Social Prescribing and Community Paramedicine in Canada - A Guide to Promising Practices

1 Social Prescribing and Community Paramedicine in Canada A Guide to Promising Practices May 2025 2 Contents About this guide .............................................................................................................................. 4 Community paramedicine and social prescribing ........................................................................ 4 The role of social prescribing in community paramedicine ..................................................... 5 A three-step process for social prescribing .................................................................................. 6 Step one: identify ........................................................................................................................ 6 Step two: collaborate .................................................................................................................. 6 Step three: connect ..................................................................................................................... 6 Applying the three-step process: Promising practices ................................................................ 7 How we collected the promising practices ................................................................................ 7 Step one: identify ........................................................................................................................ 8 Identify health-related social needs ............................................................................................ 8 Build trust ................................................................................................................................... 9 Step two: collaborate ................................................................................................................ 11 Referral to connector ................................................................................................................ 11 Connector role and co-production ............................................................................................ 12 Step three: connect ................................................................................................................... 14 Connection to non-clinical supports and services ..................................................................... 14 Monitoring and evaluation ........................................................................................................ 15 Conclusion ................................................................................................................................. 16 References..................................................................................................................................... 17 Additional references ................................................................................................................... 18 Appendix A: The Common Understanding of Social Prescribing Framework (in plain language) ....................................................................................................................................... 19 Appendix B: Intervention specialist interviewed ........................................................................ 20 Authors .......................................................................................................................................... 21 3 About Healthcare Excellence Canada Healthcare Excellence Canada (HEC) works with partners to spread innovation, build capability and catalyze policy change so that everyone in Canada has safe and high-quality healthcare. Through collaboration with patients, caregivers and people working in healthcare, we turn proven innovations into lasting improvements in all dimensions of healthcare excellence. HEC focuses on improving care of older adults, bringing care closer to home and supporting the retention of the health workforce – with quality and safety embedded across all our efforts. We are committed to fostering inclusive, culturally safe and equitable care through engagement with different groups, including patients and caregivers, First Nations, Métis and Inuit, healthcare workers and more. Launched in 2021, HEC brings together the Canadian Patient Safety Institute and Canadian Foundation for Healthcare Improvement. We are an independent, not-for-profit charity funded primarily by Health Canada. Healthcare Excellence Canada is an independent, not-for-profit charity funded primarily by Health Canada. The views expressed herein do not necessarily represent the views of Health Canada. 150 Kent Street, Suite 200 Ottawa, Ontario, K1P 0E4, Canada 1-866-421-6933 │ [email protected] Social Media X │ LinkedIn │ Instagram │ Facebook Healthcare Excellence Canada honours the traditional territories upon which our staff and partners live, work and play. We recognize that the stewardship of the original inhabitants of these territories provides for the standard of living that we enjoy today. Learn more 4 About this guide The Social Prescribing and Community Paramedicine in Canada: A Guide to Promising Practices (“guide”) is designed to help paramedics across Canada systematically use social prescribing within their paramedicine programs. The goal is to help address a wide range of health and social needs of the participants. This guide defines key concepts like community paramedicine and social prescribing. It highlights the three basic