Sonia Hsiung and Natasha Beaudin: How Connection and Belonging Can Change the Culture of Our Health System

(Access show transcript) Sonia and Natasha are two change makers, who join us to share the success of a recent social prescribing initiative through the Alliance for Healthier Communities.

Show Summary

When HIROC put a call out at the 2023 Alliance for Healthier Communities Conference for change makers, the community delivered. We heard about some amazing healthcare change makers across the province of Ontario – people like Sonia Hsiung and Natasha Beaudin, and the social prescribing initiative they have been involved in.

Sonia is with the Canadian Institute for Social Prescribing and the Canadian Red Cross, and Natasha works with the Alliance for Healthier Communities.

On this latest episode, Philip De Souza sits down with Sonia and Natasha to talk about how the social prescribing pilot started with just 11 sites working in collaboration with providers and clients. They share the ripple effect the initiative has had in community health across Ontario, Canada and internationally – how work like this is changing the culture of our health system towards connection and belonging.

Mentioned in this episode

Transcript

Imagine you could step inside the minds of Canada's healthcare leaders, glimpse their greatest fears, strongest drivers, and what makes them tick. Welcome to Healthcare Change Makers, a podcast where we talk to leaders about the joys and challenges of driving change and working with partners to create the safest healthcare system.

Philip De Souza: Hey listeners, it's Philip from HIROC. Thank you for listening. Today, we've got two guests for you, Sonia Hsiung and Natasha Beaudin. But first, let me tell you how we got to know them. As you all know, HIROC has many partnerships right across the healthcare sector. We're truly grateful to each and every one of them as they help drive us forward, all with the goal of turning the corner on patient safety. And so we recently collaborated with one of those very partners, the Alliance for Healthier Communities. We asked their members at their annual conference to tell us about individuals making an impact in the community, in other words, change makers. And we received many names and we're delighted to share Sonia and Natasha's story with you today. So listen up.

Welcome. I'm happy to have you both on the show today. And let's just start off, I'm going to ask you both, tell us a bit about yourself and where you work.

Sonia Hsiung: Sure. Hi, Phillip. I was actually trained as an electrical engineer, so I worked in the energy sector in what seems like a lifetime ago now, and that was soul sucking for me. So I went on to pursue more education and a career change into community development. And I worked in a number of different areas within the nonprofit sector, both internationally and then in Canada. And then I found myself in community health with the Alliance for Healthier Communities with the prescription community social prescribing pilot back in 2018. And I now work with the Canadian Red Cross to direct the Canadian Institute for Social Prescribing. And I still get to work with wonderful colleagues at the Alliance like Natasha and to continue learning from Alliance members.

Philip De Souza: Wow, that's quite a shift from electrical to what you do today. What got you into electrical in the beginning?

Sonia Hsiung: I think it was the thing that you do as an Asian immigrant child and that was the path that you take.

Philip De Souza: That's very true. I hear you and Natasha, tell us a bit about yourself.

Natasha Beaudin: Well, if we're going to go way back, so my degree is a Bachelor of Fine Arts and I started off doing art education and I shifted over to health education and health promotion. So I worked for almost 20 years at a downtown community health center here in Ottawa as a health promoter. And I did all kinds of things like food security work, smoking cessation, exercise groups, like our walking group and our stress reduction program. And then I was invited to lead a new project about social prescribing. So in addition to some of my health promotion work, I also led social prescribing, which got us started in all kinds of groups. In fact, some of the arts and culture groups. So some of my early work came back into my health work. And then I was invited to take a secondment with the Alliance for Healthier Communities. And so I have been working with the Alliance for Healthier Communities for over a year now as the lead for social prescribing province-wide for our members.

Philip De Souza: Wow, very good. So it sounds like community is in your DNA, Natasha.

Natasha Beaudin: For sure. For sure.

Philip De Souza: And I'm happy you brought up social prescribing because why we're here today. So can you both share how the social prescribing initiative got off the ground? What was the problem you were looking to solve?

