Professor Paul Morin of Sherbrooke University, Quebec presented his research finding to an IRISS seminar in September 2012, Glasgow.

1. The story of asset-based interventione and
theirs link to mental health in Sherbrooke,
Canada
Paul Morin, Chantal Doré, Maryse Benoît, Nicole
Dallaire, Jeannette LeBlanc
CAU CSSS-IUGS, Université de Sherbrooke
Glasgow, september 7 th, 2012
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2. Outline
• Trieste’s experience
• Capabilities approach
• Sherbrooke’s experience
• Conclusion

3. Coordination devices
- Social and Health care District and Social Plan: joint
programmes on the same Zone
- Integrated projects and monitoring on Microaree
(500 to 2500 inhabitants)
- Formal accord bewteen sanitary agency,
Municipality and Council Housing
- Social entreprises and voluntary association are
embedded in the process

4. 10 micro-territories
Caracteristics of the action:
- Plurial: All the people are concerned by the
action
- Global: the action is intersectoral because it
want to address all the determinants of
health;
- Local: the action is situated in an specific
social context.

5. Microarea Valmaura

6. Microarea Melara

7. The projects want to have an
impact:
- on the health of the residents;
- on the amelioration of practices;
- on the right to have access to health
and social services;
- on the reduction of inefficient services;
- on the ressources of the community

8. The projects want to have an
impact :
- On a paradigm shift : from the structure
to the person and to all the persons;
- On their level of capability and of their
power in the management of their
health.

9. To be able to be a system
• The territory as the setting of services;
• The care of places;
• The territory as a place of institutional
reflexivity;
• Quality of services but also capability of the
service users to decide and to do by
themselves.

10. The informational flow in the Micro-area
Program
The Regional Health budget:
The appropriateness issue Reconversion of the health
and social spending
Partnerships between local
Back from the bottom up
Authorities (health agency, public
housing agency, municipality)
From the top down
Community projects at the micro
level: A practical inquiry
The inhabitants’ voices (voice to be
helped to develop and organize, and
plurality of voices to be combined)

11. Capabilities approach
• Public institutions have the obligation to
empower those found in situations of poverty,
to strenghten their capacities in such a way
that they can choose the functionnings that
they consider valuable.
• CA is above all a paradigm for assessing
outcomes of public action and policy design,
proposing as evolution criterion to what
extent they empower individuals to act and to
choose.

12. Sherbrooke’s Research
objectives
• Describe three Neighbourhood Intervention
practices deployed in a mid-sized city as primary
health and social service interventions most likely
to contribute to the accessibility, continuity, quality
and effectiveness of the delivery of services by the
health and social service centre (CSSS in French).
• Shed light on the effects perceived by
stakeholders, including third sector organizations,
on the health of individuals, the quality of life of
individuals and the community, and the
accessibility of social and health services.

13. Sherbrooke’s Research
objectives
• Describe three Neighbourhood Intervention
practices deployed in a mid-sized city as primary
health and social service interventions most likely
to contribute to the accessibility, continuity, quality
and effectiveness of the delivery of services by the
health and social service centre (CSSS in French).
• Shed light on the effects perceived by
stakeholders, including third sector organizations,
on the health of individuals, the quality of life of
individuals and the community, and the
accessibility of social and health services.

14. Design Groups involved
• Realistic, qualitative • Users
assessment • Workers
• Third sector partners
in the
neighbourhood
• Managers
• Volunteers
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15. Data collection Data analysis
• Group interviews (n = 3) • Open-ended thematic
• Individual interviews (n = analysis with
27) emerging categories
• Observation days (n = 6) added
• Monitoring of the • Team discussions
interventions during the research
• Analysis of process
administrative
documents
• Analysis of workers’
daily logs 15

16. Ascot
• Large majority of users of Neighbourhood
Intervention services are immigrants and
refugees.
• Limited use of health and social services
• The three local communities that make up
Ascot have the top three percentages of
immigrants
• Presence of many community organizations
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17. Jardins-Fleuris
• Various types of Neighbourhood Intervention
clients: single people and disadvantaged
families (limited education, little or no social
network)
• Densely populated area
• Quarter of families are single-parent families
• Community life quite dynamic
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18. Downtown
• Most of the users of the roaming team live in
the downtown area
• Mainly highly marginalized men
• The downtown community has the highest
jobless rate among men in the Eastern
Townships, and 47.1 % of families living in
rented accommodation spend 30 % or more
of their annual income on rent
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19. Intervention objectives
• Improve the assistance provided to
citizens by strengthening the links between
neighbourhood stakeholders (citizen,
community and public networks)
• Reach vulnerable neighbourhood residents
who do not know what resources are
available and/or will not ask for help
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20. Neighbourhood workers’
functions
When the project started How they look now
• Provide proactive • Provide proactive
psychosocial support psychosocial support
• Liaise with and provide – Crisis intervention
clinical support for • Develop an intervention
partners community (formal and
• Support influential informal network)
citizens • Create links between
• Facilitate various groups residents and build the
community (group
intervention) 20
• Take action on the social
determinants of health