steps of social prescribing and their supporting components. For each step, it shares real-world examples and practical strategies (called promising practices) from across Canada to help paramedics use these approaches in their own communities. Note Throughout this guide, we use ‘participants’, ‘people’ or ‘clients’ rather than ‘patients’, ‘person receiving care’ or other commonly used terms. We do this to show that people have choice and control over their care and how they participate in the healthcare system. Community paramedicine and social prescribing Community paramedicine is an evolving model of care where paramedics primarily deliver community-based, preventive, and primary healthcare, at times alongside their traditional emergency response and transport role. It involves paramedics collaborating with healthcare professionals and community agencies to provide preventive care, offer support, and help people navigate social services (1). This approach focuses on addressing health and social needs by connecting people with community resources to improve their overall well-being (2). Evidence shows this approach improves health outcomes for underserved populations while reducing avoidable ambulance calls, emergency department visits, and hospital admissions (3). Social prescribing is the process of helping to connect people with support and services in their community to address non-medical needs that affect their health and well-being. It involves healthcare providers and community members working together with the person (patient or client) and others in the care circle (family, friends, caregivers, etc.) to co-create a plan (the ‘social prescription’) to improve their own health and connect them with others in their community (4). 5 For example, this could be a connection to a food bank, seniors centre, class, recreational activity, legal support, or grief support group. Ideally, it also includes a way to track and measure the impacts of these social supports on the person’s health experiences, health outcomes, and use of healthcare services. Social prescribing can improve a participant's mental health and well-being, has led to significant reductions in repeat emergency department visits, and can also lead to significant return on investment (5-7). The role of social prescribing in community paramedicine Social prescribing complements community paramedicine by bridging between clinical care and social/community services. When used in community paramedicine programs, social prescribing emphasizes self-determination by supporting individuals to actively participate in their own wellness. Selfdetermination includes four elements: having choice (autonomy), feeling capable (competence), feeling connected to others (belonging), and wanting to help or give back (beneficence) (8). Community paramedics are uniquely positioned to implement social prescribing because they meet people where they are – in their homes and communities. This also means they are in a strong position to identify social factors affecting their health during home and community visits (9). While this guide focuses on social prescribing within community paramedicine programs, the practices can be adapted by any paramedic service looking to integrate social prescribing into their care model. 6 A three-step process for social prescribing Social prescribing is a structured and collaborative process that connects people to nonmedical supports to address their health-related social needs. The most basic model of social prescribing supports community paramedics to do three things when serving people in their community. Step one: identify Identify that a person has non-medical, health-related social needs (e.g. issues with housing, food, employment, income, and/or social support) and build trust. Identification can be based on a paramedic’s professional judgement and/or the use of structured screening tools. Step two: collaborate Collaborate with the person as an equal partner, to make a social prescription based on what is important to them (a process often called co-production). Collaboration can happen through a direct conversation with a community paramedic, or a community health worker called a ‘link worker’ or ‘community connector’ that the person has been referred to. Step three: connect Connect the person to non-clinical supports and services within the community, document the referral, support participation, and follow up about the results. Successful connection relies on strong partnerships between community paramedics and non-health services and organizations in the community. Ongoing monitoring and documentation are also essential for learning, improving and assessing the effectiveness of social prescribing. Many community paramedicine services are already using one or more components of this basic model of social prescribing, often referring to it by different names (including system navigation). Community paramedics excel at identifying non-medical needs (step one) and connecting people to community services (step three). However, community paramedicine services across Canada are not yet consistently engaging people as active partners in developing personalized solutions (step two), and there are opportunities to improve and systematize promising practices in each step. 7 Applying the three-step process: Promising practices This section shares promising practices from community paramedicine services across Canada. To support the application of the three-step process, we have overlayed a more detailed model of social prescribing called the Common Understanding of Social Prescribing (CUSP) Framework (Appendix A). The CUSP Framework expands social prescribing to seven key components which global experts agree are the best way to help people with their social needs. (4). We’ve organized the promising practices to show how they apply the key components of the CUSP framework, within the basic three-step process for social prescribing. How we collected the promising practices We collected these promising practices through a literature review and key informant interviews with 14 community paramedicine programs across Canada (Appendix B), including Nova Scotia, Prince Edward Island, Ontario, Saskatchewan, British Columbia, Manitoba, Alberta, Northwest Territories and Nunavut. 