Sonia Hsiung: So I can start here, Natasha, feel free to jump in any time. So in around 2018, the Alliance had an opportunity to apply for a one-time grant from the Ministry of Health for something innovative. And before 2018, the then executive director at Country Roads Community Health Center, Marty Crapper had heard about this emerging social prescribing initiative in the UK that was putting in structured pathways to bridge clinical healthcare, social services and informal community supports to address wellbeing and belonging. So Marty became quite excited for the potential for us to learn from this in Ontario.

And then in the summer of 2018, Rexdale Community Health Center ran a localized social prescribing pilot that was focused on supporting families with very innovative, very interesting connections with arts and culture. So it was a very natural next step for Alliance to apply this one-time funding towards testing out what social prescribing could look like and how it could enhance the work of member organizations here in Ontario, which is how that prescription community pilot emerged. And there were 11 community health centers that were early adopters on that journey together, including Centertown Community Health Center where Natasha was. Natasha, anything you want to add on that?

Natasha Beaudin: Well, I remember coming back from a parental leave and saying, "I'm not going to take on any big projects now. I'm a parent." And my director saying, "Great, you're going to be the lead for this new project." And I went to Toronto and learned about social prescribing. And I can remember my first impression being, well, this is the work we're already doing at community health centers because our comprehensive primary healthcare is team-based. We're already making a lot of these referrals to sometimes things that are nonclinical but that support your health and wellbeing. And then on second thought, as I worked more in this way of working, I saw how it improved our model in so many ways. So helped us really integrate our work, helped make those connections between the clinical side of things and our health promotion side and the social workers and the counselors really provide that holistic care. So at first, I had to get my head around it and then once I saw all the benefits, I was able to share those benefits with my colleagues and then my colleagues started seeing the benefits of working in this way.

Philip De Souza: Very cool. And who supported you all on this journey?

Sonia Hsiung: Well, we had to start with lots of mentorship from colleagues in the UK. So we had folks from their National Health Service, we had physicians and others who had embarked on this work earlier to inform us about what they did and what they learned. But as Natasha said, it really was work that was already happening in community health centers and other Alliance members. And it was more around building a bit more of that intentionality, the structure pathway, the measurements within our system. So I would say the 11 pilot sites ended up supporting each other quite a bit. We met quite frequently, Natasha, I don't remember if it was monthly or...

Natasha Beaudin: Wasn't it daily?

Sonia Hsiung: It probably felt like daily. No, I was bothering Natasha all the time to learn and there was just so much creativity within each center as well where the teams ended up supporting each other and Centertown had a awesome team with an awesome name.

Natasha Beaudin: Yeah, I always try to come up with good acronyms because we have a lot of committees, so I called it the SOHOT team, the social prescribing horizontal team. But I think the great thing about that team having different members from across different departments in our large community health center was we could ask the nurses, "Okay, how is this going to work best for you? How is the easiest way for you to send this referral? How can we communicate what programs exist?" We could ask the physicians, we could ask the nurse practitioners, we could ask our outreach workers. We had our health analyst on that team, we had our data management coordinator. So it was like an opportunity for us to share each of our perspectives and how we could really improve our collaborations as a team and make the whole center more efficient.

Philip De Souza: I love that. And it sounds like communication is at the core, which is very critical to any initiative getting off the ground and being successful. And so with that, what has the impact looked like thus far with this initiative and what feedback have you received from the community?

Natasha Beaudin: Well, I can talk a little bit about Centertown, what I saw. So sometimes I felt like my primary care colleagues would be like, "Well, I'll send you down the hall to Natasha's yoga program", and they weren't always sure. Sometimes I felt like there wasn't always confidence that some of our health promotion programs really fit into healthcare sometimes. Sometimes I felt that way. But as Sonia mentioned earlier, being able to track those referrals instead of just saying, "Oh, just go down the hall." I verbally told the client that it wasn't... What we did with social prescribing is we tracked it through our EMR, we had that referral on the client's file, and then we could say, "Oh, did they end up attending that group?"