21. Five approaches
to intervening differently
1. Specific characteristics of the
neighbourhoods and citizens
2. Proximity of the intervention
3. Proactive dimension
4. Relational dimension and networking for
mobilization
5. Continuous adjustments 21

22. Diversity of the groups created
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23. Recurring effects across
all three neighbourhoods
• Breaks the isolation
• Fosters access to resources
• Informs people
• Builds networks
• Helps create a feeling of trust
• Encourages social participation
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24. Effects on individuals
• Action on individual quality of life
– Breaks the isolation
– Helps create a feeling of trust
– Encourages involvement
– Takes concrete action
"This feeling of trust extends to other activities in the
neighbourhood. I’ve seen people who went through the
Neighbourhood Intervention who are now involved in
activities and in neighbourhood organizations and have
taken on some responsibilities." (Institutional worker) 24

25. Effects on groups
• Social integration by community arts group
People with mental health problems and people
from the community. "This group helps people
get to know each other, to talk in an unstructured
"non-therapeutic" way. It’s not part of their
therapy." (Institutional worker)
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26. Effects on third sector partners
• Strengthens links with partners
• Supports their actions
• Mobilization reinforced with partners
• Neighbourhood Intervention acts as a
"transmission belt" between partners
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27. Effects on networks
• Helps create a feeling of trust
• Creates an intervention community
"What I often try to do with the intervention community is
to make people want to say: No! He or she is excluded.
You can do a bit, then we can choose to do a bit, or we
consider everything, then another part is you, then you,
me, we’ll get there.That happens very often. We have
credibility: they’re there, which makes me want to do
something too." (Institutional worker)
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28. Effects on the neighbourhood
• Prevention and mobilization
• Improves the quality of life
Creation of a neighbourhood dynamic that
leads to working together, a better quality
of life and a feeling of security (Partners
discussion group)
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29. Effects on the health care
system
• Crisis reduction
• Avoids aggravating the situation
• Reduces mistrust
• Medium and long-term benefits
• Access to health services
"People are referred to both the CLSC and the community because […]
the idea is not necessarily to refer people to the CSSS, it’s also because
we see that people know very little about the resources so there are a lot
of referrals made to the community." (Institutional worker)
"The Neighbourhood Intervention helps correct the CSSS’s image and
publicize the services. To correct negative attitudes towards the CSSS."
(Partners discussion group)
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"The advantage is to reach out to population groups whose health is
much more precarious." (Institutional worker)

30. Effects on the social
determinants of health
• Access to housing
• Food security
• Social support
• Social participation
"Health is also the idea of offering people in the
neighbourhood an opportunity to take action."
(Institutional worker)
"It’s as if the Neighbourhood Intervention has helped
open doors, has given people the confidence [to get
involved and take responsibility]." (Institutional worker) 30

31. Challenges
• Meet new unmet needs
• Intervene in crisis situations not
considered at the outset
• Help workers to cope with the lack of
resources, users’ distress and their own
powerlessness
• Avoid creating a ghetto, needs and
dependency 31

32. Promising, structuring
intervention
• Survival of the Neighbourhood Intervention
assured with:
– Establishment of two teams with specific territories
– Inter-division clinical support and greater fluidity in the
service corridor to improve communication between all
stakeholders
– Approach focused on results for individuals, groups and
the community
– Continuous analysis and assessment
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33. Major issues
- Efficient interface between intervention
practices of third sector organizations and
public institutions in order to synergistically
create an intervention community that is
effective in supporting and strengthening
individuals and communities.
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34. Major issues
• Development process is a value-ladden
entreprise that is linked to social practices
• Communities as locus of values
• Cititizen voice and deliberative democracy
• Importance of have public institutions at
the forefront for the development of
individual and collective capabilities
• Fragility of the experiences 34

35. Thank you!
Paul.morin@usherbrooke.ca
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