8 Step one: identify Identify health-related social needs Identifying participants who have unmet non-medical needs affecting their health (e.g., housing, food insecurity, employment, income, or lack of social support) is a key first step. Community paramedics are using structured assessment tools, remote monitoring, and proactive identification during clinical calls to identify health-related social needs. Structured assessment tools To effectively help participants, leading community paramedic programs are using structured assessment tools to identify social factors that affect health. These structured assessments ensure that paramedics consistently check for non-medical needs that significantly impact a person's overall health, allowing for more comprehensive care. Winnipeg Fire Paramedic Service’s Community Paramedic Program in Manitoba, paramedics complete a detailed home assessment during their first visit. This helps them understand how people see their own health and what they might be missing. They ask specific questions about things like transportation, food, social connections, and support systems. For instance, they might ask how someone gets groceries, if they have reliable transportation, who they can count on for help, and if they feel lonely. This gives a more complete view of the person's situation, so they can be connected with the right resources. Twenty-seven paramedic services across Canada use a standardized assessment tool developed by McMaster University CP@clinic Program (10). This tool examines health history, financial security, and mental health support using validated health risk assessments that look at things like the risk of heart disease, diabetes, falls, as well as quality of life, social isolation, and poverty. Remote monitoring Oxford County Paramedic Services (Ontario) uses remote patient monitoring for chronic conditions like hypertension, diabetes, congestive heart failure, and chronic obstructive pulmonary disease. This allows paramedics to identify and address health issues early, helping prevent hospital admissions by shifting to a preventative care model. 9 Proactive identification of social needs In Alberta’s EMS Mobile Integrated Healthcare program, paramedics proactively identify social needs during clinical calls. They can either support the person directly or refer them to a patient navigator (who is a staff member within the dispatch centre). The patient navigator will provide preventive service recommendations and contacts. By taking a holistic approach to patient assessment, community paramedics identify not only medical needs but also social determinants that may be contributing to health issues. Additionally, 911 paramedics proactively refer to community paramedic programs, as well as to the patient navigator. Build trust Trusted professionals or community members, such as community paramedics or community leaders, identify people who could benefit from social prescribing. These individuals play a key role in initiating the process of social prescribing. By building trust and developing relationships first, community paramedics can more effectively connect people with social services, especially in communities with historical reasons to distrust authority. Adapting appearance and service delivery In the Community Paramedicine Program at British Columbia Emergency Health Services, community paramedics are changing their appearance to build trust in some communities by removing the red stripe from their vehicles and wearing polo shirts instead of standard uniforms. Services are adapted to community rhythms like fishing seasons and religious observances. In rural Mennonite and Hutterite farming communities, paramedics in British Columbia recognize the significance of Sunday church services and help coordinate transportation for individuals who may not have family support. Ongoing collaboration with local leaders and organizations, and policy adaptations, ensure sustainable, culturally grounded healthcare solutions. For example, they have previously developed relationships with the broader community to enable community paramedics to be physically embedded within rural and remote communities, rather than deployed from ambulance stations, and they want to build on this approach. Meaningful engagement with First Nations, Inuit and Métis communities Medavie Health Services West’s Mobile Integrated Health program in Saskatchewan emphasizes genuine collaboration with the Saskatoon Tribal Council. Paramedics receive training from First Nations, Inuit and Métis organizations and are embedded within the Tribal Council’s health bus. This reciprocal relationship builds deep understanding of community services and aligns care with First Nations, Inuit and Métis needs. Paramedics