And then what I started seeing happen was my colleagues in primary care, so physicians would say, "I was really dreading that checkup with that client this morning because they're so anxious and it's hard to actually get through the checkup. But they've been doing that stress reduction program now for six months and I saw a change in how our checkup went. We were able to get through it. I was able to really get to what matters to the client because..."I heard things like that or I heard we started a coffee drop in as just an easy way for some of our clients who were quite isolated and quite fearful from joining groups. And then I would hear from my physician colleagues, "They brought it up in their appointment that they enjoy this coffee club and that they've made some social connections and just the mere fact that the client brought it up in that limited time we have together tells me how much they value it and what an impact it had on them."

And then I'll say one more quick thing is we flagged 50 clients who were frequent users of primary care and who also had end codes associated with low level anxiety, low level depression, loneliness, isolation. And we targeted them for our social prescribing. And what we saw by the end of our nine months was that their primary care visits decreased by 50%. So that's a nice concrete piece of evidence where we can say, "Ah, yes, if clients are going to meet with their doctor or their nurse practitioner every week and talking about feeling lonely, there's limited ways that a clinician can respond to that, but there's these other nonclinical supports that can help that client with some of those needs."

Philip De Souza: And it's very timely you bring that up, Natasha, because I'm sure everyone's been watching the news. And here's all about the variety of reports and the epidemic of loneliness is quite prevalent and not just in community health centers, but everywhere. So I know our listeners appreciate you bringing that point up as well. And yeah, Sonia, please add as well.

Sonia Hsiung: Yeah, there was just so many fantastic stories that came out from all of the different pilot sites. And as Natasha said, that ability to track the outcomes was just powerful. On the topic of loneliness, we saw an overall decrease in people's sense of loneliness by 49%. And that is huge. That was over just a nine-month period and people reported better mental health, better sense of connection to their community. And what was really important as an outcome of this pathway is that people said they felt that they were seen and heard as whole persons even when were in their clinical appointments. And that made such a shift in peoples' sense of self-confidence, their sense of purpose, their sense of, yes, I can manage my own health and I have the ability and capacity to do it in this way.

Another thing that we haven't mentioned was that there was a big push to towards co-creation in the social prescribing pathway and how it was implemented at Alliance centers, was that clients are people who also have gifts to contribute and that they were invited to contribute their gift in their communities. And that was also where we saw a very significant shift in seeing people as health creators and not just users of the healthcare system. So that's the personal and community impact, but there's also this continued ripple effect of the success of the pilot having inspired a lot of organizations and communities right across Canada and internationally. So we received the first award for an international project from the Social Prescribing Network in the UK because of the strong equity lens that Alliance members apply to their initiatives. And Centertown hosted a learning delegation from Singapore for, Natasha, was it six weeks, eight weeks?

Natasha Beaudin: Yeah, something like that. Yeah. They came to learn both about social prescribing and about the model of community health centers to bring that back to their community and to their healthcare system.

Sonia: It's really wonderful. And that was a time limited pilot that ended in 2020 right before the whole system's attention shifted towards the pandemic. But we're continuing to see, and we have continued to see, interest from different communities and also funders to continue building out and expand on this work and expand on the impact.

Philip De Souza: No, it's very good. And speaking of that impact, what's next for you both and even this initiative?

Sonia Hsiung: Yeah, just say that with the funder interest, there was at least three different social prescribing programs that emerged from that, that Natasha is now leading and deepening and making happen. So Natasha, do you want to speak to those?

Natasha Beaudin: Sure. So in 2021, we launched a three-year project called Links to Wellbeing, which is a partnership with the Older Adult Centers Association of Ontario. And that's helping to connect socially isolated, older adults with seniors active living centers across Ontario. And we are still recruiting health partners for that project. So if anyone's interested, feel free to get in touch in the fall, sorry, about a year ago we started the black focus social prescribing. So with this project, we're working with four community health centers to develop a social prescribing model that is grounded in black and Afrocentric values and principles with a focus on supporting families and children.

