Unpacking the Design, Implementation and Adoption of Community-Integrated Healthcare Services in Indigenous Communities

Background: Community-based integrated care initiatives operate within the community and are designed to coordinate care around peoples needs. Owing to their multi-dimensional and multi-component design, community-based integrated healthcare models offer more comprehensive services to enhance the care of individuals with complex health and social needs. Many community-based integrated care models show improved access, patient satisfaction, cost savings, and reduced health system usage. This workshop showcases innovations in community-driven integrated healthcare initiatives that address inequities in health and healthcare for Indigenous populations.A team at the University of Alberta CARE Lab has developed an implementation framework based on global evidence. The framework outlines key mechanisms and outcomes for the design, implementation, and uptake of community-based integrated healthcare services in Indigenous communities. A key determinant identified in the framework for successful implementation is the employment of local Indigenous health workers who participate in co-designing health programs and facilitate their implementation. Thus, sufficient workforce resourcing is crucial for successful program implementation, particularly where current programs rely on the capacity of an already overburdened local workforce. Moreover, implementation strategies in Indigenous communities have focused on incorporating the expertise of Indigenous community members, Elders, and health planners; many of whom have unique skills, particularly in the fields of cultural adaptation, tailoring interventions, and appropriate implementation to mitigate barriers to implementation. Audience: This workshop is intended for community-based practitioners, health promoters, community members, patients, health system decision-makers, and academics Approach: The aims of this workshop are to () Reflect and build knowledge on the factors that enable or impede the participation of local Indigenous health workers in the co-design and implementation of integrated care services, and the skills and capacity required; (2) Identify mechanisms critical to the design, implementation, and uptake of community-based integrated initiatives in Indigenous communities. The workshop will begin with a brief presentation on the topic of equity in implementation practice (5 mins), followed by a brief presentation (5 mins) of a community-based integrated healthcare model example focused on culturally safe reproductive and maternity care for Indigenous families in northern, rural, and remote communities. In small group discussions (20 minutes), participants will reflect on the following questions: What resources or assets are critical to advocate for in the community or within organizations to support implementing and sustaining community-based integrated care programs? What evidence is needed to support implementation planning and strategies for community-led integrated programs that support diverse partnerships and promote localized application? Outcomes: The workshop key insights and directions will be summarized in a paper for publication, with the intention of contributing to scholarship on community-based Integrated healthcare models in Indigenous communities. Additionally, the discussions and insights gleaned from the workshop will be summarized and shared in a report presented to a Community Implementation Committee overseeing a community-based integrated healthcare model for Indigenous communities in northern Alberta. The group insights will also inform the refinement of implementation strategies for the community-based integrated healthcare model. The Alberta Strategy for Patient-Oriented Research (SPOR) SUPPORT UNIT Learning Health System Team is interested in equity-focused implementation science, and the discussions emerging from the workshop will be of particular interest to them.

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