participate in First Nations, Inuit and Métis-led programming, recognizing their role as part of a broader support network. This collaborative approach fosters trust and ensures culturally responsive care. In the Community Paramedicine Program at British Columbia Emergency Health Services, trust is built through face-to-face interactions and partnerships formed through direct community 16 Conclusion This guide underscores a transformative approach to healthcare. Community paramedics across Canada have made impressive strides in using components of social prescribing, demonstrating a strong commitment to holistic and person-centred care. They've pioneered innovative programs and forged valuable community partnerships. Promising practices have emerged despite a challenging context for practice change: • Documentation systems can be fragmented, hindering seamless care and outcome tracking. • Funding models can lack stability, impacting long-term service delivery. • Lack of standardized tools and pathways can lead to inconsistent implementation. • Capacity limitations inhibit community paramedics and partners’ abilities to meet the core needs of the people they serve. Aligning promising practices to the CUSP Framework highlights how community paramedics are integrating social prescribing’s key steps which aim to holistically improve health outcomes through non-clinical supports. The promising practices emphasize community partnerships, structured assessments, persondirected goals, and building trust as we shift from reactive to preventative care that addresses the root causes of health issues. Looking ahead, services have the opportunity to strengthen and systematize their social prescribing practices (deepening their engagement with each step of the CUSP Framework) and enhance their collaboration with community organizations for greater support. 17 References 1. Shannon B, Baldry S, O’Meara P, et al. The definition of a community paramedic: An international consensus. Paramedicine. 2023;20(1):4-22. doi:10.1177/27536386221148993 2. Allana A, and Pinto A. Paramedics Have Untapped Potential to Address Social Determinants of Health in Canada. Healthcare Policy [Internet]. 2021;16(3). Accessed April 1, 2025. https://www.longwoods.com/content/26432/healthcarepolicy/paramedics-have-untapped-potential-to-address-social-determinants-of-health-incanada 3. Nolan, M. J., Nolan, K. E., & Sinha, S. K.. Community paramedicine is growing in impact and potential. CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne. 2018; 190(21), E636–E637. doi: https://doi.org/10.1503/cmaj.180642 4. Muhl C, Mulligan K, Bayoumi I, Ashcroft R, Godfrey C. Establishing internationally accepted conceptual and operational definitions of social prescribing through expert consensus: a Delphi study. BMJ Open [Internet]. 2023 Jul 1;13(7):e070184. doi: https://doi.org/10.1136/bmjopen-2022-070184 5. Alliance for Healthier Communities. Rx. Social prescribing in Ontario: Final report. March 2020. Accessed April 1, 2025. https://www.allianceon.org/Rx-Community-SocialPrescribing-In-Ontario 6. Polley M, Bertotti M, Kimberlee R, Pilkington K, Refsum C. A review of the evidence assessing impact of social prescribing on healthcare demand and cost implications [Internet]. 2017 Jun. Accessed April 1, 2025. https://westminsterresearch.westminster.ac.uk/download/e18716e6c96cc93153baa8e7 57f8feb602fe99539fa281433535f89af85fb550/297582/review-of-evidence-assessingimpact-of-social-prescribing.pdf 7. Canadian Institute for Social Prescribing. A healthier Canada: An analysis of the potential economic and social impacts of social prescribing. July 19, 2024. Accessed April 1, 2025. https://www.socialprescribing.ca/a-healthier-canada 8. Bhatti S, Rayner J, Pinto A. D, Mulligan K, & Cole D. C. Using self-determination theory to understand the social prescribing process: a qualitative study. BJGP open, 5(2). 2021 9. Lunn TM, Bolster JL, Batt AM. Community Paramedicine Supporting Community Needs: A Scoping Review. Health & Social Care in the Community. 2024 Jan;2024(1). Accessed April 1, 2025. https://onlinelibrary.wiley.com/doi/full/10.1155/2024/4079061 10. CP@Clinic. McMaster University Microcredential for CP@clinic Paramedic Training Program – . March 19, 2024. Accessed April 1, 2025: McMaster University Microcredential for CP@clinic Paramedic Training Program - CP@Clinic 18 Additional references Canadian Institute for Social Prescribing. Social Prescribing in Canada 2025: Bridging the Gap Between Health and Social Care (plus fact sheets). 2025. Accessed April 3, 2025. https://www.socialprescribing.ca/resources Mulligan, K. Social prescribing in Canada: coproduction with communities. In Social Prescribing Policy, Research and Practice: Transforming Systems and Communities for Improved Health and Wellbeing. Cham: Springer International Publishing. 2024: 131-145 Mulligan, K., Card, K. G., & Allison, S. Social prescribing in Canada: linking the Ottawa Charter for Health Promotion with health care’s Quintuple Aim for a collaborative approach to health. Health Promotion and Chronic Disease Prevention in Canada: Research, Policy and Practice, 44(9), 355. 2024. Mulligan, K., Card, K. G., & Allison, S. Social prescribing in Canada: health promotion in action, 50 years after the Lalonde report. Health Promotion and Chronic Disease Prevention in Canada: Research, Policy and Practice, 44(6), 241. 2024. Shannon B, Eaton G, Lanos C, Leyenaar M, Nolan M, Bowles K, et al. The Development of Community paramedicine; a Restricted Review. Health & Social Care in the Community. 