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Home for All: 

What supportive housing agencies can do to 

be anti-oppressive and culturally competent 

A Toolkit 

Developed in collaboration with community stakeholders by: 

Supportive Housing and Diversity Group (SHAD) 

Supportive Housing 

and Diversity Group

Best Practices in Developing Anti-oppressive and Culturally Competent Supportive Housing 

Printed in Canada, 2008 

This project was partially funded by Canada Mortgage and Housing Corporation (CMHC). 

The views expressed are the personal views of the author(s) and do not represent the official 

views of CMHC.

Remi Warner, Research Coordinator 

Sajedeh Zahraei, Principal Investigator (SHAD member) 

Deqa Farah, Co-Investigator (SHAD member) 

Joan Nandlal, Co-Investigator 

Irene Jaskulka, Co-Investigator (SHAD member) 

Volletta Peters, Co-Investigator (SHAD member) 

Gladys Cheung, Co-Investigator (SHAD member) 

Aseefa Sarang, Co-Investigator (SHAD member) 

Paula Wynter, Co-Investigator (SHAD member) 

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Acknowledgements 

Supportive Housing and Diversity Group (SHAD) would like to extend their appreciation to those individuals who 

made this project possible. 

The documents composing the Best Practices in Developing Anti-Oppressive, Culturally Competent Supportive 

Housing project are the outcome of a one-year research project undertaken by the Supportive Housing and Diversity 

Group (SHAD), with partial funding from the Canada Mortgage and Housing Corporation. This work was accomplished 

through the substantial contributions and participation of many stakeholders, including service users and their family 

members, service providers, and researchers. We would like to express our sincere thanks to everyone who contributed 

to the success of the project through their various roles as focus group participants, focus group facilitators and notetakers, 

key informants, Project Management Team members, and Project Reference Group members. 

The Project Management Team (PMT) included SHAD members, the Research Coordinator, and the Manager 

of the Community Research, Planning and Evaluation Team at the administrative lead agency, CAMH. The PMT 

functioned in a creative, advisory, and decision-making role with regard to the research’s direction, content, findings, 

analyses, and presentation. PMT members (originally consisting solely of SHAD members) conceived of the project 

and, after gaining funding, met on a monthly basis, corresponding regularly via e-mail to review and make decisions 

about project developments. In addition to planning, participating in, and helping to conduct the research process, 

PMT members reviewed and revised research materials arising from this process, and they played an active role in 

recruiting research participants at the various research phases. 

The Project Reference Group (PRG) consisted of consumer/survivors, family members, SHAD members, 

supportive housing providers, mental health and addiction service providers, researchers, and members of agencies 

serving immigrants and refugees. The PRG functioned in an advisory capacity, with PRG members serving as critical 

informants at all phases of the project, providing input as well as sharing knowledge, experience and expertise to 

assist in developing a firm understanding of the consumer group’s needs and goals. PRG members had expertise in 

multiple areas of diversity and mental health, housing, addictions, and/or immigration settlement. 

As the primary author of the SHAD Toolkit, Project Background Document, and Literature Review, the 

Research Coordinator played a key role in all aspects of the project including designing the research, organizing and 

facilitating focus groups and workshops, conducting site visits and key informant interviews, researching and writing 

the literature review, analysing the data, developing the SHAD model, and authoring the Toolkit. 

We also offer our thanks to the following: 

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Graphic design and typesetting: Alexandra Hickey 

Plain language editing: Clear Language and Design 

Editing: Deqa Farah, Irene Jaskulka, Joan Nandlal, and Sarah Waldman 

Editing of Project Background Document and Acknowledgements: Deqa Farah and Liberty Karp 

Housing provider recruitment: Terry Baker, RENT Coordinator, The RENT network (Resources Exist for 

Networking and Training) and Gladys Cheung, Toronto Mental Health Housing and Support Network 

SHAD member agencies that have committed funding and resources to the project at various stages 

International key informants: Cashain David, Director of Care Services, Ujima Housing Association; 

James Mwesigwa, Manager, Frantz Fanon House; Kofi Sunu, Head of Care, Kush Supported Housing 

and Outreach Services; and Pat Quarcoo, Manager, Easmon House. 

Local key informants: Sojourn House, Chai Tikvah, Nishnawbe Homes, Yee Hong Centre – Aw Chan 

Kam Chee Evergreen Manor, Rainbow House, and Caritas 

Focus group facilitators: Deqa Farah, Parvathy Kanthasamy, Grace Huh, Annie Tse, Anna Kavalak, 

Neelam Sharma, Katherine Salinas, Sajedeh Zahraie, and Remi Warner (Research Coordinator)

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Focus group note-takers: Sajedeh Zahraei, Deqa Farah, Tina Wilson, Kimberly Schonewille, 

Faduma Hassan, Siva Sivagurunathan, Steve Youk, Gladys Cheung, Emillie Nguyen, Aseefa Sarang, 

Carmen Marquez and Volletta Peters. 

Project Management Team (PMT) 

NAME PMT Position ORGANIZATION 

Sajedeh Zahraei 

Principal Investigator 

(SHAD member) 

Centre for Addiction and Mental Health (CAMH), 

Community Support & Research Unit (CSRU) 

Remi Warner Research Coordinator Centre for Addiction and Mental Health (CAMH), 

Community Research, Planning and Evaluation Team 

(CRPET), Community Support & Research Unit (CSRU) 

Gladys Cheung Co-Investigator (SHAD member) Hong Fook Mental Health Association 

Deqa Farah Co-Investigator (SHAD member) Community Resource Connections of Toronto (CRCT) 

Irene Jaskulka Co-Investigator (SHAD member) LOFT Community Services 

Joan Nandlal Co-Investigator Centre for Addiction and Mental Health (CAMH), 

Community Research, Planning and Evaluation Team 

(CRPET), Community Support & Research Unit (CSRU) 

Volletta Peters Co-Investigator (SHAD member) Mainstay Housing 

Aseefa Sarang Co-Investigator (SHAD member) Across Boundaries: An Ethnoracial Mental Health Centre 

Paula Wynter Co-Investigator (SHAD member) Canadian Mental Health Association (CMHA) 

Project Reference Group (PRG) 

NAME 

Donna Alexander 

Uzo Anucha 

Amy Go 

Deqa Farah 

Azar Farahani 

Carolina Gajardo 

Anne Marie Grant 

Irene Jaskulka 

Jasmine Li 

Denise Otoo 

Shahla Pezeshkzad 

Janet Priston 

Laura Simich 

Annie Tse 

Diane Walter 

Sajedeh Zahraei 

Jim Zamprelli 

Remi Warner 

ORGANIZATION 

Centre for Addiction and Mental Health (CAMH), Substance Abuse Program for African 

Canadian and Caribbean Youth (SAPACCY) 

School of Social Work, York University 

Yee Hong Geriatric Centre 

Community Resource Connections of Toronto (CRCT) (PMT/SHAD Member) 

City of Toronto, Refugee Housing Task Group 

COSTI Immigrant Services 

Consumer 

LOFT Community Services (PMT/SHAD Member) 

Access Alliance Multicultural Community Health Centre 

Mental Health Survivor 

Family Member 

Canadian Mental Health Association (CMHA), Rehabilitation Action Program (RAP) 

Social Equity and Health Studies, University of Toronto; Centre for Addiction and Mental 

Health (CAMH) 

Hong Fook Mental Health Association 

Margaret Frazer House 

Centre for Addiction and Mental Health (CAMH), Community Support & Research Unit 

(CSRU) (Principal Investigator, PMT/SHAD Member) 

Canada Mortgage & Housing Corporation (CMHC), Policy & Research Division 

Centre for Addiction and Mental Health (CAMH), Community Research, Planning and 

Evaluation Team (Research Coordinator, PMT Member)

Table of Contents 

Acknowledgements.............................................................................i 

Part 1: Introduction.......................................................................... 1 

What is the purpose of this toolkit?....................................................... 1 

Who is this toolkit for?.................................................................. 2 

What is in this toolkit? .................................................................. 2 

How is the toolkit organized? ............................................................ 2 

Part 2: Background........................................................................... 6 

What are Cultural Competence and Anti-Oppression?........................................ 6 

The SHAD Model of Anti-oppressive, Culturally Competent Supportive Housing ................ 7 

Part 3: The Problem ........................................................................ 11 

Racialised and ethnic minority service users face barriers and challenges..................... 11 

Problems with the system............................................................ 11 

Issues for racialised and ethnic minority service users.................................... 12 

Related additional barriers affecting service users ......................................... 15 

Voice and Choice.................................................................... 15 

Integrating Family and Community.................................................... 16 

Community Development, Partnership, Coordination, Education & Advocacy................ 18 

Holistic Support..................................................................... 18 

Part 4: How to implement cultural competence and anti-oppression............................ 20 

Best practice recommendations for HOUSING............................................. 20 

Housing Model...................................................................... 20 

Housing management, rules & policies................................................. 23 

Housing Services.................................................................... 25 

Housing Activities & Programming..................................................... 27 

Housing location and neighbourhood.................................................. 29 

Physical Quality, Structure & Design................................................... 30 

Best practice recommendations in SUPPORT.............................................. 32 

Types of supports offered in supportive housing......................................... 32 

Who provides the supports........................................................... 37 

How the supports are delivered....................................................... 39 

Best practice recommendations for AGENCIES............................................. 41 

The organisation’s norms, principles, and policies ....................................... 41 

Identifying Assets and Needs......................................................... 47 

Human resources: management, policies and practices................................... 48 

Service: access and delivery.......................................................... 52 

Best Practice Recommendations for the SYSTEM........................................... 56 

Access............................................................................. 57 

Funding............................................................................ 57

Part 5: Appendices.......................................................................... 63 

Appendix A: Case Studies..................................................................... 64 

Appendix A (1): Case Studies from the United Kingdom.................................... 64 

Appendix A (2): Case Studies from Toronto............................................... 69 

Appendix B: Glossary Of Terms................................................................ 77 

Appendix C: Evaluation Tools & Other Resources............................................... 81 

Appendix C(1): Cross et al. Cultural Competence Continuum Scale............................ 81 

Appendix C(2): CAMH Organizational Diversity Scale & Measures............................ 82 

Appendix C(3): Standards and Indicators of Organisational Cultural Competence............... 83 

Appendix C(4): A Definition of Linguistic Competence...................................... 88 

Appendix C(5): Diversity: Ethnoracial Issues and Home / Community Care.................... 89 

Appendix C(6): Evolving Philosophical Approaches of Human Services in Multicultural Contexts... 95 

Appendix C(7): Comparing Values of Multicultural and Anti-Racist Approaches................ 96 

Appendix C(8): A Model for Diagnosing and Removing Institutional Racism................... 97 

Part 6: References Cited..................................................................... 99

Part 1: Introduction 

Housing and community supports are recognized determinants of health. They are vital in health promotion, 

they help prevent mental illness and addictions, and they support people who are in recovery. Many people 

with mental health or addictions issues have trouble accessing affordable, stable housing. The challenges they 

face include the stigma of addictions and mental illness, the lack of community supports as well as poverty 

and marginalization. These challenges are more intense for racialised and ethnic minority service users, who 

may also face 

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language and cultural barriers; 

lack of access to existing housing and mental health services; 

lack of culturally appropriate services; and 

institutional and systemic racism and discrimination. 

More than 47% of Toronto’s population is foreign-born. This is the highest proportion in North America, 

and one of the highest in the world. Moreover, 42.8% of Toronto’s population is of ‘visible minority’ background 

(2001 Census), supportive housing agencies need to consider issues of diversity as they design and deliver 

supportive housing. 

