Background: Stroke is a chronic disease affecting over 100,000 Canadians/year. As the Canadian population ages, more people are living longer with stroke and other chronic conditions (comorbidities). As a chronic disease, stroke care requires interprofessional, integrated approaches to care that extends across health and social sectors. There are marked inequities in stroke incidence, quality of care, access, complications and health outcomes based on factors such as race and social determinants of health. As new models of integrated stroke care are implemented, health professionals require different education and a broader understanding of the healthcare system to work collaboratively across health sectors. The skills needed to support stroke patients transitioning across health sectors require competency in interprofessional practice, stroke care, quality, safety, and integrated care. Current trends in educating future and current health professions include: 1) Increasing IPE to better prepare professionals for collaborative practice and cross-sector integrated care; 2) Education that is more patient-centred, community, and chronic disease oriented; 3) Competency- based education to be able to address health inequities and to be able to advocate for and partner with patients, families and communities; 4) Health professions education informed by the care delivery system in which its graduates will work; 5) Engaging community members e.g. health professionals, patients and families with lived experience demonstrates positive learning outcomes and student experiences and is critical in identifying learning priorities and designing, implementing and evaluating educational interventions.

Approach: This project employed a community-engaged co-designed approach to develop, implement and evaluate an experiential learning activity for health professions students that increases their knowledge and skills in providing equitable interprofessional integrated stroke care for older adults from vulnerable populations. The project addresses the intersection of EDI with interprofessional practice enabling students to apply and practice relevant skills to promote access to equitable and culturally appropriate stroke care. We co-designed the educational materials, case scenarios, vignettes, student and facilitator guides with patients and caregivers with lived experience with stroke, community stroke team members, a graduate nursing student, and faculty with interprofessional and integrated care, reflective practice and experiential learning expertise.

Results: The learning materials were integrated in two undergraduate nursing courses in the winter 2025. One course was in-person and one online. Student experiences and reflections will be shared. It is anticipated that this project will enhance learners' knowledge, promote active learning, problem-solving, critical thinking and reasoning competencies. Learning activities will emphasize development of additional health professions competencies for interprofessional practice, EDI, person-centred care, advocacy, and critical and reflective thinking.

Implications: This project offers important learnings and insights in co-designing experiential health professions education materials that reflect the current realities of integrated stroke care across the care continuum. In addition, it can be used with both health professions students and existing healthcare professionals delivering integrated stroke care.

Next steps: We plan to share this work with other health and social care professionals across our university programs and with integrated stroke care programs. Revise materials based on this year’s implementation for continued integration in health professions education curricula.

Background
The intersection of an ageing population, socioeconomic deprivation, and debilitated health and social care services leaves care provision in England in need of drastic transformation. Integrated Care Systems in England provide interventions for communities that are superdiverse, with new patterns of inequality and segregation influencing health policy and fiscal strategy. Despite record advances in care ingenuity and radical treatment, the COVID-19 pandemic significantly impacted health and social care workforces, with practitioners reporting burnout, unsafe staffing levels and decreasing recruitment. To meet the demand for competent and skilled health and social care practitioners, this study seeks to examine the relationship between professional education within Integrated Care Systems and the advancement of fair and equitable health and social care for those in diverse communities.

Approach
This project employs a multi-stranded, mixed method approach to develop understanding of the requirements of underserved groups to receive fair and equitable health and social care within Integrated Care Systems and conceptualise this knowledge into a model for training professionals for use within educational programmes. Scrutiny of the available literature and scoping of available interventions in the primary phase of the study examined methods in use for training professionals within Integrated Care Systems and developed the conceptual framework underpinning the design of the current qualitative phase of the research. A constructivist grounded theory methodology has been employed to explore the perceptions and experiences of service users, carers and health and social care professionals on the provision of fairness and equity of care provided within Integrated Care Systems. This process has been co-produced with community leaders from underserved groups and health and social care professionals to ensure a collaborative and culturally competent methodology is implemented throughout.

Results
The study has identified core components of fairness and equity within health and social care, including commitments to person-centred practice, conceptualisation of integrated care within Integrated Care Systems as a driver for addressing inequalities and opportunities for culturally component methodologies to improve care provision for underserved communities. The findings from the qualitative study will be conceptualised in a co-production approach into an instructive framework for health and social care professional education.

Impact
This project provides contribution to the existing theoretical literature on the understanding of fair and equitable health and social care through a social justice lens, with a focus on groups typically underserved by traditional care provision. Examining these principles within the context of Integrated Care Systems and integrated care provides contemporary knowledge aligned to current national policy within England as well as drivers for service reformation as illustrated within the 9 Pillars of Integrated Care. In later phases of the project, the results will impact both empirical knowledge of the training curricula for use within Integrated Care Systems for fair and equitable care provision, alongside opportunity to influence policy and workforce development agenda.

