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‘A prescription for fun’: How social prescribing is aiming to connect vulnerable Canadians to their communities (Erin Anderssen, The Globe and Mail)

Article by Erin Anderssen, Published by The Globe and Mail. January 2, 2024.
Image by Spencer Colby, The Globe and Mail.

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When the pediatric staff at the Vanier Community Service Centre meet with the children and teens from the Ottawa families they serve, they ask about their worries, and their hopes. Their young clients carry adult burdens: unstable housing, food insecurity, family trauma. But they dream of dance and swimming lessons, cooking classes and trips to the space museum, activities their parents can’t afford.

Two brothers, recently arrived from Haiti, saidthey wanted to meet a police officer. A 12-year-old girl from Afghanistan wished to spend time with horses. A five-year-old boy, who is non-verbal, communicated to staff with gestures interpreted by his mom that he wanted to learn how to ride a bike.

Another boy, 8, wanted to walk in a forest. He had never never seen one, even though the wooded hiking trails of Gatineau Park are a 15-minute drive from his neighborhood.

The doctors, social workers and nurses at the centre’s Social Pediatric Hub collect all these wishes, and then they write prescriptions, literally, to make them come true. They line up a tour of the police station, find a bike, book summer camp among the trees, a dance class at the National Arts Centre, a family outing to the RCMP Musical Ride stables.

Renée Aird, the program’s clinical co-ordinator, hands each child the instructions to stick on their fridge, and she asks them, “What’s this for?”

“This is a prescription for fun,” they tell her.

The one-year pilot project is testing an approach known as “social prescribing” to improve the well-being and quality of life for vulnerable children. Imported from Britain, the idea originally saw doctors writing prescriptions for community and wellness activities for patients, especially seniors, who were socially isolated.

In Canada, grassroots programs of this kind have expanded across the country for students, immigrants and low-income Canadians. The Fraser Health Authority in British Columbia has a team of “community connectors” who offer social prescribing to seniors. A similar program exists in Alberta.

Another new Ottawa pilot project will test how the approach can be used to build community for the clients of Housing First programs in the capital. Housing First provides apartments without conditions to people who are homeless, and then offers the supports they need to recover from addictions or mental illness.

An approach now adopted around the world, research has found that Housing First is highly effective at keeping people housed.But clients often reported feeling socially isolated and struggle to make connections in their new neighborhoods, says University of Ottawa psychology professor Tim Aubry, who is the lead researcher for the new pilot. “Some of them have been homeless for years,” he says. “It’s a big leap to go to yoga class.”

The pilot will connect about 30 Housing First clients with programs or activities they choose – such as walking groups, gym memberships or volunteering – and follow them over the year to see whether the practice improves outcomes, such as quality of life measures. If successful, Dr. Aubry says, the practice could be adopted by Housing First programs across the country.

Kate Mulligan, the senior director of the Canadian Institute for Social Prescribing, which was created by the federal government in March, 2022, recently returned from England. There, the practice has become formalized into the health care system, with paid workers who create individual social support plans for anyone who is referred to them – a co-ordinated system Dr. Mulligan envisions for Canada.

While in England she visited Frome, a town of 29,000 about 200 kilometres west of London, where teachers, firefighters and postal workers have been trained to connect vulnerable people to their local social-prescribing program. Meanwhile, regular “talking cafes” in town operate as community drop-in spots, for visitors to meet people and get connected to activities.

“They are trying to involve the whole community,” says Dr. Mulligan, “making sure we all are looking after each other.”

Social prescribing emerged from research showing the physical and mental health burden of rising rates of loneliness, as well as a growing awareness among health care providers that, for patients struggling with chronic stress exacerbated by issues such as poverty, racism or isolation, pills and conventional treatments had limited benefits.

In December, a group of 31 politicians, researchers and patient advocates published a letter in the British Medical Journal calling on the government to reduce the over-prescription of antidepressants for patients with mild conditions by instead investing more in areas such as social prescribing.

While the cost-effectiveness of the approach is still being studied, research shows that health outcomes are better when a patient’s quality of life is higher. Adverse experiences in childhood can be mitigated by positive ones. And as Housing First advocates say, the chances of a person staying housed and recovering from an addiction also increase when they find meaning and belonging off the street.

“We hear, ‘I am lonely,’ all the time,” says Kelly Howson, the manager of the Housing First program at Ottawa’s Options Bytown. When people move into an apartment, their caseworkers walk the neighborhood with them, mapping the pharmacy, grocery store and restaurants. Ms. Howson sees the difference it makes when a client is greeted by name at the local coffee shop, or they become comfortable working out at the local gym, or volunteering.

“A home is not just a place to put your head down,” she says. “It is a place where you can feel safe and be part of your community and give back.”

As Alex Kennedy knows, building that kind of home takes time and effort, especially when simply surviving has been the focus for so long. Mr. Kennedy, 44, moved into a studio apartment provided by Options Bytown in the spring, after living for months at the downtown men’s shelter. He had been homeless, off and on, for years before that, while struggling with an addiction.

“Initially, it was just nice to have four walls around me and a door,” Mr. Kennedy says. “But, after a while, it’s a bit of a culture shock to have a room again. It becomes about starting a new life.”

Moving away from the people you knew on the street, Mr. Kennedy adds, means finding a way to fill your day. “That’s the hardest part,” he says. “I have a lot of time on my hands.”

To keep busy, he volunteers at the shelter a couple mornings a week, and attends Alcoholic Anonymous meetings at night. He also sits on the advisory committee for the social prescribing pilot. “Some people need a nudge,” Mr. Kennedy says, of the goal behind the program. “Otherwise, you languish.”

At the Vanier centre, social workers search through a list of 160 sponsored activities to find the right match, making sure that transportation is organized, and checking in with families as the day approaches. “We all need to be focusing on hope,” Ms. Aird says, including the staff at the clinic; granting wishes is also a prescription to help prevent burnout.

Natasha Dauplaise credits the social prescribing program with restoring her 14-year-old daughter Kayley’s confidence, after she was bullied at school for her learning disability. Kayley told the social workers her dream was to “see the world,” and that she often babysat for her neighbors. Using her prescriptions, she has attended museums, passed a babysitting course and took a November trip to Disney World, with the Dreams Take Flight charity that organizes the Florida visit for children with special needs.

What’s more, Ms. Dauplaise says, Kayley learned to successfully advocate for herself. “It helped her feel better in her skin.”