In 2002, a group of housing and support providers came together as the Supportive Housing and 

Diversity Group (SHAD). Their aim was to improve housing stability and reduce homelessness for racialised 

and minority ethnic clients with mental health and addictions issues. 1 They knew that racialised and ethnic 

minority tenants in supportive housing faced many barriers yet these barriers had not been studied. They also 

knew that little work had been done to identify what housing and support providers could do to address the 

needs of racialised and ethnic minority tenants in supportive housing. 2 

To fill this gap, the Supportive Housing and Diversity Group (SHAD) took on a one-year research project. 

The Centre for Addiction and Mental Health (CAMH) was the lead agency, and the project was funded by the 

Canada Mortgage and Housing Corporation. This toolkit is the result of that project. The project also created a 

background document and a literature review, which are available from SHAD members websites. 

What is the purpose of this toolkit? 

The main goal of the Best Practices in Developing Anti-Oppressive, Culturally Competent Supportive Housing 

project is to find out the best ways to provide supportive housing to people from different ‘racialised’ and 

‘ethnic minority’ communities who are dealing with mental health and addiction issues. We hope that this 

toolkit will 

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improve programs and services for Toronto’s growing racialised and ethnic minority 

population; and 

1 SHAD partners that participated in the study and development of this toolkit include: Across Boundaries, Canadian Mental Health 

Association- Toronto Branch (CMHA), Centre for Addiction and Mental Health (CAMH), Community Resource Connections of 

Toronto (CRCT), Hong Fook Mental Health Association, LOFT Community Services and Mainstay Housing. 

2 Unless otherwise indicated, we use the term ‘supportive housing’ in the broad sense to refer to a range of housing options linked to 

a variety of support services. Support services may be ‘floating’ (i.e. disconnected) or ‘attached’ to the housing premise. 

Introduction 1

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create a more equitable system in which all service users – regardless of race, culture, 

ethnicity, or creed – enjoy the benefits of effective mental health and housing services and 

programs. 

Who is this toolkit for? 

The toolkit is for people who want to guide organizational change at all levels in the supportive housing 

sector, including at the frontline, in management, agencies and the system as a whole. We hope that people at 

all levels will use this toolkit to help make programs and services more accessible and effective for racialised 

and ethnic minority service users. 

What is in this toolkit? 

This toolkit provides a framework and it outlines anti-oppressive and culturally competent practices and 

principles that can guide a process of organizational change. All of the points in this toolkit are recommendations. 

We use the term ‘best practice recommendation’ because most of the statements in this toolkit are 

recommendations rather than reports of existing best practices. The fact that best practices are not yet in place 

reflects the fact that the supportive housing sector needs to pay more attention to issues of cultural competence 

and anti-oppression. 

The recommendations in this toolkit are broad enough to apply to diverse supportive housing models 

and contexts. You should be able to tailor the best practice recommendations to your agency and apply the 

sections that have implication for your service or organization. Your organization will need to define how it 

will implement and achieve these recommendations. We encourage organizations to develop more precise 

evaluation tools, benchmarks and measures, working in partnership with the communities they serve. To do 

this, please use the evaluation tools and resources included in the Appendices. 

How is the toolkit organized? 

The toolkit begins with a section that outlines the barriers and challenges faced by racialised and ethnic 

minority service users. Housing and support providers and broader system stakeholders must consider these 

barriers and challenges as they design and develop culturally competent, anti-oppressive supportive housing. 

Our best practice recommendations are organized in four sections, or domains. We have identified four 

basic principles critical to realizing cultural competence and anti-oppression. We have included a number of 

resources in the appendices to help support agencies. Here are the definitions of each domain and principle, 

and a list of the information appended to the toolkit. 

Domains 

All of the best practice recommendations that derive from our research fit into four areas, or domains. 

We have borrowed and adapted definitions of each domain from the 2002-2003 CSRU Housing Stability study. 3 

Housing: Refers to the design and quality of the physical structure of the building, the overall housing 

model, how the house is run and operated (the management, rules and policies), the services, activities and 

programming, and where it is located within a neighbourhood and the broader community. 

3 CSRU (Community Support Research Unit), Centre for Addiction and Mental Health. (2002-2003). A Guide to Improving Housing 

Stability: Benchmarks and Recommended Practices. The Community Research, Planning and Evaluation Team, Community Support 

and Research Unit, Centre for Addiction and Mental Health, Toronto. 

2 Home for All

Support: Refers to all forms of support provided to service users by supportive housing providers and 

other service providers. 

Agency: Refers to the organizational policies, practices, and procedures, which allow supportive housing 

agencies to provide culturally competent and anti-oppressive supportive housing. 

The best practices recommendations included in this section outline the basic conditions and practices 

agencies need to start a process of anti-oppressive, culturally competent transformation. This domain includes 

critical information for anyone who works within an agency. 

System: Refers to policies, practices, procedures and initiatives that are beyond the immediate power 

and scope of any single agency on its own. This section outlines the changes needed on the systemic level to 

effectively develop anti-oppressive, culturally competent supportive housing. 

Principles 

We recognize that values and principles are essential in guiding institutional and system change. Our research 

identified four key principles that are complementary to and critical to realizing cultural competence and antioppression 

in supportive housing contexts: 

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voice and choice; 

integrating family and community; 

community development, partnership, coordination, education and advocacy; and 

holistic support. 

These principles, and the best practice recommendations that correspond to them, apply to all service 

users/tenants in supportive housing. The principles are meant to help steer policies and practices in agencies 

toward cultural competence and anti-oppression. Here is what each of these principles means: 

Voice and Choice: Refers to service users having choice, input and control over (1) their housing 

situation, including where they live, with whom they live and control over decisions about and affecting their 

daily life, and (2) the support they receive such as how often, when, and what kind of support they receive. 5 

Integrating Family and Community: Refers to the goal of integrating and connecting individuals with 

family members (if they choose, and using the service user’s own definition of family). It also refers to 

integrating and connecting the individual to members of the community, as defined by the service user, as part 

of an ongoing effort to reduce stigma and isolation, promote health and increase resilience. The principle of 

family and community integration also entails 

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shifting away from reliance on professional services; 

recognizing the key role of informal supports; 

shifting toward more autonomous self-help and mutual aid groups for service users 

and family members; 

supporting, recognizing and including family members at all stages of the recovery 

process; and 

4 CMHC (Canada Mortgage and Housing Corporation) (2002). ‘Evaluating Housing Stability for People With Serious Mental Illness at 

Risk for Homelessness’. CMHC Research Highlight, No. 100, page 3. 

5 Our definition is derived from Trainor et al.’s (2006) definition of empowerment in supportive housing contexts. 

Introduction 3

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integrating service users into regular community settings and programs not specifically 

or exclusively designed for people with mental health or addictions issues. 

Community Development, Partnership, Coordination, Education & Advocacy: Refers to four key areas: 

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community development achieved by strengthening, and supporting capacity-building 

within communities; 

■ ■ education about mental health and addictions and services, in order to reduce stigma and 

make services more accessible; 

■ ■ advocacy at individual, agency, and inter-agency levels, about issues of cultural competence 

and anti-oppression, in order to promote health and foster housing stability for people from 

marginalized communities; and 

■ ■ partnership and coordination between and among mainstream and ethno-specific service 

providers, community organizations, racialised and ethnic minority service users, family and 

community members, and various levels of government in order to improve supportive 

housing so that it is more integrated, culturally relevant and accessible. 

Holistic Support: Refers to a strengths-based, health promotion and recovery perspective which entails 

that providers consider a wide range of social and cultural determinants of health and complementary supports. 

This value is informed by an understanding that the individual service user is a ‘whole person’, with a range 

of aptitudes, strengths and support needs beyond their immediate medical situation. When service providers 

use this principle they do not interact with service users solely on the basis of their physical illness, addiction(s) 

or housing needs. Rather, they attend to the individual’s social, educational, political, economic, cultural and 

religious or spiritual needs, circumstances and interests. 

Other information 

The toolkit also includes a wealth of other information that will help agencies undertake culturally competent, 

anti-oppressive organizational change. The following materials are included in the appendices: 

Case Studies: This section includes information from site visits in Toronto and interviews with supportive 

housing providers in London, England. Each featured housing program was selected for its culturally competent 

design and program or service orientation specifically geared to meet the housing and support needs of 

racialised and ethnic minority service users. 

Glossary of Terms: The glossary includes definitions of key terms and concepts. 

Evaluation Tools and Other Resources: This section includes a range of materials that will help users 

adapt our recommendations to their agency: 

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Olavarria et al’s (2005b) ‘Standards and Indicators of Organizational Cultural Competence’; 

Cross et al’s (1989) ‘Cultural Competence Continuum Scale’; 

CAMH’s (2000) Organizational Diversity Scale & Measure; 

Goode and Jones (2003) Definition of Linguistic Competence; 

Lum et al (2007) Diversity: Ethnoracial Issues and Home/Community Care; 

6 Here we mean community development in the broader sense as capacity-building within communities. The term is not used, 

as is often the case in supportive housing contexts, to mean developing a ‘sense of community’ through collective activities. 

That understanding of community is included in the principle of Integrating Family and Community. 


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Janzen et al.’s (2006) Evolving Philosophical Approaches of Human Services in Multicultural 

Contexts; 

Vickers’ (2002) Comparing Values of Multicultural and Anti-Racist Approaches; 

Henry and Tator’s (2007) A Model for Diagnosing and Removing Institutional Racism. 

We would also recommend that users read the project background document and the literature review 

produced for this study. Both are available from SHAD members website. 

Background 5

Part 2: Background 

What are Cultural Competence and Anti-Oppression? 

Cultural Competence is an approach that ensures that agencies and programs are appropriate for people from 

a broad range of cultures. It is an ongoing and evolving process that includes learning about different cultures, 

and developing behaviours, attitudes, policies, and practices that create a “system of care”. Agencies, programs 

and individuals that display cultural competence develop and adapt services that are appropriate for the 

cultural needs of specific people, and make it possible for more diverse groups of people to access services and 

programs. 7 

An anti-oppression approach to service puts structures of power and privilege at the centre of analysis 

and concern. This approach pays attention to, and questions, the unjust exercise of power in society, institutions 

and interpersonal relations. 8 Anti-oppression asks people to take a holistic approach to diversity, paying 

attention to a diversity of oppressions and noticing how various oppressions overlap. People can face oppression 

because of their race, ethnicity, language, culture, religion, ability, sex, sexual or gender identity, immigrant or 

refugee status, income and family status among other reasons. Anti-oppression means more than just working 

towards making marginalized groups feel more included within institutions and society. Instead, it encourages 

people to question the structures and processes that keep people excluded, and to work for change. The aim of 

anti-oppressive practice is to empower individuals and communities to have more control over the resources 

and processes that affect their lives, and to change or eliminate structures that oppress people in institutions 

and in society. 

Both cultural competence and anti-oppression require that we pay attention to how oppressions 

intersect. To do this, we must recognize that people hold multiple identities and social locations, and we must 

pay attention to diversity not only between groups but also within groups. We must also examine how identities, 

social locations, experiences and systems of oppression ‘intersect’ along multiple avenues of power (including 

but not limited to race, gender, class, religion, ethnicity and ability) in ways that shape individual and collective 

experiences, as well as systems and institutions. 

Both cultural competence and anti-oppression require that people pay attention to the invisible cultural 

and political norms and standards that structure institutions and social relations. In Canada, these norms and 

standards include whiteness, Christianity and heterosexuality. The norms include and privilege some groups 

while excluding and marginalizing others. 

When agencies do not acknowledge the dominant norms and standards, they set up structures that 

reproduce social inequalities from the larger society. The only way to avoid reproducing social inequalities is 

to take a comprehensive approach to diversity. To do this we must consider differences in culture and power, 

worldview and life-chances and find ways to include these differences. Unless we do, we help reproduce the 

invisible identities and social locations that are assumed to be the norms. 

