University of Western Ontario: Tools aim to improve care for people experiencing substance use stigma


Stigma and discrimination associated with substance use have been shown to contribute to barriers to care, especially among marginalized and Indigenous communities. Now, a team of researchers at Western and the University of British Columbia have launched an Action Kit of resources for health care providers in order to help combat substance use stigma and improve care in the future.

“The Action Kit encourages practitioners and organizational leaders to engage people with experiences of stigma and poor care in a way that ensures their voices are heard and prioritized,” said project co-lead Nadine Wathen, professor at the Arthur Labatt Family School of Nursing at Western. Wathen says these tools support efforts by organizations and systems to improve social and health outcomes on a large scale.

Colleen Varcoe, professor emeritus of nursing at UBC says stigma and discrimination make it very hard for people to seek care, particularly if they’re Indigenous, or are assumed to have a history of substance use. “They expect they’ll be judged, disrespected or denied care because they are assumed to be ‘faking it’ or to be looking for drugs.”

With the recognition that this work needs to be embedded into the larger strategy of an organization, the new tools, strategies and resources, called the EQUIP Equity Action Kit, include both self-directed learning modules for practitioners but also larger strategically-focused resources.

The action kit includes:

E-learning modules on what equity-oriented health care means and how health care professionals can provide services in a trauma- and violence-informed, culturally safe way,
Organizational planning tools and report cards to help organizations assess their current practices and also implement tools to address stigma and reduce racism toward Indigenous people and others who are targets of discrimination,
Videos and tools that highlight the effects of substance use stigma and other harmful practices and how to enact strategies to address them, including how to identify barriers to care, and how to change stigmatizing language.
In addition to being co-lead on the overall project, Wathen led the development of the Trauma- and Violence-Informed Care Foundations e-learning module. Developed alongside members of Western’s Gender, Trauma & Violence Knowledge Incubator, this e-learning module is being adapted for use in Western’s Nursing curricula, and related modules are being developed across different content areas, including cancer screening, public health nurse home visits, gender-based violence services and teacher education.

A key partner on this work is the London InterCommunity Health Centre (LIHC), which provides health and social services to those who experience barriers to care, including poverty, homelessness, mental health and substance use issues in the London community. LIHC has deep expertise in health equity and substance use health.

“Having the opportunity to contribute to the EQUIP Equity Action Kit demonstrates how equity-oriented care is an ever-evolving process. Our team is hopeful that our experience working in substance use health can help others build their skillset and feel more confident in working with this marginalized population by delivering high quality, trauma – and violence-informed care,” said Greg Nash, director of Program Development and Complex Urban Health at LIHC.

Practitioners at LIHC both contributed to the creation of the Action Kit and are also using the tools to continue to improve care. Other partners in the project include Pain BC, Kílala Lelum, and the Community Action Team Vancouver.

“We partnered with health and social service providers and people with lived experience to develop guidance, strategies and resources to improve pathways to care for people who experience substance use stigma and related types of discrimination. A key goal is to help organizations, staff and providers to deliver care that is non-judgmental, and that will encourage people to seek help when they need it – not avoid seeking help,” said project co-lead Annette Browne, a professor of nursing at UBC.

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