So we're asking how can we make social prescribing culturally safe and decolonize aspects of the healthcare system to improve health outcomes for black people in Ontario? So that one has been quite exciting and interesting to work on. And in the fall, our third project, we launched social prescribing for Better Mental health, which is funded by the Public Health Agency of Canada. And we're working with 28 sites to improve social prescribing pathways and developing resources and tools. And we have also started an online learning module on social prescribing, which will be widely available in November.

Philip De Souza: Wow. I think every point you brought up, I was like, this is amazing. There's so much momentum and the word 'possibility' came to mind. And so thinking of those two things, where do you both draw your inspiration and motivation from to keep this impact, this movement moving?

Sonia Hsiung: I think for me, on a personal level, my mother was an immigrant to Canada as a single mother, and I was old enough to have seen how difficult I was to settle in a new place, build connections, find jobs, find housing, and the one thing she did find was a primary care provider. And I just think how amazing and how much easier her journey would've been if we had this interconnected network across the board. And I'm also continually inspired and just pushed by the other passionate change makers that I have the privilege of working with, like Natasha. And I think that passion begets passion and it really helps to drive what we do forward because there are challenges, there are mistakes, there are failures, and it's wonderful to have a community around where we can support each other.

Natasha Beaudin: I think Sonia and I work very well together, and even I have some new colleagues and I said, "Okay, once you start working with social prescribing, you don't have to work hard to get the enthusiasm up." The people who are interested in this bring a lot of enthusiasm and they bring a lot of passion. I feel like having worked at a downtown community health center for many years, I really saw the strength of our community members and our clients and how a lot of those folks faced just challenges that you would be really surprised to know exist in a wealthy country like Canada, in a wealthy city like Ottawa. So people living in poverty, living with challenges with their housing, with accessing food, with accessing equity on many, many different levels.

And then seeing those people work hard on their goals and triumph, there is nothing comparable to watching that in terms of inspiration. And even earlier when Sonia mentioned that role where the clients could step in and volunteer, that's where I saw some amazing strengths come out. We started a creative writing group and we had peer leaders trained and seeing people step into a role, people who maybe were on a long-term disability or had different reasons for not being able to step into the workforce fully, but they could take on a role and take on some leadership and seeing that client blossom with those opportunities, that was very impactful.

Philip De Souza: Most definitely. And so this story you've both painted, it sounds fantastic. I'm definitely encouraged and I'm motivated, but if there are one or two pieces or even three pieces of advice you can share with our listeners right now, if they wanted to start something like this or partner with you both or one of your organizations to do something like this, what would that advice be?

Natasha Beaudin: I think something that I always say is that you can start small. I always start with a pilot. I always start small. I test things out and then slowly build as I go. There's some really easy referrals that exist for social prescribing, like 211, Ontario Caregivers Organization, the Seniors Active Living Centers through the Older Adult Center Association of Ontario, or even my physician colleague at Centertown, Dr. Kent, shared that she had a client who was expressing feelings, isolation so the doctor asked a few questions, "What did you used to like to do? How did you connect before?" "Oh, we always used to have dogs." And the client got a dog. And then through walking the dog made some social connections and needed a dog sitter when she went away. And then the client also expressed that she used to go to church.

And so the doctor said, "Well, could you connect with another church again?" And the client started going to church and joined the choir and found community in those ways. And then when something very difficult happened in that client's life, she had a community that surrounded her. People said, "Oh, I didn't see you walking your dog, so I just dropped by to check in on you", or "You weren't at choir practice for a couple of weeks, so how are you doing?" So it doesn't have to be complicated. It can be just simple community connections and it just means asking one or two extra questions with your client.

Sonia Hsiung: That's awesome, Natasha. To add on to that, and I think as the undertone also of what you've been saying is collaborate. Collaborate, collaborate, collaborate. I think part of how this work has been so successful is that everyone sees themselves in the pathway. Everyone can see themselves as a contributor, as a recipient, as someone who is a connector, someone who knows someone who needs to be connected. And this is around collaborating within the health teams, between the health teams and the community, between practitioners and also at the systems level. And so to me, that is a really huge part of how we can continue the momentum in this work. And a part of what we're doing at the Canadian Institute for Social Prescribing now is for us to be able to collaborate across provinces, across regions, bringing in leaders like Natasha and others who can collectively build a foundation for this work across Canada and advance this knowledge and awareness and changing the culture of our healthcare system towards connection and towards belonging.