7 Based on the definition included in the Report of the Cultural Competence Workgroup for the Projects for Assistance 

in Transition from Homelessness, 2002. Projects for Assistance in Transition from Homelessness (PATH). 

www.pathprogram.samhsa.gov/pdf/text/CulturalCompetence_8_20’02.asp. 

8 Anti-oppression is different from culture-centred approaches in several ways. For more information about the differences 

between these approaches, see Appendices C[VI] and C[VII]. 


The SHAD Model of Anti-oppressive, Culturally Competent 

Supportive Housing 

The conceptual framework expressed in the SHAD Model arises out of analyzing what we learned by consulting 

service users, family members, community members, researchers, and housing and service providers. Our 

model represents the inter-relations of all five principles organizing this toolkit: cultural competence; antioppression; 

voice and choice; holistic support; integrating family and community; and community development, 

partnership, coordination, education and advocacy. Their inter-relations, and implications for our conceptual 

framework, are explained below. 

Our research findings and model are in concert with best practice principles and values endorsed in the 

wider supportive housing literature, particularly the work of Nelson and Peddle (2005). However, our model 

addresses some important gaps in existing models of best practice. 

To understand our model, start at the centre of the circle. This represents the end goal or target toward 

which one is ultimately aiming and striving for – individual voice and choice. Moving outwards, through the 

outer circles, the model depicts the necessary conditions, which make individual voice and choice possible for 

racialised and ethnic minority service users. The circles are arranged in order ascending from the micro to 

macro contexts of social interaction. Each succeeding principle, or circle, envelopes and includes the principles 

and circles that precede it. Encompassing and informing all of these principles is the overarching principle and 

value of cultural competence and anti-oppression, which connects and informs each of the other principles. 

Cultural competence and anti-oppression is signaled in the diagram by the four arrows that cut across all four 

principle circles. Anti-oppressive, culturally competent policy and practice is in this way represented as a basic 

precondition and necessary vehicle for the realization of all four principles, culminating in voice and choice. 

At the centre of this client-centred model of anti-oppressive, culturally competent supportive housing is 

the individual service user. As with service users from wider population, racialised and ethnic minority service 

users most want to have meaningful choices and a voice in relation to the kinds of housing and supports that 

they receive. The value of voice and choice is aligned with the goal of empowerment. Other research has 

shown that empowering service users by increasing their input (‘voice’) into, access to, and choice of, 

appropriate resources (housing, financial, professional, socio-cultural) promotes prevention, recovery and 

resilience, while nurturing self-esteem, self-worth, self-respect and confidence in the process (Nelson et al 

2001). We cannot emphasize enough how important empowerment is for people who have had their voices 

marginalized and/or silenced – both as people with mental health or addictions issues, and as members of 

non-dominant groups. 

To realize voice and choice for racialised and ethnic minority service users, services and resources must 

be accessible to, and appropriate for, racialised and ethnic minority service users and communities. To do this, 

agencies must adopt targeted, culturally competent and anti-oppressive policy and practice. This point has too 

often been overlooked in the wider best practice literature. Our model draws attention to the ways in which 

the lack of access to appropriate services and resources makes it difficult for racialised and ethnic minority 

service users to meaningfully exercise their voice and choice. 

Our second circle positions families and communities as central stakeholders and partners in the support 

equation. It emphasizes the importance of integrating families and communities in the empowerment and 

recovery process. Our research revealed that community integration was particularly important for racialised 

and ethnic minority persons because of the often heightened levels of stigma, social isolation and alienation 

that they face, both from members of their own community and from members of the broader society. These 

Background 7

SHAD Model of Anti-Oppressive, 

Culturally Competent Supportive Housing 

Access: Access: Culturally Culturally 

Competent, Competent, Anti-Oppressive 

Anti-Oppressive 

Policy Policy and and Practice Practice 

Socio-Cultural Resources 

Socio-Cultural Resources 

Professional Resources 

Professional Resources 





Financial Resources 

Financial Resources 





Consumer 

Family / 

Voice 

Community 

and Choice 

Integration 





Community 

Development 

Housing Resources 

Housing Resources 

Holistic 

Supports 

Political, 

Economic, Social, 

Housing and 

Health Systems 

& Institutions 

Adapted from Geoffrey Nelson and Sarah Peddle’s (2005) Housing and Support for People Who Have Experienced Serious Mental Illness: 

Value Base and Research Evidence 


service users face stigma, social isolation and alienation both as racial and ethnic minorities and as people 

with mental health and addictions issues. Our model adds family integration as a principle because research 

participants accorded family critical importance in the recovery process. Our research participants frequently 

asked for more family-friendly housing programs, supports and services. We would like to emphasize, in 

keeping with our principle of voice and choice, that agencies must allow individual service users to define the 

families and communities that they wish to integrate into. Service providers should not presume or prescribe 

family and community for the consumer. 

Our third circle, community development, partnership, coordination, education and advocacy, is 

another critical condition for realizing individual voice and choice and family and community integration. 

These preceding principles require: 

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strong, well-resourced and supportive communities and families to integrate into, and to 

receive resources and supports of choice from; 

advocacy work and education at various (individual, agency and system) levels; and 

partnership and coordination between and among mainstream and ethno-specific service 

providers, community organizations, racialised and ethnic minority service users, family and 

community members, and various levels of government. 

The Access Arrows on our model move from the centre of the circle to the periphery. In this way, the 

model encourages users to move from considering only individual access to valued resources towards 

considering how families and communities of service users are involved and have access to resources. In 

cross-cutting all four circles, the Access Arrows continually remind the user that cultural competence and antioppression 

values, policies and practices must inform everything that service providers do when considering, 

and interacting with, racialised and ethnic minority individuals, families, and communities. 

The fourth circle, holistic supports, highlights the importance of making a diverse and comprehensive 

range of supports and resources available and accessible to racialised and ethnic minority service users, 

families and communities. Holistic supports address broader social and cultural determinants of health. Four 

kinds of resources are particularly critical in maintaining and promoting service user health and housing 

stability, as pointed out in the work of Nelson and Peddle (2005): 

■ ■ Financial Resources These are the sources of income, including employment and disability 

benefits and various subsidies, that service users need in order to be able to pay the rent 

and exercise some choice and control over the type of housing they wish to live in, and the 

kinds of supports they wish to receive. 

■ ■ Housing Resources These are both the models of housing that service users can choose 

from, and the qualities, supports, designs, and locations of housing available. 

■■ 

Professional Resources These are the supports provided to service users by paid 

professionals. In keeping with our holistic conception of the kinds of supports required from 

a non-Eurocentric framework of recovery and rehabilitation, we include a wide range of 

supports and support workers in this category including social workers, case managers, 

settlement workers, legal counselors, therapists, psychiatrists, employment counselors, and 

traditional or faith healers. We advocate expanding the category of ‘professionals’ to include 

health workers and health promoters that provide holistic, complementary therapeutic 

alternatives. 

Background 9

■ ■ Socio-cultural Resources These are informal and voluntary forms of support and 

resources, whether provided by members of the family or peers and organizations from 

the wider community. These supports should be culturally relevant and use an antioppression 

framework to address ongoing histories of marginalization. They should also 

link service users with community events and activities to address their need for social 

and cultural belonging. 

The arrows that link the four resources in the holistic supports circle highlight the importance of ongoing 

communication, partnership, coordination and accountability between and among the various resource 

and support providers, including housing and service providers, governmental agencies and informal support 

providers. 

Finally, this model recognizes the numerous and important ways in which forces on the system level 

– including the political or policy environment, funding priorities, market forces and housing and health care 

systems – operate to constrain or support agencies attempting to realize and implement the principles and 

corresponding best practices recommended in our toolkit. 


Part 3: The Problem 

Racialised and ethnic minority service users face barriers and challenges 

In our research, we used focus groups, interviews and workshops to ask racialised and ethnic minority service 

users to give us their perspective on supportive housing. This section articulates what we heard. It lists the 

challenges and barriers that racialised and ethnic minority service users face both in supportive housing and 

beyond. We believe that providers and broader system stakeholders must consider these challenges and 

barriers as they design and develop culturally competent, anti-oppressive supportive housing. 

Quotes from the service users, family members and service providers consulted in this study are 

presented in text boxes beginning with the one below: 

“ ” 

Our biggest challenge is in accessing supportive housing. The most important thing is 

easy access. First, we need to get in. Everything else is luxury (Service User). 

I have never heard of supportive housing (Service User). 

My friend’s daughter age 21, tried to live in a group home but lasted only 2 weeks 

because she didn’t fit in … She was the only one from her culture and she did not 

know anyone there and she ended up homeless (Family Member). 

Very few people from my community are living in supportive housing, not because they 

don’t’ need it but because of the stigma. It’s degrading for them and they don’t want to 

admit it and reach out. People prefer to live with family, relatives (Service User). 

When I used to work at [x] Supportive Housing, I could count on one hand how many 

minority clients there were, very small percentage, they were mostly white clients 

(Housing Provider). 

I have lived in this country for 27 years and I did not know until now that there was 

this kind of support for people like me who suffer from depression. I feel ashamed of 

my ignorance. Why is no information available to everyone? (Service User). 

Problems with the system 

The challenges faced by racialised and ethnic minority service users are not being addressed by housing 

and support providers or the overall supportive housing system. 

The cultural and linguistic incompetence of the supportive housing system is keeping many 

racialised and ethnic minority service users out of supportive housing. It is keeping them stuck in 

inappropriate housing conditions where they do not have the supports they need. 

Service users from backgrounds with histories of colonization and disempowerment often feel 

excluded and powerless in the larger society. Their feeling and experience of alienation contribute to mental 

health and addictions issues. 

The Problem 11

Racialised and ethnic minority service users do not trust the mental health and addictions system. 

Here are some reasons: 

■■ 

■■ 

■■ 

they have experienced discrimination or been misdiagnosed because of Eurocentric health 

models and practices; 

they have experienced racism and stereotyping; and 

the system does not understand the broader social, cultural, political and economic contexts 

that affect their health and well-being. 

“ ” 

If you are English, there are 10 workers who speak English. You have better chances. 

But if there is only one Chinese worker, then you have one chance. You have much 

lesser chances (Service User). 

I left the housing because the tenants were very bad. They were not clean and they had 

dogs. I could not find any place to pray. When I used to tell the workers about the food 

and place to pray, they used to tell me I complain too much. So I left (Service User). 

The food is bad [in my housing] and they serve ham. When you tell them you cannot 

eat, they get angry. One time a worker told me “hey buddy, this is not Saudi Arabia” 

(Service User). 

I lived in a housing where the people I shared the place with were racist. They made 

fun of me all the time and the workers didn’t do anything (Service User). 

When you tell a white person you are dealing with racism they think you are making 

it up. They look at you with an expression “there you go again.” I think only a person 

who experiences something can understand it (Service User). 

There are lots of mainstream workers with “qualifications” but who are cross 

culturally incompetent (Service User). 

Where we live is bad for our health. Psychiatrists should visit so that they can 

understand our issues. These houses are uninhabitable (Service User). 

If you are always exposed to ugliness, garbage is everywhere…drugs are sold around 

the corner and you are dealing with mental illness and you have children [who] are 

exposed to danger, then how are you supposed to get better? It will make you 

anxious...I am afraid every-time my kids go out (Service User). 

Issues for racialised and ethnic minority service users 

Few service users from racialised and ethnic minority communities use supportive housing. Here are 

some factors that contribute to this lack of access: 

■■ 

■■ 

12 Home for All 

barriers to access within agencies and at the system level; 

they are reluctant to seek mental health and addiction services because of the stigma;

■■ 

■■ 

their mental health and addiction issues are not detected early, and intervention 

is delayed; and 

they rely on family members as care givers. 

Racialised and ethnic minority service users who are in supportive housing generally access 

supportive housing when they are in crisis. Too often, these service users access supportive housing from a 

hospital, shelter or, less often, the criminal justice system. 