Background

Based at Canada’s largest academic health sciences network, the University Health Network (UHN), the Gattuso Centre for Social Medicine is a data and partnership-driven program integrating health and social care delivery for UHN’s most medically and socially complex patients. The Centre for Social Medicine recognizes that health and poverty are inextricably linked. To address long-standing health disparities, the Centre co-designs models of care with partners across sectors and patients with lived experience towards sustainable solutions. These care models focus on “super-utilizers” — patients with repeated emergency department (ED) and inpatient visits — with comprehensive and wrap-around health and social supports to better address structural factors such as homelessness, food insecurity and poverty.



Audience

This workshop invites health and social care professionals, policymakers, and leaders interested in multi-sector partnerships to improve population health. Ideal participants are those looking to co-design interdisciplinary, integrated care models that align with local needs and strengthen multi-stakeholder cooperation for sustainable impact.



Approach

The link between health and social outcomes demonstrates the importance of co-designing the program with people with lived experience, incorporating local knowledge from community partners and forging relationships with all levels of government to improve population health. The workshop will explore the creation of the Social Medicine Initiatives developed collaboratively with the Lived Experience Advisory Council and implemented through cross-sectoral partnerships:

Social Medicine Housing Initiative (Dunn House) an innovative model of permanent supportive housing that integrates community supports and mobile, low-barrier access to care including primary care, psychiatry, and harm reduction with affordable housing.

Social Medicine Care Model that addresses complex medical and health needs through supports from Nurse Practitioners and Community Health Worker teams.

Stabilization & Connection Centre to provide preferential care to patients experiencing alcohol and/or opioid intoxication.

Participants will engage in a 20-minute interactive session, where they will discuss action plans for implementing partnership-driven integrated care models in their communities.



Outcomes

Participants will leave equipped with strategies for fostering inter-agency partnerships and strengthening collaboration to meet local health needs. Participants will learn the fundamentals of engaging with individuals with lived experience, service providers, and other stakeholders throughout the design, implementation, and evaluation stages. The program will cover identifying best practices for delivering integrated care, improving population health, and recognizing high-priority populations. Additionally, participants will learn strategies for generating partnerships with government and philanthropic donors, enhancing their capacity to support community health initiatives effectively.

Patient stories will highlight the impact of the Centre for Social Medicine, underscoring its role in connecting patients with essential resources, reducing avoidable ED visits, and fostering sustainable housing solutions. This workshop offers attendees a framework for community-driven integrated care to strengthen partnerships that can improve health outcomes for vulnerable groups.

Background: Individuals at risk of, or living with, cardiac conditions such as heart failure are at increased risk of mental health conditions such as depression and anxiety, and vice versa. There is a need to establish better processes for supporting communities to understand gaps in their care delivery systems for brain-heart interconnected conditions and for the co-design, implementation and evaluation of community-driven health initiatives such as community planning tools and education/communication strategies developed in collaboration with local government decision-makers and other community partners to address existing gaps in brain-heart interconnected care.

Approach: We established a research coalition with patients/caregivers, primary care physicians and cardiac and mental health specialists, and government decision-makers to guide this project.In collaboration with regional decision-makers in two Ontario Health Teams and provincial level decision-makers at Ontario Health we used asset mapping to identify and catalog services and resources in Ontario, Canada that support adults with interconnected brain-heart conditions. We interviewed patients, caregivers, clinicians and service providers (n=25) to understand their living/lived experiences accessing the brain-heart care services identified in the asset maps. Alongside decision-makers and patient, caregivers, and clinicians, we collaboratively identified priority areas for intervention and conducted a rapid scoping review to detail existing options for intervention. We are now co-designing an intervention that will be implemented in two Ontario Health Teams and evaluated to determine acceptability, effectiveness, scalability, and sustainability.

Results: Few services exist to support the mental health needs of people with heart failure. Clinicians and patients/caregivers are not aware of the services that do exist. There is a lack of patient buy-in for preventative services that target modifiable behavioural risk factors (e.g., smoking cessation, diet, and exercise programs) despite evidence of their effectiveness in reducing risk of brain-heart conditions. Patients experience long wait times for services. Most services offer limited support in French and other languages; patients must rely on interpreters. There are very few services customized for patients and caregivers from ethno-cultural minority groups.

The research coalition has targeted the need to increase clinician and patient/caregiver awareness about and buy-in for of community-based interventions that address the prevention and self-management of interconnected heart-mental health challenges (e.g., exercise programs, self-coaching, support groups, nutrition services). Our scoping review is underway guide intervention co-design work; it will be complete by March 2025. Intervention testing will begin in April 2025.

Implications: This project demonstrates how clinicians and service providers can be supported to work with and alongside government decision-makers and communities to create partnerships for integrated care that can result in the co-design of new models of integrated regional care delivery systems for adults with brain-heart interconnected conditions. Based on our evaluation results, we will work with government decision-makers to spread and scale our intervention across the province and country.

