax, foreign-income reporting requirements, and a broad range of other taxes have introduced complexity and potential traps for the unwary. At the provincial level, the five provinces with a National Hockey League team have raised their top marginal tax rates over the last 10 years. Because the financial stakes can be high, understanding the tax laws and the tax-planning opportunities for professional athletes has become more important than ever. This article addresses some key income tax issues and planning opportunities for professional athletes earning income from the provision of cross-border services in Canada and the United States.

Virtual urgent care is here to stay: driving toward safe, equitable, and sustainable integration within emergency medicine.

Virtual care in Canada rapidly expanded during the COVID-19 pandemic in a low-rules environment in response to pressing needs for ongoing access to care amid public health restrictions. Emergency medicine specialists now face the challenge of advising on which virtual urgent care services ought to remain as part of comprehensive emergency care. Consideration must be given to safe, quality, and appropriate care as well as issues of equitable access, public demand, and sustainability (financial and otherwise). The aim of this project was to summarize current literature and expert opinion and formulate recommendations on the path forward for virtual care in emergency medicine. We formed a working group of emergency medicine physicians from across Canada working in a variety of practice settings. The virtual care working group conducted a scoping review of the literature and met monthly to discuss themes and develop recommendations. The final recommendations were circulated to stakeholders for input and subsequently presented at the 2023 Canadian Association of Emergency Physicians (CAEP) Academic Symposium for discussion, feedback, and refinement. The working group developed and reached unanimity on nine recommendations addressing the themes of system design, equity and accessibility, quality and patient safety, education and curriculum, financial models, and sustainability of virtual urgent care services in Canada. Virtual urgent care has become an established service in the Canadian health care system. Emergency medicine specialists are uniquely suited to provide leadership and guidance on the optimal delivery of these services to enhance and complement emergency care in Canada.

(232) The Use of Restorative Therapies for Erectile Dysfunction: A Review of the Current Canadian Landscape

Abstract Introduction Erectile dysfunction (ED) is the inability to achieve or maintain an erection that is sufficient for sexual performance. Restorative therapies are heralded as options to restore one’s natural, spontaneous erection without the need for pharmacologic therapy. There is a growing interest in these therapies including low-intensity shockwave therapy (Li-EST), platelet-rich plasma (PRP) and stem cells for the treatment of ED. However, limited data exists to support their routine clinical use. With direct-to-consumer marketing, numerous clinics across Canada now offer this therapy. We sought to investigate the landscape of restorative therapies for ED across Canada. Objective The objective is to evaluate how restorative therapies for ED are being marketed and administered to patients. Our study hopes to analyze cost, indications for treatment, equipment utilized, treatment protocol, clinic ownership, level of training for staff, and whether a urologic consult is required prior to treatment. Methods Searches were made on a private Google browser with queries that include phrases “Shockwave therapy for erectile dysfunction in Province/Territory”, “PRP therapy for erectile dysfunction in Province/Territory”, among others. Searches were also made to include any stem cell regenerative therapies for ED. Clinics advertising their services online had their public website analysed for preliminary data collection. Our team captured data on costs, treatment duration, success rates, adjuvant therapies administered and more. Data obtained was then compared against existing literature to assess the accuracy of marketing towards patients. Results To date, we have obtained preliminary results from 107 clinics across Canada offering a form of restorative therapy for ED. We hope to contact every clinic offering these services in Canada by the end of the study period in August of 2023. Out of the identified clinics thus far, 72.9% are offering SWT and 49.5% are offering PRP treatment for ED, with 27.1% of clinics offering both. Our team was unable to identify any clinics providing stem cell therapy for ED. The average cost of SWT from the data we have collected thus far is $1701.92, ranging from $500 to $3500 for a six-treatment protocol that a majority of clinics opt for. Similarly, the average cost of PRP is $1458.22, ranging from $875 to $2000 per treatment. 15% of clinics reported a success rate for SWT, with a mean of 76.81% (ranges 50-100%). A singular clinic has quoted the success rate of PRP at 75% currently. Out of the 107 clinics contacted, 74 of them listed their ownership and staff. 12.2% of the clinics that listed their staff had a urologist present, 56.8% of them had a non-urologist MD employed on staff, and 31.1% did not have an MD present at the clinic. Conclusions Our study has so far found that Li-SWT and PRP for restorative therapies are being largely marketed directly-to-consumer with very little urologic intervention prior to treatment throughout Canada. The study highlights similar trends found in the US, taking advantage of the psychosocial burden faced by patients that suffer from ED, tacking on substantial financial costs for restorative therapies. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific.

Access and Equity of Legal Support Services for Racialized Survivors of Sexual Violence

Existing research reveals that survivors of sexual violence (SSV) face barriers in reporting sexual assault, such as fear of the criminal justice process. These barriers are more complex for racialized SSV, whose unique needs and experiences may differ from White SSV. In order to increase accessibility of legal support for SSV, a project offering free legal services in Canada was developed to support survivors by providing them with the legal information necessary to make informed decisions about reporting. One of the primary goals of the project was to tailor services to racialized SSV in order to ensure equitable access to justice for this population. This paper presents the outcomes of these efforts from multiple stakeholders involved in the project’s implementation. Our findings reveal important considerations for what constitutes justice for racialized SSV, and the importance of centering them in the design and implementation of support services.

Public Service in Canada post‐COVID‐19 pandemic: Transitioning to hybrid work and its implementation challenges

AbstractThe impact of the COVID‐19 on the nature of work cannot be overstated. In Canada, following the largest and quickest transition to remote work ever, a significant number of public servants found themselves working from home for most of 2020 and 2021. As governments come out of the pandemic, they begin transitioning to hybrid work arrangements. This article analyzes attitudes and perspectives of public servants in the Public Service of Canada on return to office and transitioning to hybrid work. It also discusses how these can inform research and practice in Canadian public administration.