“ ” 

We have to get hospitalized to get this information [about supportive housing] 


When I found out that I had mental illness, I was then homeless on the street for 6 to 

7 months…I wandered in Chinatown and the police picked me up and sent me to the 

hospital. They asked me if I needed housing, I said “yes”, then they let me go and I 

was back on the street. If someone explained to me all these [supportive housing 

options], it would have been helpful. It was not until I learned about Hong Fook that 

I found out [about supportive housing] much later (Service User). 

There is a lack of information regarding supportive housing availability for consumer 

survivors. “It is like a secret” and we only find out that they exist if we go to a shelter. 


Racialised and ethnic minority service users have trouble navigating mental health services. They 

do not have information about supportive housing or the other public resources and supports that are available 

in the community. This information would reach them if it was in their languages, their media and their 

communities. 

Racialised and ethnic minority service users who cannot access supportive housing often live in 

unacceptably poor housing conditions in impoverished neighbourhoods. In this environment they feel 

anxious about their safety and security and their physical and mental health and well-being. 

Racialised and ethnic minority service users regularly encounter racism and discrimination, which 

contributes to and compounds their mental health and addictions issues. Here are some specific issues these 

service users face: 

■■ 

■■ 

■■ 

■■ 

■■ 

discrimination in the housing market, including racism on the basis of skin colour and 

visible markers of difference; 

discrimination on the basis of gender, class/economic situation, citizenship status, and 

health condition; 

‘cultural racism’ based on stereotypes and degraded cultural, linguistic or religious 

characteristics, features and practices; 

landlords who violate their rights under landlord-tenant laws; and 

illegal housing conditions. 

All of these factors interact and intersect to shape service users’ experiences and health predicaments. 

The Problem 13

“ ” 

Everywhere we went we faced discrimination. These racist experiences had a strong 

impact on my son’s and my emotional well-being (Family Member). 

Legal status is another major barrier, if someone loses their papers. People without 

status can’t access subsidized housing…They end up in illegal apartments. It’s 

discrimination (Housing Provider) 

While I was homeless, I found a room in the basement of a house…I was abused by 

the landlord and his family. I did not know anything about my rights, so I did 

everything for them. They made me cook for them, clean and do the laundry. The 

basement was very cold, rooms were not heated, not enough water, no hot water 

available…I find many years later that this is not allowed in Canada. Who will tell us 

information? When you are poor everyone abuses you and if you don’t speak English 

no one will help you (Service User). 

We were refused housing in a ‘nice buildings’…They always have an excuse to refuse 

us. That’s why we’re only able to rent in bad buildings (Service User) 

When service users encounter cultural-linguistic incompetence and racial or cultural discrimination 

within supportive housing contexts, they feel more marginalized, isolated and alienated. It also makes them 

mistrust the health care system. 

“ ” 

The worker that I have is Canadian. Sometimes she is too rude and direct. In my 

culture we appreciate harmony and respect. As immigrants we try to learn about 

Canadian culture but workers should also learn about their own culture and our 

culture (Service User). 

“People from [my] culture do not wear their shoes inside their homes. It is a different 

lifestyle. Some workers do not understand and when they are asked to remove their 

shoes they get upset and think its rude (Family Member). 

People’s sense of ‘home’ and their ideals of home vary significantly from culture to culture. This 

includes how their home is organized, norms about how many people live in the home, what behaviour is 

appropriate, and the design and décor. Diverse ideas about home are not adequately accommodated in 

existing models. 

“ ” 

The western way (cultural norm) is one person in one room but other cultures have 

many family members under one roof (Service User). 


Frontline workers in supportive housing feel overwhelmed or unable to fully provide culturally 

competent programs and services. They are hampered by the fact that agency management is not committed 

to cultural competence and anti-oppression, or has not allocated resources for this work. 

Supportive housing agencies feel unable to implement cultural competence and anti-oppression 

initiatives because the system has not made political, policy, and resource commitments to: 

■■ 

■■ 

■■ 

affordable housing; 

supportive housing; and 

the specific housing and health needs of racialised and ethnic minority service users in 


Related additional barriers affecting service users 

Voice and Choice 

“ ” 

I believe they believe ‘They are addicted, homeless, and they don’t know anything, 

who cares’ (Service User). 

They don’t give you choices…When I asked to be transferred they told me ‘We can’t 

offer you the Taj Mahal’ (Service User). 

Workers put pressure on clients to stay in substandard housing– ‘either stay in this 

place or you’ll be homeless’ (Service User) 

[Staff] don’t really listen. Their attitude is ‘you people are sick, your suggestions, ah, 

let’s pretend to hear’ but they simply don’t care” (Service User). 

Racialised and ethnic minority service users feel they are not consulted, informed and in control of 

decision-making processes and resources that affect their lives, including decisions about where they live, 

and what supports they receive. When supportive housing contexts use consultation processes, the voices and 

choices of racialised and ethnic minority service users are often unheard, because these processes are culturally 

and linguistically inaccessible. 

Racialised and ethnic minority service users do not have the information and resources they need 

to make meaningful choices. For example, service brochures are not available in languages other than English 

and services are not advertised in the media in racialised and ethnic minority communities. 

Racialised and ethnic minority service users are concerned about racial streaming processes and 

practices in supportive housing such as assigning service users to housing in particular neighbourhoods on 

the basis of their race. 

Racialised and ethnic minority service users do not want service providers to form stereotypes 

about them, or to label their culture based on outward appearances or ethnic or cultural origins. Service 

users have diverse interests and multiple identities. Some of these identities are not based on ethnicity. 

The Problem 15

“ ” 

Some workers place Black people in poor neighbourhoods. One housing worker had 

the choice of giving me a house in the beaches or Finch and Weston Road and she 

tried to give me housing in Finch and Weston Road because she thought it’s my 

community. I wrote an angry email and I ended up getting housing in the Beaches 

(service User). 

Integrating Family and Community 

“ ” 

Clients face alienation, which is more than just being alone...Me, I have been in the 

country 23 years and I daily deal with disconnect to others in society. I have to 

manage, otherwise face mental health issues. You need to belong and be valued for 

who you are (Housing Provider). 

We are alone. If you are left on your own with your problems you cannot get better 


Social housing is far from social. There is no sense of community (Family Member). 

We shouldn’t idealize being in an ethnic community. Often the stigma is greater. In 

my community, if you tell them you have a mental illness they think you’re ready to 

kill them or push them in front of a bus (Service User). 

It is hard in this country to act like before when there was a lot of support. Everyone 

is struggling and alone. By the time you are done dealing with your problems you 

are exhausted and you have no energy for anything else (Service User). 

The housing is not suitable culturally. Supportive housing is not convenient for 

children. They don’t pay attention to the needs of children (Service User). 

When there are multi-generational families living together in the home, this produces 

a problem in supportive housing because of requirements of how many people could 

live there, etc. We have legal constraints on who we can house…For larger families – 

for example parents with six children - supportive housing does not accommodate boys 

and girls to be in separate rooms. It’s too expensive…How many share a bedroom, 

sleeping in the living room, are all based on cultural values (Housing Provider). 

Existing housing models do not cater to families. There are few family-based models of supportive 

housing. Few families can access the models that do exist. This is partly because of strict admission criteria, 

including laws about room occupancy, and the fact that there are so few affordable multi-roomed housing units. 


Housing providers often assume that family means the modern Western idea of the nuclear family. 

As a result, they do not accommodate 

■■ 

■■ 

different types of families, including the extended family which is common 

in many cultures; and 

different cultural norms of who does or does not belong in the home and in 

individual rooms. 

Service users and family members would like to see family members more involved in the recovery 

process. 

Family members who live with kin with mental health or addictions issues often feel overwhelmed 

and under-supported. 

There are not enough socially and culturally relevant peer support groups and programs for 

racialised and ethnic minority service users and family members. Most groups and programs serve service 

users and family members from dominant ethno-racial groups and are socially, culturally and linguistically 

oriented towards their needs and experiences. Racialised and ethnic minority service users and family members 

feel left out of these groups. 

“ ” 

From my experience, my daughter is really isolated. She needs a peer support group 

from the same age group to relate to age and culturally and I need family support 

group. It’s hard to find (Family Member). 

Racialised and ethnic minority service users often feel far from communal and family networks. 

They feel that they are ‘warehoused’ far from these important connections, and that many housing providers 

treat ‘home’ as merely a physical space. The service users feel that housing providers see social and cultural 

networks, and formal and informal supports, as luxuries. 

Being isolated and disconnected from their family and other members of the community often 

contributes to and reinforces mental health and addictions problems. Newcomers, especially those without 

family support, are particularly likely to be isolated and to follow a downward cycle of alienation and illness. 

Service users from racialised and ethnic minority backgrounds face high levels of stigma from within 

and outside their communities. Stigma and shame lead many service users to isolate themselves from their 

respective communities. They discourage many from using housing and health services specifically for people 

with mental health and/or addictions issues. 

Poverty significantly contributes to and reinforces service users’ isolation. Financial constraints 

restrict mobility and socialization in the wider community because of the cost of programs, services and 

transportation, difficult working hours, and living in isolated locations. 

When racialised and ethnic minority service users have unstable housing, particularly for financial 

reasons, they are less able to establish and maintain enduring social relations and networks. 

While most service users prefer independent ‘supported housing’ models, service users who live in 

supported housing often feel isolated, insufficiently supported, and left to their own resources once they 

have been placed. 

The Problem 17

“ ” 

You feel very insecure…Never know when you have to go. You don’t know what it’s 

going to be like tomorrow, whether you have to move or not. It’s never a home 


Community Development, Partnership, Coordination, Education & Advocacy 

“ ” 

Capacity building is always geared towards service providers. We need to start 

gearing capacity building towards communities (Service Provider). 

Racialised and ethnic minority service users from communities that are not well established or wellresourced 

have few or no community-based institutions and programming to integrate into. 

Many racialised and ethnic minority communities do not have appropriate and accurate information 

about mental health and addictions issues. The lack of information reinforces stigma about mental health 

and addictions, which contributes to service users being isolated. 

The supportive housing system is very fragmented, partly because of the range of stakeholders, 

agencies and governmental departments involved. The fragmentation makes it difficult for service users to 

access supportive housing. The lack of integration means that agencies often work at cross-purposes or in 

isolation from one another. 

Holistic Support 

“ ” 

There is “pill pushing” instead of caring. They don’t ask about how you are dealing 

with life (Service User). 

I got ill after coming to Canada…. For about 10 years I had to work in a dead end 

job. I used to work as a drafts person in [my country] but now I had to keep going 

back to the same packing job…I wanted to study but I had to work in a factory 

because my [relative] sponsored me…Not being able to go to school to upgrade my 

credentials really affected my health (Service User). 


The social determinants of health contribute to the ill health of racialised and ethnic minority 

service users. These factors include: 

■■ 

■■ 

■■ 

■■ 

■■ 

■■ 

■■ 

■■ 

poverty; 

unemployment, underemployment; 

lack of educational opportunities; 

little recognition of foreign education credentials; 

homelessness and housing instability; 

being victimized by crime and violence; 

systemic racism and abuse; and 

‘settlement stress’ resulting from social exclusion and not enough social support. 

The supportive housing and health care systems do not recognize and use traditional non-western 

cultural, spiritual and religious-based forms of support and therapy. 

Mental health and addictions services, including housing and support programs, often do not treat 

racialised and ethnic minority service users as ‘whole persons’. When agencies interact with service users 

only on the basis of their illness – as opposed to their health, strengths and assets – they reinforce stigma and 

downplay the consumer’s self-healing powers, agency and their role in the recovery process. 