Philip De Souza: I love that. Just hearing about this initiative and hearing the impact it has, like I said, it's definitely warmed me up, but we got to learn about you both and you, Sonia, first from your colleague, Kate. We had put out a call-out to all the Alliance members about people who are change makers, and she talked very highly of you, Sonia. Told us your story about how we have to have you on our leadership podcast because you bring such a unique lens and the things you're doing is making a huge impact. And then you introduce us to Natasha, and so all this to say that you both are definitely change makers in the sector, but you are both individuals who want to share knowledge across the sector so that others can scale these learnings to ensure that the system keeps moving, that people are connected, that community is thriving. And so I just want to congratulate you both on being amazing change makers. We appreciate you.

Natasha Beaudin: Aw, thank you so much.

Sonia Hsiung: Thank you.

Philip De Souza: And I thought I'd end off with a few lightning round questions to ask you both. And so do both of you have any piece, like a motto you live by?
Natasha Beaudin: So when I worked at the health center, I used to have this way to start my day to ground myself, and I had some guiding words and it would be like compassion centeredness, groundedness, and confidence. Those would be my four words I would often start my day with before I met with clients.

Philip De Souza: No, I love that.

Sonia Hsiung: I don't think I can top Natahasa. That was brilliant.

Philip De Souza: What's one thing you both are either reading or watching right now that you're just like, "I'm so happy this is in my life."

Natasha Beaudin: Ted Lasso is my favorite TV show.

Philip De Souza: Love it.

Natasha Beaudin: I also read this great book recently that was quite inspirational called I Will Live For Both of Us, a story of Inuit resistance by Joan Scott. And it's about a small group of Inuit in a small town called Baker Lake and how they resisted uranium mining. They organized and were able to resist a huge mining company and the Canadian government to prevent uranium mining in their community. It was very inspirational.

Sonia Hsiung: Yesterday I was at a fantastic workshop with Cormac Russell, and for those of you who might not know him, Cormack Russell is a wealth of knowledge and expert in asset-based community development and he has a book called The Connected Community: Discovering the Health, Wealth, and Power of Neighborhoods and just really fantastic and I would encourage everyone to listen to him. I think you can find him on YouTube or read the book. It was just the beautiful way of and recentering and regrounding the work that I do in community and in what matters and in the gifts of the people.

Philip De Souza: Very cool. If you both, separately, I had to deliver a 40-minute presentation without any preparation whatsoever. No preparation, but you had to give a presentation on whatever this is, something that I'm assuming it'll be something that means a lot to you that you can easily give. What topic or what would that presentation be about?

Sonia Hsiung: I would talk about food. I think I can free flow 40 minutes on food.

Natasha Beaudin: I'd love to do a presentation on my garden. I don't know if there'd be a great audience for that, but I have a small little urban garden that I love.

Sonia Hsiung: I love it. Do you have food in your garden, Natasha?

Natasha Beaudin: We have grapes, we have raspberries, we have lots of veggies, and I just mix the flowers and the veggies altogether. So it's very small space, but a lot happening.

Philip De Souza: Oh, that's even better. Well, we're so happy we had this time to chat with you both and just the fact that you won, you were nominated as change makers and the fact that I could definitely see you both as change makers is an amazing accomplishment. We in the healthcare community salute you and most importantly, I'm so grateful you're part of the community and you're giving back in this way as well now by sharing your story. So I really appreciate that. So thank you, Sonia. Thank you Natasha.

Sonia Hsiung: Thank you.

Natasha Beaudin: Thank you so much for having us.

Thank you for listening. You can hear more episodes of Healthcare Change Makers on our website, hiroc.com, and on your favourite podcasting apps. If you like what you hear, please rate us or post a review. Healthcare Change Makers is recorded by HIROC's communications and marketing team and produced by Podfly Productions. Follow us on Twitter at @HIROCGROUP or email us at [email protected]. We'd love to hear from you.