What you need to know
In the Ontario child and youth mental health sector, there are no consistent strategies, frameworks or guidelines for organizational practices to improve racial equity for clients, family members and staff. The authors of the commentary profiled highlight five organizational practice domains that support the provision of equitable services, including: (1) organizational leadership and commitment, (2) inter-organizational and multi-sectoral partnerships, (3) workforce diversity and development, (4) client and community needs and engagement, and (5) continuous improvement.
COVID-19 has had a disproportional impact on the mental health racialized adults. This is due to many factors, including poor housing conditions, precarious labour and racism. Racialized youth in Canada also face significantly more barriers to care than their White counterparts. They are more likely to mistrust the health system, resulting in underutilization of health services and poorer health outcomes. Recent events in Canada and across the world have motivated many organizations to reflect on their role in perpetuating racism and how they can be part of the solution to end racial inequities. However, in Ontario’s child and youth mental health sector, there are no consistent strategies, frameworks or guidelines for organizational practices aimed at improving racial equity and supporting staff in providing equitable services.
What did the researchers do?
The Ontario Centre of Excellence for Child and Youth Mental Health and Children’s Mental Health Ontario have embarked on a journey towards advancing racial equity in the child and youth mental health sector in Ontario, Canada. This journey began with an exploratory review of the literature and a scan of organizational practices that support racial equity in child and youth mental health agencies across the province. Racialized leaders, service providers, youth and family members were included in their implementation science and quality improvement approach.
What did the researchers find?
The literature on racial equity approaches includes five organizational practice domains:
- Organizational leadership and commitment. Strong leadership and a public commitment to anti-racism is essential in improving racial equity. Organizations must align their vision, policies and resources. Organizational progress is positively associated with leaders who provide positive feedback, express interest and engage in racial equity training, driving change.
- Inter-organizational and multi-sectoral partnerships. Advancing racial equity requires working with other community organizations to share knowledge and connections to improve outreach, access and coordination of care to racialized communities. Together, organizations can also facilitate system-level changes that address social determinants of health. For example, cross-sectoral collaborations with the education sector and community-based partnerships with churches have demonstrated improved mental health outcomes for youth and broader outcomes for racialized communities by overcoming stigma, facilitating early identification of mental health needs and increasing points of access to mental health care.
- Workforce diversity and development. Engaging racialized staff, recruiting more diverse workforces and training staff in cultural responsiveness, anti-racism and racial equity to reduce negative biases leads to equitable outcomes. Staff that are representative of the communities they serve have the knowledge and experience to understand and address the needs of racialized communities. They can also overcome the mistrust that stems from systemic racism, negative experiences and outcomes.
- Client and community needs and engagement. Quality engagement and equal partnership with racialized youth, family members and communities is required to directly incorporate their voices and co-develop services as well as organizational and system-level initiatives. Anti-racist mental healthcare also emphasizes the importance of providing assessments and services that are culturally and linguistically appropriate. Important work is already taking place to establish culturally responsive care, such as frameworks for providing culturally responsive and strengths-based services to Indigenous communities.
- Continuous improvement. This includes developing frameworks with an equity lens, focusing on accountability through evaluation procedures and identifying areas for improvement. Engaging impacted communities for feedback and interpreting data is also required to ensure that efforts are not perpetuating inequity and gain valuable feedback for improvements. Confidential race-based demographic data from staff and clients, centered in racial equity, can further inform agencies of the unique needs and strengths of their own organization, as well as the communities they serve.
How can this information be used?
Training staff on anti-racism and collecting race-based data is a start to advancing racial equity, along with addressing barriers of funding and organizational capacity. Researchers, policy-makers and child and youth mental health service providers need to work together. They must aim for significant and sustained progress to ensure children and youth from varied cultural, ethnic and linguistic backgrounds receive the best care possible.
What future research is recommended?
Future research is required to understand the role of the Board of Directors, isolating and evaluating behavioural and organizational outcomes of racial equity focused training, and identifying effective strategies to retain and learn from racialized staff.
About the researchers
Gabrielle Lucente, Julia Kurzawa, and Evangeline Danseco, Ontario Centre of Excellence for Child & Youth Mental Health, Children’s Hospital of Eastern Ontario, Ottawa, ON, Canada