How to implement cultural competence and anti-oppression 19

Part 4: How to implement cultural competence 

and anti-oppression 

Best practice recommendations for HOUSING 

Housing refers to the design and quality of the physical structure of the building, the overall housing model, 

how the house is run and operated (the management, rules and policies), the services, activities and 

programming, and where it is located within a neighbourhood and the broader community. 

To address each of these areas, our best practice recommendations fall into the following categories: 

■■ 

■■ 

■■ 

■■ 

housing model; 

management, rules and policies within the housing unit; 

the services, activities and programmes administered, organized and run by the housing 

provider; 

where the housing is located, and its physical structure, quality and design. 

Housing Model 

“ ” 

People should have options to integrate or to live with people from the same ethnic 

groups (Service User). 

For me, I have to live with people from the same culture, who speak the same 

language… If I have to live with others in the same house, I’d rather live with my 

family (Service User). 

Our (ethno-specific) model has been very successful. Consumers don’t have to move out 

of the community…They have comfort, familiarity and a sense of being ‘home’. Creating 

a sense of family, community and home is crucial to the rehabilitation process… It also 

helps with the difficult transition process (faced by service users who are living away 

from home for the first time). (Toronto Area Ethno-specific Housing Provider) 

To develop anti-oppressive and culturally competent housing models, we recommend that agencies: 

■■ 

■■ 

■■ 

advocate for and expand the number and range of ethno/cultural-specific and genderspecific 

housing programs and models 

focus on increasing the programs and models of housing for different ethnic groups, 

genders, and religious communities 

make mainstream programs and services more culturally competent and anti-oppressive by 

adjusting their policy outlook and introducing new practices. 


“ ” 

In our house, there were 5 women and 15 men, not many women. The men would 

gather in the living room to drink beer and watch TV. Sometimes we wanted to watch 

TV but we were not comfortable to stay there with the guys around (Service User). 

Where I live it is very nice. It is a women’s housing. They are very sensitive to women’s 

issues and empower women. I learned a lot of things about being a woman. They 

taught us anti-oppression. I never thought about issues of power and women’s issues 

that way before. I like it (Service User). 

Voice and choice 

“ ” 

There is no empowerment without culturally competent service options 


To allow service users voice and choice in housing models, we recommend that agencies: 

■■ 

■■ 

adopt the ‘Housing First’ model and approach to supportive housing. In this model, housing 

is an unconditional human right. It does not depend on a person’s mental health status or 

phase of recovery. 

advocate for, implement and expand a supportive housing model that allows individuals to 

choose their own housing. In the current model, sites are built to increase service users’ 

housing options. This only leads to ghettoization. 

“ ” 

Let the money (rent supplements) follow the client and let them choose their own 

community…There needs to be a program where rent supplements travel with the 

client to avoid the ghettoization of rent support where high vacancies may be related 

to poor maintenance issues (Housing Provider). 


Integrating families and communities 

“ ” 

If you label a building for mental illness then I would be hesitant to live there because 

of the way people in the community view it. It needs to be mixed, scattered 

apartments, integrated into the community (Service User). 

If it is possible to accommodate family in supportive housing, it’s the best 


Go away from building more supportive housing. We need more partnerships with 

the private sector. More choices, more integration, normal rental housing…You can 

choose your own destiny when you rent…Market rent housing with a subsidy from 

the government in a nice neighbourhood would make a big difference to help us 

move on from our emotional troubles and torture history (Service User). 

I like the model which is living in ‘for profit’ housing. I pay the rent to the maximum 

that I can afford and the program pays the rest. For example, a unit that is $1200, I 

pay $900 and the rest is paid by this project (Service User). 

To integrate families and communities in housing models we recommend that agencies: 

■■ 

■■ 

■■ 

■■ 

move away from models in which service users are concentrated in public buildings 

dedicated to supportive housing. 

advocate for, implement and expand supported housing models that place service users in 

regular housing that is integrated and dispersed in the community. 

advocate for, implement and expand models that stress partnerships between public or 

community-based providers and private landlords. One example is the head-lease model in 

which the supportive housing provider supplements market rent. These models give tenants 

more housing options and increase their integration in the community. 

develop models that consider the supports and housing that families need. For example, 

agencies could build family-only buildings in shared (congregate) settings, or provide 

floating supports to service users who live with relatives in the family home. 


Housing management, rules & policies 

“ ” 

People who work in the home should know our culture. Canadian workers are not 

patient with people who speak other languages. We need workers who respect us 


There are people working without status, they are here illegally and they can’t get 

into social housing. They still pay rent, put something in place. We shouldn’t 

discriminate against these people. Should be integrated with members of their 

community and other people. (Housing Provider). 

Agencies are too strict. Service users are only admitted if they have a formal diagnosis. 

This screens out many (racialised and ethnic minority) people because stigma often 

prevents them from getting an assessment in the first place (Service Provider). 

To develop anti-oppressive and culturally competent housing management, rules and policies, we 

recommend that agencies: 

■■ 

■■ 

■■ 

■■ 

develop policies that outline acceptable behaviour for staff and tenants in the supportive 

housing unit. These policies must explicitly address cultural competence and antidiscrimination/anti-oppression. 

If there is conflict, arbitration procedures must happen 

without delay. 

give tenants an orientation when they enter the housing program. The ideal orientation will 

tell tenants about their rights and responsibilities, how to make a complaint, and explains 

the agency’s policies, practices and procedures. It also links tenants with existing advocacy 

groups so that they can voice any grievances and concerns. 

take immediate action when tenants encounter racism or discrimination in their housing. 

Ideally, the agency would tell the tenant about their rights, explain what options they have 

and help them register a formal complaint. The agency would also respect and support the 

tenant’s choice about what action they want to take. 

make sure that the bodies that make decisions within supportive housing are culturally and 

linguistically accessible and competent. They should include diverse tenant representatives. 

½½ 

A description of linguistic competence is included in Appendix C [4]. 

“ ” 

In our agency, we call tenants members. Half of our Board of Directors are members. 

Members have input into programming and every tenant has the opportunity to 

get involved in our Member Advisory Committee which approves all new policies. 

Managers are involved in ensuring diverse representation on the Advisory 

Committee. It’s new. People were scared at the beginning but it’s worked out really 

well (Housing Provider). 


We also recommend that agencies: 

■■ 

■■ 

■■ 

■■ 

■■ 

■■ 

■■ 

accommodate diverse religious observances and spiritual practices. 

admit people without immigration status or identification papers on a ‘don’t ask, don’t tell’ 

basis. 

½½ 

For more information, read the System best practice recommendations. 

admit service users who have not been formally diagnosed, and help these service users get 

diagnosed. 

½½ 

For other suggestions about how to improve admission procedures, see the Agency best 

practice recommendations. 

translate housing program and policy materials into diverse languages and distribute these 

materials to tenants and family members. 

use professional interpreters when service users or families need translation services. This 

protects service users’ rights to privacy and confidentiality; agencies should never use 

bilingual tenants as interpreters when handling sensitive issues. This ensures accurate and 

competent translation. 

collect statistics about tenant demographics, sources of referral, length of tenure and reasons 

for moving. This data will help to identify and document the experiences of racialised and 

ethnic minority service users, and the issues they face. Ideally, agencies would 

½½ 

½½ 

½½ 

systematically review demographic changes in the general population 

compare these changes to their own tenant and staff demographics 

adjust their services and staff to reflect the pool of actual and potential service users. 

–– 

For more information about how to do this, see the System best practice 

recommendations. 

In mixed gender settings, try, if possible, to keep it balanced. 

For more about organizational norms, principles, and policies, please read the Agency best practice 

recommendations. 

“ ” 

Language service is 100% important. Every document has to be translated into 

Korean. (Service User) 


To allow service users voice and choice in housing management, rules and policies, we recommend that 

agencies: 

■■ 

hold regular house meetings with tenants. These meetings allow tenants to voice their 

grievances, concerns, issues and wishes. The meetings and decision-making processes 

should be linguistically accessible and culturally competent. They should use consensus 

decision-making. Decisions made at these meetings should be followed. 


■■ 

■■ 

■■ 

give tenants and service users a variety of channels for voicing their grievances. Tenants and 

service users must know that they will not be punished for what they say. They should be 

allowed to make anonymous complaints. 

regularly ask service users to evaluate housing programs. The tools used in these 

evaluations should include questions that ask about the agency’s cultural competence and 

anti-oppression practice. 

allow tenants a voice and role in decisions about which tenants to admit, as long as the 

decisions follow agency policy and respect laws about human rights and does not foster 

discrimination. 


To integrate families and communities in housing management, rules and policies, we recommend that 

agencies: 

■■ 

■■ 

 

accommodate a range of cultural definitions and understandings of ‘family’ in housing 

policies, planning and design. This means: 

½½ 

½½ 

being more flexible in rules about room and housing occupancy, to accommodate large 

and extended families; and 

allowing visiting members of a tenant’s family (including the extended family) to stay 

for extended periods of time. 

if a service user consents, involve family members in decisions and decision-making processes 

within the supportive housing unit, and inform them of these decisions and processes. 

 

Housing Services 

The Yee Hong Centre – Aw Chan Kam Chee Evergreen Manor long term care facility 

in Markham, Ontario offers its tenants numerous culturally appropriate programs 

and services. These include daily Tai Chi every morning, on-site Christian and Buddhist 

religious services, celebration of Chinese holidays, Chinese interior décor, on-site 

library stocked with Chinese reading and audio-visual materials, and access to Chinese 

cable tv and daily newspapers in the main lounge. 

To develop anti-oppressive and culturally competent housing services, we recommend that agencies: 

■■ 

provide culturally diverse, religiously acceptable foods for tenants by: 

½½ 

½½ 

½½ 

½½ 

recognizing that food may not always be appropriate for religious, cultural or dietary 

reasons; 

involving tenants in choosing the menu and preparing food; 

allowing family members to bring food to service users who live in shared 

accommodation; and 

where possible, allowing tenants to cook their own food by giving them access to 

cooking and storage facilities. 


■■ subscribe to culturally and linguistically diverse cable T.V. and print media such as 

newspapers and magazines. 

■■ make sure that on-site libraries include culturally relevant, linguistically accessible reading 

and audio-visual material. Ideally, libraries would also include materials that refer 

 

consumer-tenants to community resources. 

Offering holistic support 

 

Sojourn House is the largest refugee shelter in Toronto and has been in existence for 

13 years. The new 9- storey facility on Ontario Street contains both a shelter with 

50 beds spread over two floors (2nd and 3rd floors), and 52 transitional housing 

apartments spread over four floors (4th to 7th floors). There are some 14 support 

staff on site, including an on-site transitional housing coordinator, 2 housing workers, 

5 settlement counselors, a trauma counselor, a child and youth program worker, and 

case supervisors and social workers for higher need clients. 

■■ 

■■ 

To offer holistic housing services, we recommend that agencies: 

provide diverse religious and spiritual care services within the building, or make these 

services accessible to tenants by partnering with religious and spiritual care providers in the 

wider community. 

offer alternative and traditional medical remedies on site. 

 

The Rainbow Boarding Home is owned by Joyce Chung, who has operated the 

boarding home in the Parkdale area of Toronto for the past 20 years. The Rainbow 

Boarding Home houses 20 tenants, 2 per room. The second floor is female only, and 

the top floor is male only. While not planned as a culturally specific or targeted 

boarding home, the home naturally evolved into one because of the Chinese cultural 

origins and contacts of the owner-operator, who speaks Cantonese. Many of the 

tenants in this boarding home are Cantonese speaking. The dominant culture of the 

home is Chinese and Chinese cultural customs are observed within the home. Chinese 

food is offered daily and is provided by two former local Chinese restaurant owners 

and cooks. Medicinal Chinese herbal teas are provided to tenants, along with 

alternative traditional non-prescription home remedies such as Tigers balm. Chinese 

cable tv and newspapers are also available to tenants. 