2022;30(6). Accessed April 1, 2025. https://onlinelibrary.wiley.com/doi/full/10.1111/hsc.13985 Muhl C, Mulligan K, Bayoumi I, Ashcroft R, Godfrey C. Defining Social Prescribing: Fostering Common Understanding of a Vital Tool in the Integrated Care Toolbox. December 28, 2023. 23(364) doi:10.5334/ijic.ICIC23475 19 Appendix A: The Common Understanding of Social Prescribing Framework (in plain language) The CUSP approach expands social prescribing to seven key components. In this model, trusted individuals such as community paramedics identify people with health-related social needs and refer them to a community connector. The connector works equitably alongside the person to co-produce a social prescription: a connection to non-clinical supports and services and ensures ongoing monitoring and evaluation (4). 1. Identification of health-related social needs: The process begins with identifying individuals who have unmet non-medical needs affecting their health (e.g., housing, food insecurity, employment, income, or lack of social support). This identification can occur in clinical or community settings. 2. Trusted identifiers: Trusted professionals or community members, such as community paramedics or community leaders, take note of people who could benefit from social prescribing. These individuals play a key role in initiating the process of social prescribing. 3. Referral to connector: Once identified, individuals are referred to a "connector" (sometimes called a link worker or navigator) who specializes in providing personalized support and helping the person make their own decisions. The referral ensures that individuals are guided toward relevant resources and services. 4. Connector role: The connector is vital to social prescribing. They provide personalized support by building trust, collaboratively creating action plans, removing barriers to community resources, empowering self-management, ensuring ongoing support and maintaining accountability through documentation and follow-up. 5. Connection to non-clinical supports and services: Both identifiers and connectors facilitate access to community-based, non-clinical services tailored to the individual's needs (e.g., support groups, educational programs, arts activities). 6. Co-production: Social prescriptions are co-produced collaboratively by the individual, identifier, and connector. This ensures that the intervention is tailored to the person's unique circumstances, goals, needs, and strengths. 7. Monitoring and evaluation: Ongoing monitoring and documentation is critical for learning, improving, and assessing the effectiveness of social prescribing interventions. It helps make social prescribing a regular part of systems rather than a one-off occurrence and provides clear structures for accountability and improvement. 20 Appendix B: Intervention specialist interviewed It is with thanks that we list below those who were interviewed for this guide: • Alan Batt, Paramedicine Program Lead and an Assistant Professor (adjunct) at Queen’s University • Amy Poll, Director, Community Paramedicine Program: BC Emergency Health Services, Provincial Health Services Authority (British Columbia) • Angela Sereda, Senior Operations Manager, Mobile Integrated Health Program, Medavie Health Services West (Saskatchewan) • Brent McLeod, Manager/Commander - Hamilton Paramedic Service (Hamilton, Ontario) • Donald MacLellan, Director, Mobile Integrated Healthcare, Medavie Health Services (Chatham-Kent, Ontario) • Husein Lockhart, Leader of Community & Industrial Services, AMS Inc. (Northwest Territories and Nunavut) • Ian Naugler, Advance Care & Community Paramedic (Ottawa, Ontario) • Jamie Walter, Superintendent of Community Paramedicine, Oxford County (Oxford County, Ontario) • JD Heffern, Chief Paramedic for Indigenous Services Canada with the Government of Canada • Jodi Possia, Training Officer Paramedic Education, Community Paramedicine, Winnipeg Fire Paramedic Service, City of Winnipeg (Manitoba) • Marty Mako, Commander, Mobile Integrated Health, Niagara Emergency Medical Services (Niagara, Ontario) • Mathieu Grenier, Deputy Chief - Clinical Programs, County of Renfrew Paramedic Service (Renfrew, Ontario) • Ryan Kozicky, Director – EMS Mobile Integrated Healthcare, Alberta Health Services – EMS (Alberta) 21 Authors Kate Mulligan, PhD, University of Toronto, is the founder and Scientific Director of the Canadian Institute for Social Prescribing. A health geographer and policy researcher, she's a global expert in systematic, community-led interventions for health and well-being. Syrine Gamra, MPH, is driven by a passion for implementing science, shaping health policy, advocating for change, and leading initiatives that foster positive impact. Through rigorous research and systems-level thinking, Syrine aims to dismantle systemic barriers and create pathways to equitable healthcare access and delivery. Juwairiya Ahmad, MPH, is committed to advancing health equity by addressing social determinants of health and strengthening community health systems. She strives to erase health disparities and ensure equitable access to care by bridging gaps between policy and practice through research, advocacy, and community-driven solutions. Cheryl Cameron, MEd, is an Advanced Care Paramedic and the Director of Operations with Canadian Virtual Hospice. She is a PhD candidate with Monash University studying engagement practices in the development of integrated care programs and a senior fellow with the McNally Project for Paramedicine Research.