• Background:
Access to healthcare services is experienced unequally throughout Birmingham – one of the most deprived and diverse cities in the UK. Following the principles of the ‘inverse care’ law, many Birmingham residents have the least healthcare services available to them, precluding them from living as healthily as possible. In this paper, we discuss some of the health inequalities in West Birmingham – a locality characterised by some of the highest levels of deprivation in the UK, and a ‘superdiverse’ population. The paper provides a better understanding of how ‘under-resourced superdiverse’ communities deal with existing barriers and healthcare services shortages in their locality, and sheds light on the role of ‘bricolage’, (hyper)local voluntary, community, faith, and social enterprise (VCFSE) organisations, and the importance of co-production.

• Approach:
This a collaboration between Universities, the NHS, Citizens UK, and VCFSEs who teamed up to better understand the lived experience of West Birmingham residents trying to access their healthcare services.
The team co-designed innovative methodologies of health listening and co-produced initiatives, funded by the project partners, to help tackle some of the barriers that lead to poor health outcomes in West Birmingham.

Together, the team held five listening events with residents from ‘under-resourced and superdiverse’ communities to understand local challenges to accessing health services. Local VCFSEs facilitated residents to attend, providing space, refreshments and space for children to play. At these events 80 participants from minoritised backgrounds outlined their issues accessing healthcare, the impact on their health and wellbeing, and how they coped when facing challenges.

• Results:
The biggest barriers to healthy living and accessing health services residents identified included:
- GP accessibility
- Language barriers and lack of suitable translation/interpretation services available
- Lack of continuity of care
- Inadequate support and provision for children and young people services

Other barriers to health services were related to wider social and structural determinants that affected general health and wellbeing because these are areas of deprivation. Including:
- Local Authority closing down local sports centres and swimming pools in underserved areas
- Lack of investment to support voluntary, community, faith and social enterprise
- Poverty and cost of living concerns
- Digital exclusion

• Implications:
Using the findings, the project team then hosted a ‘community sandpit’ event to co-produce solutions to respond to these challenges. As a result of this initiative, five follow-up projects were funded to support health and wellbeing among local residents. We end this presentation with a discussion of these projects, reflecting on how West Birmingham residents are far from passive social agents waiting to be served by the NHS, who resort to ‘bricolage’ and/or turn to VCFSEs for support. As such we argue that a shift in language is needed to acknowledge this (i.e., moving away from ‘deprived’ or ‘under-served’ to ‘under-resourced’). We also conclude that the impact of superdiversity should not be trivialised when tackling health inequalities, and how a place-based approach is often better suited than scalable one-size-fits-all approaches often favoured by policymakers and funders.

Background
Our vision is to support a positive culture in the social care sector, with improved wellbeing for people receiving and providing care and support.

Introduction
Wales is a small country with a big ambition. Although we have made notable progress in bringing strengths-based, person-centred approaches into social care, economic disparity and inequality in access to health and social care challenge our vision. The Social Services and Well-being (Wales) Act 2014 gave us a legal framework to focus on these issues and in doing so, give people greater freedom to decide which services they need while promoting consistent, high-quality services across the country.

Social Care Wales is a professional body who want to make a positive difference to social care in Wales. We wanted to see the Act’s aims realised and we wanted to do it with social care professionals and the communities they serve.

Approach
During the COVID pandemic, communities led innovate responses to challenges using place-based approaches. We wanted to take this wisdom and use a place-based care lens to our work.

Here’s our journey so far:
· Principles – we researched and worked with a range of stakeholders to give people some principles that can support their work whilst giving flexibility to do place-based care.
· Participation – we explored new ways for people to get involved in not only our work but the work of communities and wider systems. We embraced the ‘What matters?’ conversations.
· Partnerships – we developed new connections to support social care, and we brought people together.

Result
· Principles – we planned strategies, and we published guidance and resources for people to use and to feed into and we are collaborating with people in the social care sector to create new ones. Social care workers are starting to proactively seek out Social Care Wales for learning and development opportunities. Ymlaen and Workforce Strategy Resourceful Communities Partnership – Co-production Network for Wales Multisector collaboration to improve community wellbeing | WCPP

· Participation – we have involved over 100 people in the Place-based Care Community, connected people across sectors for better collaboration and they were part of the development and testing of new resources. Project finder - Social Care Wales - Research, Data & Innovation Research, innovation and improvement (RII) skills resource - Social Care Wales - Research, Data & Innovation Strengths-based practice | Social Care Wales

· Partnerships – we helped build stronger relationships, especially between health, social care and charities/non-profits. We now understand each other’s work better and have started exploring further collaboration opportunities with other sectors. Balancing Rights and Responsibilities Programme Evaluation - Social Care Wales - Research, Data & Innovation

Implications
We’ve seen a lot of small, positive shifts across the social care sector and beyond and we believe that these will contribute to the bigger, sustainable changes. We’ll continue advocating for place-based approaches which build on the work and expertise of local people, organisations and the strengths and needs of different areas.

Social Care Wales continues to explore how best to work with a wider variety of people and engage more people with lived experience of providing and/or accessing care.