Housing Activities & Programming 

 

Frantz Fanon House was established in London, England in 1999 by the Ujima 

Housing Association in partnership with Greenwich Social Services. Named after the 

famous Caribbean psychiatrist and writer, the project provides supportive housing 

to young Afro-Caribbean men who have spent long periods of their lives in secure 

psychiatric hospitals. In-house activities are culturally tailored, and include such 

indoor games as dominos. The program has forged numerous partnerships with 

other ethno-specific and mainstream agencies that enable tenants to participate in 

various educational, vocational and peer support programs in the community. 

Tenants are for instance linked to a Black peer support group in Greenwich, which 

meets weekly, and brings together Black Minority Ethnic clients to discuss how to 

cope and support one another. 

To develop anti-oppressive and culturally competent housing activities and programming, we recommend 

that agencies: 

■■ 

■■ 

■■ 

■■ 

offer culturally diverse in-house programs and activities that are tailored to meet the diverse 

cultural preferences of service users or tenants. 

celebrate and observe culturally diverse holidays. 

offer tenants educational forums and activities relating to issues of cultural diversity and 

anti-oppression. 

make sure that agendas for tenant house meetings include time to address issues and 

concerns relating to diversity. 


To allow service users voice and choice in activities and programming, we recommend that agencies: 

■■ 

■■ 

■■ 

give service users of diverse backgrounds culturally relevant choices and a voice in choosing 

daily activities and programming. 

make sure that tenants can access information about programs and resources available in 

the community. This means providing information in appropriate languages. 

partner with ethno-specific community agencies and programs to provide culturally 

competent programs and activities. 



“ ” 

The best thing that helped me was to be connected to people, to feel like you belong 


 

It’s really important to keep people busy and occupied making plans, seeing a future 

basically…Then it is much more easier for them to integrate into community. Without 

this [drive] people are lost (Mental Health worker). 

 

The Yee Hong Centre – Aw Chan Kam Chee Evergreen Manor long-term care facility 

provides residents with over 14 social, recreation, therapeutic and religious daily 

programs, most of which are open to the wider community on a fee basis. 

Community integration and networking is further facilitated through residents’ 

participation in events hosted in the wider community and at other Nursing Homes, 

including Baycrest and Villa Colombo. 

■■ 

■■ 

■■ 

 

To integrate families and community in activities and programming, we recommend that agencies: 

provide regular day programming for service users, within and beyond the supportive 

housing unit. This will help nurture a sense of community among and between tenants, and 

with members of the wider community. 

make sure that tenants are active in, and integrated into, regular community settings, events 

and activities. 

offer day programming that is open to wider members of the community, including family 

members and friends of service users. One agency that has done this is Yee Hong. 

½½ 

For more information about Yee Hong, read the Case Study in Appendix A (2). 

 

The Chai-Tikvah Foundation group home offers numerous community development 

activities, connecting tenants to regular community programming and peer support 

programs within and beyond the home. These have helped to build a strong sense of 

community and integrate tenants into the wider community. Social activities include 

‘Club Simcha’, which is hosted at the group home and provides consumers an 

opportunity to socialize with each other. A weekly ‘Bagel Club’, funded by the Jewish 

Federation of Greater Toronto and hosted in a community centre, brings tenants 

together with other members of the community over lunch and involves them in 

various structured activities. 



To strengthen community connections in activities and programming, we recommend that agencies: 

■■ 

provide education about mental health and addictions issues to members of the surrounding 

community and neighbourhood. These events will help to reduce stigma and fear. 


To offer holistic activities and programming, we recommend that agencies: 

■■ 

engage service users’ strengths and assets in all programs and activities rather than only 

focusing on their needs and deficits. 

Housing location and neighbourhood 

“ ” 

Where I live now is the best thing that happened to me…I live in the same 

neighbourhood I lived before. I chose the neighbourhood. My worker helps me and 

supports me. I live near the mosque, halal stores and I am close to my friends, relatives 

and community (Service User). 

I like my [supportive housing] because I am close to my community. I can drop in on 

my neighbours. I am not isolated. There are people to help you when you need help 


My Somali neighbours help me a lot and they clean when I am sick. They look after 

the children and they bring the kids from the school and day care. I am lucky. That is 

why I like this neighbourhood. I have a lot of support (Service User). 

To offer anti-oppressive and culturally competent housing locations and neighbourhoods, we recommend 


■■ 

■■ 


allow tenants to choose whether or not to live in neighbourhoods close to other members of 

their community and community institutions and resources such as grocery stores, religious 

institutions and community organizations. 

increase service users’ access to clean, safe neighbourhoods, with green spaces, parks, and 

walking paths nearby, where a sense of safety and security can be established and 

maintained. 

“ ” 

I had a positive experience with my case worker and housing worker. The worker was 

helpful. She presented me with options. I eventually got what I wanted (Service User). 


To allow service users voice and choice in housing location and neighbourhoods, we recommend that 

agencies: 

■■ 

■■ 

■■ 

give service users choices about where they live, and what neighbourhood they live in. 

make sure that case workers ask service users where they want to live rather than assuming 

they know which neighbourhood or community is appropriate 

do not tell service users that they must live in specific neighbourhoods. 


 

The Yee Hong Centre – Aw Chan Kam Chee Evergreen Manor long term care facility is 

located in the heart of the Chinese community in Markham, Ontario (Greater Toronto 

Area) and is adjacent to a Chinese-run mall featuring a variety of ethno-specific 

services, restaurants and grocery stores. The townhouse units surrounding the manor 

are reserved for seniors and family members, which enables family members to stay 

near to their elderly family members in the adjoining long-term care facility. 

To integrate families and community in housing locations and neighbourhoods, we recommend that 

agencies: 

■■ 

■■ 

house families in family-friendly neighbourhoods. This means areas that are close to 

schools, parks, recreational resources, religious institutions and other basic services that are 

essential to raising a family. 

allow service users who want to live close to their family members to do so. 

“ ” 

For Spanish families, it is very important to live close, because we like to see our 

family frequently (Service User). 

Physical Quality, Structure & Design 

When you’re designing housing you have to talk to communities first to make sure it’s going to work for them. 

Have tenants/members involved at the board level, planning activities and running them (Housing Provider). 

To create buildings that are anti-oppressive and culturally competent, we recommend that agencies: 

■■ 

30 Home for All 

make the physical design of housing culturally and religiously appropriate by consulting 

with consumer-tenants, family members, and members of the wider community. Here are 

some examples of recommended best practices: 

½½ 

½½ 

½½ 

½½ 

allocate space for religious or spiritual practice; 

make sure kitchens have good ventilation; 

find out what direction the entrance should face (in Hindu observance and the Feng 

Shui norms); 

for Hindu service users, make sure the kitchen is far away from prayer space;

■■ 

½½ 

½½ 

½½ 

for Muslim service users, install hand-showers close to the toilet and make sure the 

toilet does not face North East; 

make sure the building has balconies for drying cottons; and 

for differently-abled service users, make sure the building has wheelchair-accessible 

spaces, bathrooms and halls. 

use interior décor that is culturally diverse, religiously inoffensive and that reflects the 

diversity and cultural preferences of tenants. 

 

The Chai-Tikvah Foundation group home observes Jewish traditions, Sabbath, 

holidays and provides kosher foods, with two dishwashers and two sinks on-site, to 

facilitate kosher observances. 


 

The Yee Hong Centre – Aw Chan Kam Chee Evergreen Manor long-term care facility 

contains supported, self-catering units along one wing of the building, and highersupport, 

long-term geriatric care units in the other wing. Bridging the two wings is 

a community centre and outdoor courtyard. These allow residents to socialize with 

one another, and to maintain contact with family members and the wider 

community. Programs and events hosted in the community centre and courtyard 

are open to non-residents. 

To integrate families and community in buildings, we recommend that agencies: 

■■ 

■■ 

■■ 

make sure that housing units and buildings include indoor and outdoor spaces that families 

and the community can use for socializing. If a building or unit does not have this kind of 

space, redesign or reallocate space for this purpose. 

½½ 

Read more in the Case Studies of Yee Hong Manor and Sojourn House in Appendix A (2). 

build congregate units that house less than 15 tenants. These smaller-scale units help avoid 

institutional feel and stigma. Some good examples are included in the case studies of 

supportive housing programs in the UK in Appendix A (1). 

build and expand multi-roomed housing units that can accommodate larger families. 



To strengthen community connections, we recommend that agencies: 

■■ 

consult organizations and community members from racialised and ethnic communities 

about the design of culturally appropriate supportive housing units. 

Best practice recommendations in SUPPORT 

Support refers to all forms of support provided to service users by supportive housing providers and other 

service providers. This section does not discuss services and programs provided by housing providers: these 

are discussed in the Housing section. 

Our best practice recommendations for supports fall into the following categories: 

■■ 

■■ 

■■ 

types of supports offered; 

who provides the supports; and 

how the supports are delivered. 

Types of supports offered in supportive housing 

“ ” 

Canada is one of the most multicultural nations. Cultural determinants should be 

included in the broader health services being provided (Housing Provider). 

Reclaiming culture is a big part of the recovery. Recovery has much to do with finding 

who you are and empowering who you are. This is in fact 90% of the battle. If you 

are proud of who you are and where you’re from then the issues are mostly solved 

(Service Provider). 

We need current events discussions that use an anti-racist perspective and address 

history of colonization that provide opportunities for people who do not have a voice 

in society to speak (Service Provider). 

To develop anti-oppressive and culturally competent supports, we recommend that agencies: 

■■ 

■■ 

■■ 

provide supports and therapy in mother-tongue languages. 

link service users to culturally relevant community events, activities, programming, and 

services, including those that engage and address racism/internalized racism, social 

exclusion, and other issues pertinent to racialised and ethnic minority service users. The 

supports and activities should help service users who have internalized racism and social 

exclusion to understand that the root causes of their oppression are outside of themselves. 

This can help in the healing process and place their confusion, anger, disappointment and 

other feelings outside of themselves. 

create forums that allow racialised and ethnic minority service users to discuss current 

issues and interests, as well as histories and experiences of oppression. 


■■ 

■■ 

■■ 

■■ 

■■ 

offer supports that address and engage issues relating to cultural identity and historical 

experience as part of the recovery process. This is particularly important for groups with 

histories of colonialism, slavery, genocide or cultural dispossession. 

give tenants information about Canadian laws, and their rights and responsibilities. 

link tenants to legal services and public resources. 

make sure that health professionals who provide counselling and support services related to 

post-traumatic stress disorder are culturally and linguistically competent. 

help service users navigate the mental health and addiction systems and to access 

appropriate health services and resources. 


“ ” 

Nobody tells you what supports and services are there. You have to keep searching 

until you find what you need (Service User). 

To allow service users voice and choice in types of support, we recommend that agencies: 

■■ 

■■ 

■■ 

■■ 

make sure that support workers ask service users and families what kinds of ‘support’ they 

need and prefer. Ideally, workers would offer client-centered supports so that service users 

have control over the kinds of supports they receive, and when, where and how often they 

receive support. 

give service users information about the range of formal and informal support services and 

resources available in the community. This will allow service users to make informed 

decisions about what kinds of support could be most helpful. 

help service users look for appropriate housing. 

give service users choices about what neighbourhood and type of housing to live in. If 

service users want to move, give them information about their alternatives. 



“ ” 

It is difficult to find group therapy for Iranian people (Service User). 

I joined (an Asian) family support group. It’s nice. I can vent and the members have lots 

of experience to learn from and give good resources. Before I joined, I never knew 

there was such a thing called supportive housing and how it helps (Family Member) 

There is a great difference when we have a support system around us. We feel safe and 

more motivated to do things and participate in different activities (Service User). 

The family is a huge factor in wellness. You have to work closely with family 

(Housing Worker). 

Across Boundaries includes the whole family in the treatment process. We do not do 

the number game - that is not working with the family because it would increase the 

workload of staff (Service Provider). 

To integrate families and communities in types of support, we recommend that agencies: 

■■ 

■■ 

■■ 

■■ 

■■ 

■■ 

■■ 

when planning support, respect and recognize different cultural definitions of family and 

familial roles. 

consider the informal supports from family and community members as a key part of the 

recovery plan. 

support peer-led initiatives and refer service users to these groups. 

establish and support linguistically accessible, culturally competent and culturally relevant 

service user and family peer support groups. These groups should include diverse racialised 

and ethnic minority persons. 

½½ 

For more information, read the Caritas Case Study in Appendix A (2). 

link service users to community programs and services that are not necessarily or 

specifically geared towards people with mental health or addictions issues. This will help 

reduce stigma and increase community integration. 

gear supports to families, as well as to individuals. More specifically: 

½½ 

½½ 

Use home visits to make sure that service users living in the family home have support 

from case managers and other support workers. 

When planning support, include access to daycare as well as after-school and weekend 

recreational programming for children. 

with the consumer’s consent, involve families in the support and recovery process. Families 

can be involved in assessment, treatment and follow-up. More specifically: 

½½ 

½½ 

Consider the family as a ‘client’, along with the individual consumer. Keep family 

members informed and involved in support planning and decision-making processes. 

Make family-based therapies available to service users and family members. 


½½ 

Help service users to locate and re-connect with estranged family members. For 

example, link immigrants and refugees with overseas family members and help service 

users connect with family members over holidays. 


“ ” 

When I went to the mosque I complained to them about the racist treatment I received 

and about what happened to my son at school. Everyone was helpful (Family Member). 


■■ 

■■ 

create and strengthen formal and informal partnerships and links with community-based 

organizations and public institutions such as ethnic and religious-based organizations, 

settlement agencies, schools, hospitals, shelters, police and others. These connections will 

broaden and enhance support networks and help service users connect to services. 

work with racialised and ethnic minority communities to provide education about mental 

health and addictions issues. This will help to reduce stigma and isolation for racialised and 

ethnic minority service users. 

½½ 


The best practice recommendations for Agencies includes more information about how to 

do this. 

“What is of no doubt is that the experience of many of the complementary therapies 

are benign and often sensorily pleasurable and emotionally uplifting. The user often 

gets attended to and regarded in a positive way. It was suggested that when one 

goes to a complementary therapist, one is taken seriously as a person, but does not 

have to be in the ‘sick role’ in order to get positive attention. This may feel new for 

the user and initially empowering in itself” (Sharon Jennings, Complementary 

Therapies in Mental Health Treatment, cited in Safe Haven report, UK, p.65). 


“ ” 

As newcomers, we need immediate support that provides us with the right 

information, especially to go to school and gain independence (Service User). 

What really helped me when I came to my crossroads was the Work on Track program 

at Seneca College…The program helped me refocus on my goals (Service User). 

Across Boundaries has an Ayurvedic medical practitioner. If Across Boundaries can 

have it, why not CRCT and CMHA. It should be covered by OHIP. We cannot go all the 

way to the west to get that service (Service User). 

A lot of Tamil go to medicine men who come from India and have healing sessions. 

It costs a lot of money. If there was cultural treatment services people would go 


To offer holistic supports, we recommend that agencies: 

■■ 

■■ 

■■ 

offer supports that focus on health and wellness and that are directed towards the ‘whole 

person’. This means that supports address the service user’s physical needs, but also their 

mental, spiritual, emotional, social, cultural and economic well-being. 

make talk therapy, such as, psychotherapy more available to racialised and ethnic minority 

service users, instead of relying only on medication for treatment. 

give service users access to complementary therapies such as: 

½½ 

½½ 

½½ 

½½ 

½½ 

½½ 

½½ 

½½ 

½½ 

½½ 

Ayurvedic medicine 

Aromatherapy 

Acupuncture 

Art therapy, music therapy or drumming therapy 

Herbal medicine 

Homeopathy 

Massage 

Naturopathic medicine 

Reflexology 

Tai Chi 

–– 

For suggestions about how to deal with the cost of alternative therapies, read the 

Funding section of the best practice recommendations for the System. 

■■ 

■■ 

partner with religious institutions, traditional healers and community organizations to give 

service users access to religious and spiritual-based forms of support such as prayer or 

meditation. 

link service users to educational and employment-related supports, including: 

½½ 

½½ 

English as a Second Language/literacy classes 

Adult learning classes 


■■ 

■■ 

■■ 

½½ 

½½ 

½½ 

½½ 

½½ 

Secondary and Post-secondary Educational programs 

Vocational training, Apprenticeships and Co-op Placements 

Employment counselling and career planning 

Workshops of various kinds related to health promotion and illness prevention 

Volunteer work 

encourage and support service user entrepreneurial activities and initiatives. For example, 

obtain micro-credit loans or support initiatives that allow service users to work from home. 

½½ 

To learn more, read the Chai Tikvah Case Study in Appendix A (2). 

during support planning, consider other wellness-centred activities such as participating in 

sports, arts, hiking, walking, as well as recreational hobbies and cultural activities. 

provide immigration and settlement supports, services, and information. These could be 

offered by support workers, or through partnerships with immigrant and settlement 

agencies. 

½½ 

To learn more about engaging issues of cultural identity, racism and oppression in 

support planning, and of linking service users to culturally relevant community activities, 

programming and services, read the best practice recommendations for Support. 

Who provides the supports 

“ ” 

We’ve had a huge change in clients over the past 8 years. They’ve become much 

more diverse. Yet we have no ethno racial staff…and only white survivors (Housing 

Provider). 

When you have a mental problem, the first thing that’s affected is language.…We 

need support workers and counselors that speak our first language. It is important 

because talking about feeling is difficult when you can’t use your own language to 

express yourself (Service User). 

My worker is a Somali and she understands me. I do not need to explain anything to 

her; because we speak the same language and same culture, I can only tell her what I 

need. I don’t have to explain everything (Service User). 

I told the manager [of the program] that I wanted to work with a woman. She told 

me that I should work with this worker (who was a man) or they will refuse service to 

me. I cannot work with a male worker. I think you understand that it is difficult to 

work with a male worker. You cannot tell them everything. As a woman there are 

boundaries that we cannot cross with a male worker. Thank Allah, they hired another 

worker [from my background] who was a woman. She is very nice and I am happy 

with her. She knows her job very well (Service User). 


To make sure that an anti-oppressive and culturally competent staff provides support, we recommend 


■■ 

■■ 

ask service users if they want support workers who understands or can relate to their 

experiences as a racialised and ethnic minority person. Keep in mind that one person from a 

particular group does not represent that entire group. Therefore, do not look into racialised 

staff as your representatives of their culture group. 

if the service user does want a match, find a support worker who: 

½½ 

½½ 

½½ 

speaks their preferred language; 

has a similar cultural reference points, and social position, including religion, gender, 

class, immigration experience, mental health and addictions history and experience, 

sexual orientation; and 

is familiar with the issues and experiences they confront as a member of a racialised or 

ethnic minority group 

–– 

More detailed information about human resource issues, including staff 

composition, training, and competency, is included with the best practice 

recommendations for Agencies. 


To integrate families and communities in who offers support, we recommend that agencies: 

■■ 

hire peer support workers as paid staff. Other paid support workers should include members 

of the racialised or ethnic minority community who have expert knowledge about the 

community, but are not professionally trained as support workers. This does not mean that 

agencies should stop using services provided by professionals. Rather, the informal supports 

should complement the professional supports. 


“ ” 

I told my therapist [who is from the same religious-cultural background] about my 

issues about religious healing and he understands and supports me. He knows what I 

am talking about. It is good to have someone who listens to you...I saw 5 different 

psychiatrists, some were nice but they could not explain anything to me. I did not 

understand them. Now I understand my illness (Service User). 

To offer holistic supports, we recommend that agencies: 

■■ 

■■ 

make sure that service users can get support from support workers who practice alternative 

or traditional healing methods and traditions such as traditional healers, elders, and religious 

care providers. 

hire community health workers and members of the community who have peer support 

training in therapy or counselling. This is especially important when there are few 

professional, culturally competent support workers from the communities being served. 


Caritas was started by an Italian priest in the Toronto area in 1980. Fr. Carparelli 

worked with a group of parents and families to respond to the absence of culturally 

appropriate, holistic programs and supports for people in the Italian community 

suffering from addictions. The Caritas Project is informed by a ‘Therapeutic 

Community’ (TC) model, which emphasizes the importance of community and peer 

supports, self-help, and an orderly, structured daily routine in a residential facility 

removed from drug-related environments. Many of the staff are former Caritas 

residents themselves. This reduces the communication gap between staff and service 

users, while promoting trust and confidence in the recovery plan. Having staff that 

residents can identify with has also had an important role modeling effect, with staff 

functioning as effective ‘identity change agents’. 

How the supports are delivered 

“ ” 

Workers should have compassion. Sometimes some workers look like they really hate 

you. I think that is wrong because you speak little English and you eat different food 

people should not hate you (Service User). 

My worker thought I was having delusions when I told her about my experience with 

[a Canadian security agency]. Only a Muslim person knows that (Service User). 

Don’t do referrals. People so often face barriers and discrimination. You have to 

take people to the referred agency, and ensure that a connection has been made 


To make sure that supports are provided in ways that are anti-oppressive and culturally competent, we 

recommend that agencies: 

■■ 

■■ 

■■ 

make sure that support workers learn about and reflect on how culture, social location, and 

historical experience shape (without determining) the health experiences, perceptions, 

coping strategies, expectations, and communication styles of themselves and the service 

users they work with. 

educate support workers about how interlocking systems of oppression shape service users’ 

health, and how agencies may challenge or reproduce these same structures. 

offer training and education to help service user-tenants become sensitive to instances of 

internalized racism. Encourage service users to confront and negotiate their internalized 

racism. Refer service users to appropriate support groups, resources and forums. 


■■ 

■■ 

■■ 

■■ 

offer counselling using styles and approaches that take into account differences in cultural 

boundaries and norms (of appropriate behaviour, social interaction, communication style, 

and lines of questioning. 

consider and respect cultural differences in the perceived responsibilities and duties of 

support workers, in keeping with service users’ understanding of the worker-client 

relationship. 

make sure that support workers actively follow up referrals and help service users navigate 

the service system. By doing so, they can check that the service user has connected with the 

agency, service or program. Service users frequently do not get the help they need. Some 

reasons include not knowing their right to service, being subjected to discriminatory 

treatment and/or being dismayed and/or disoriented by the complex, fragmented nature of 

the service system. 

when service users experience racism and discrimination, refer to them appropriate supports 

and resources in the community. 


To allow voice and choice in how supports are delivered, we recommend that agencies: 

■■ 

allow service users to decide their cultural identities and who they consider to be members of 

‘their community’. Ask service users to name their identities and communities. Do not ascribe 

identities and communities on the basis of ethnic origin, race or other visible markers. 


To integrate families and communities in how supports are delivered, we recommend that agencies: 

■■ 

■■ 

consult and include family members, when appropriate, when planning and providing 

support. 

nurture independence among service users by giving them the tools they need to make 

decisions and accomplish tasks. This means that support workers should not patronize 

and over-assist service users who can carry out tasks on their own. 



■■ 

hold regular monthly meetings between tenants, housing workers and support workers. 

These meetings will promote housing stability and make sure that various support workers 

are working towards the same goals. 


Best practice recommendations for AGENCIES 

This section describes the organizational policies, practices, and procedures which allow supportive housing 

agencies to provide culturally competent and anti-oppressive supportive housing. Our recommendations draw 

on the views of the research participants and incorporate the best practices articulated in the wider housing 

and health literature. 

We recognize that some of the recommendations in this section will be difficult to achieve, since systemlevel 

constraints hinder agencies and frontline staff. In this context, each agency should 

■■ 

■■ 

■■ 

■■ 

consider the recommendations in this section as ideals to strive for; 

assess its own starting-point along the continuum of cultural competence and antioppression 

using the Cultural Competence Continuum Scale in Appendix C[1] and the 

CAMH Diversity Evaluation Scale in Appendix C[2]; 

prioritize which recommendations to implement in the short and long term; and 

advocate and collaborate on issues of cultural competence and anti-oppression at the interagency 

and systems level. 

Our best practice recommendations for agencies fall into the following categories: 

■■ 

■■ 

■■ 

■■ 

organizational norms, principles, and policies; 

identifying assets and needs; 

human resources management, policies and practices; and 

accessing and delivering services. 

This section does not include best practice recommendations that focus more narrowly on either housing 

or supports. To minimize repetition, those recommendations are included in the Housing and Support sections. 

The organisation’s norms, principles, and policies 

“ ” 

Diversity needs a constant state of vigilance (Service Provider). 

You cannot do access and equity without linguistic access (Housing Provider). 

Everybody has culture, and everything is cultural…Culture means more than ethnocultural…People 

need to experience all of who they are simultaneously so we need 

to articulate frameworks for housing that address the whole…And it is not just about 

culture. It is about cultures in unequal relations of power. The key is to shift power 


Frontline service providers don’t have much influence. They cannot be very creative, 

whereas managers can. We need to ensure good agency and management practice 

and policy around issues of cultural competence and anti-oppression…The standpoint, 

leadership and commitment of management is really important. If they don’t have 

the commitment then it doesn’t go anywhere (Service Provider). 


To make sure that an organization’s norms, principles and policies are anti-oppressive and culturally 

competent, we recommend that agencies: 

■■ 

■■ 

■■ 

■■ 

■■ 

■■ 

■■ 

■■ 

■■ 

make cultural competence and anti-oppression issues, including anti-racism, a priority. To 

do this, boards and upper management must budget time and resources to review, develop, 

and implement tools, policies and practices that support cultural competence and antioppression. 

embrace an approach to organizational change that is based on the values and principles 

outlined in this toolkit. 

check that its policy, mandate and mission statements explicitly articulate the principles, 

values and goals of cultural competence, anti-oppression and anti-discrimination. 

make policy documents readily accessible to service users, family members and staff, in 

appropriate languages. 

integrate concerns with ethno-racial and cultural diversity into other considerations of power 

and inequity such as gender, ability, class, sexuality, health, and immigration status, since 

all of these factors interact to shape the experiences and life-chances of racialised and ethnic 

minority service users. 

make sure that upper management takes leadership so that all staff 

½½ 

½½ 

½½ 

hold a clear and common understanding of cultural competence and anti-oppression, 

understand why the agency has adopted this approach, and 

appreciate the benefits of working from these principles and values. 

To do this, management should hire consultants or facilitators trained in these issues to help 

with this work. Management can also define and establish clear objectives for cultural 

competence and anti-oppression, and place a strong emphasis on the accountability of key 

players. 

involve all levels of staff in developing policies and values, and consult with ethno-racially 

diverse service users, family and community members. 

remember that developing a culturally competent and anti-oppressive organization is an 

ongoing process. It requires continual vigilance, monitoring, and progression along a 

continuum from worse to better, as outlined in the models in Appendix C. 

be aware of the organization’s history in doing cultural competence and anti-oppression 

work. Remember that the history will affect how the agency is perceived in the community. 

In agencies with negative reputations, management and staff need to work hard to build 

trust and create a better image for the agency. 


“ ” 

Being culturally competent has to start with the whole organization: governance, 

policies, etc to have a critical lens to all of them. It has to be a learning organization 


You need policies but you also need to have staff buy-in into these policies. Where 

are staff in process of policy development? If this is done in exclusion from staff, 

tenants, then there is no ownership and weak commitment (Housing Provider). 

You must develop targets and goals to address the issues of anti-racism and cultural 

competence (Service Provider). 

Organizations need to be guided by principles and values. It is important to be very 

principled in practice (Service Provider). 

We also recommend that agencies begin the change process by: 

■■ 

■■ 

■■ 

■■ 

establishing an ethnically and racially inclusive advisory committee to address issues of 

cultural competence and anti-oppression. The committee should: 

½½ 

½½ 

½½ 

½½ 

½½ 

½½ 

represent all relevant stakeholders including frontline staff, upper management, service 

users and family members, and wider members of the community; 

compensate service user members for their time; 

meet regularly to review and evaluate agency policies and practices, set cultural 

competence/anti-oppression objectives, goals and targets, and oversee evaluations and 

the implementation of recommendations; 

use some of the resources in Appendix C such as the Model for Diagnosing and 

Removing Institutional Racism (Appendix C[8]), the definition of Linguistic Competence 

(Appendix C[4]), the Cultural Competence Evaluation Tool (Appendix C[3]) and the 

definition of Institutional Racism in Appendix B; 

seek advice from professional consultants or exemplary service providers that have had 

some success implementing cultural competence and anti-oppressive policies and 

practices; and 

consult with communities served to develop an Action Plan and timelines that are 

integral to the agency’s overall strategic plan, mission and policy. The action plan should 

include specific steps, as well as measurable goals and targets for administration, 

programs and frontline service delivery. 

making all staff responsible for realizing the cultural competence and anti-oppression action 

plan, rather than making ethnic and racial minority staff responsible for this work. 

making the organization’s leadership accountable for implementing the action plan. 

developing auditing and accountability tools and mechanisms that can 

½½ 

check that cultural competence and anti-oppression policies are followed; and 


■■ 

■■ 

■■ 

■■ 

■■ 

■■ 

½½ 

monitor levels of realization of short and long-term cultural competence/anti-oppression 

targets and goals. 

A comprehensive example developed for health care agencies is included in Appendix C [3]. 

setting up conflict resolution and complaint processes that are clearly articulated in 

organizational policy documents. Tell service users and frontline workers about these 

processes in appropriate languages. 

working actively to make the organizational culture more inclusive and accommodating of 

diversity. Some outward and tangible expressions include: 

½½ 

½½ 

½½ 

½½ 

recognizing and celebrating diverse cultural-religious holidays; 

adopting interior décor that reflects the cultural diversity of service users; 

using culturally diverse foods when catering meetings; and 

posting information and signs in multiple languages. 

committing regular time and space at management meetings to discuss issues of cultural 

diversity, cultural competence and anti-oppression. 

allocating meeting time for informal, open-ended, and relaxed discussions of cultural 

competence and anti-oppression issues with agency staff, service users, family and 

community members. 

discussing issues of cultural competence and anti-oppression in an inclusive rather than an 

accusatory manner. This provides a safe space for people to express views that may be 

unpopular. To do this, focus discussion on the ways in which policies, processes and 

procedures serve to marginalize particular groups, rather than on problems with specific 

individuals. Present cultural competence and anti-oppression as a ‘win-win’ situation for all 

parties while pointing out the need for power and resources to be shared more equitably. 

using a framework of equity, cultural competence and anti-oppression to make decisions 

about research, purchasing and procurement. 

 

Across Boundaries [an ethnoracial community mental Health centre in Toronto 

which provides services and supports to people of colour who are experiencing 

mental health problems] creates an environment where anti-racism analyzing takes 

place…We are the only service provider that uses an anti-racism model of service 

delivery….Staff always remain mindful of experiences of colonization, shades of 

skin colour etc. Each individual has a story to tell of racism if we are honest (Across 

Boundaries staff). 



“ ” 

People of colour are missing in decision-making bodies…Voice requires service 

providers to give up power. This needs to be made clear (Service Provider). 

Agencies must commit resources and budget time to allow front line workers to provide 

information and choices to consumers and family members (Service Provider). 

We have to be very careful about stereotyping, that we don’t get into the ‘pot luck’ 

diversity (Service Provider). 

The real issue is not only who is involved but also how are they involved, if we are to 

avoid tokenism. Is it just input that we want or can they really influence decisionmaking? 

You have to train [service users] how to participate. Teach them what their 

role is and how to influence decisions (Housing Provider) 

To allow voice and choice in organizational norms, principles and policies, we recommend that 

agencies: 

■■ 

■■ 

■■ 

consider service users to be ‘members’ of the agency or organization and give them input 

into decision-making about policies and programming. More specifically: 

½½ 

½½ 

½½ 

set up a socially and culturally diverse Service User Advisory Committee. The committee 

should meet regularly with management and staff to contribute to, and approve, 

organizational policies and programming. 

give service users the information, resources and supports they need to effectively 

participate in organizational decision-making bodies. 

make sure that decisions made by service users and family members on agency decisionmaking 

bodies are consequential. Implement the decisions and communicate them to 

service users. This will encourage further participation by service users and show that 

their involvement is not merely tokenism. 

recognize differences among service users from the same racialised and ethnic minority 

background. Do not stereotype service users as having particular socio-cultural 

characteristics. Do not call upon, or expect, individuals to represent entire communities. 

Make sure that diverse members of the community are engaged in decision-making and 

consultation processes. 

In the case of potentially conflicting service needs and demands among groups served, set 

up a transparent, participatory, and inclusive conflict resolution process. Use the process to 

negotiate differences and arrive at a compromise. 



To integrate families and communities in organizational norms, principles and policies, we recommend that 

agencies: 

■■ 

■■ 

■■ 

include family members in organizational policy and decision-making bodies, and in 

program and agency evaluation processes. 

provide space, funding, support and resources to service user and family peer support 

groups and initiatives. 

make sure that the agency mandate, policy and vision put peer leadership in a critical role. 


“ ” 

Everybody deserves housing; it’s a human right…Society at large needs to accept that 

we all have a right to housing (Housing Provider). 

If we simply throw up our hands and accept that we cannot provide consumers with 

culturally relevant services due to system and agency constraints, then we are a 

participant in their disempowerment (Service Provider). 

Languages and access to information should be at the top of policy development. 

Access to a universal system of interpretation as a human right and prevention is 

critical (Service Provider). 

Policy makers and funders don’t have as much power as we think. We need to engage 

political leaders to ensure issues of access and equity are seen to (Service Provider). 

To strengthen community connections in organizational norms, principles and policies, we recommend 


■■ 

■■ 

■■ 

■■ 

■■ 

undertake advocacy with, and on behalf of, service users and family members around issues 

of accessibility, cultural competence and anti-oppression. 

reflect issues of accessibility, cultural competence and anti-oppression in agency policy, 

strategic vision, and practice. 

create opportunities for members of racialised and ethnic minority communities to meet and 

discuss their mental health, addictions and housing needs, issues and concerns. Support 

these initiatives. 

engage communities in advocacy efforts, rather than only political representatives and policy 

makers in positions of power. 

collaborate and advocate with other agencies on related issues such as: 

½½ 

½½ 

½½ 

½½ 

government policy and funding committed to cultural competence and anti-oppression; 

making access to basic services in diverse languages a human right; 

making housing a human right; 

investment in affordable housing; and 


½½ 

the need for a national housing policy and strategy. 

–– 

NB: involve racialised and ethnic minority community members and leaders in 

developing programs, policies, and evaluations to ensure that these are congruent 

with the needs, assets, expectations and desires of the communities being served. 


“ ” 

People don’t like to interact on the basis of the label – ‘mental health patient’ (Mental 

Health worker). 

To offer holistic supports in organizational norms, principles and policies, we recommend that agencies: 

■■ in organizational materials, refer to service users as individual tenants or members rather 

than solely as people with mental illness or addictions. 

■■ embrace a recovery and strength-based model of health. This model should inform agency 

policy and programming. 

■■ remember that not everyone is comfortable with the term ‘consumer survivor’, since it 

emphasizes the experience of illness. 

■■ validate non-Western paradigms of health, including those informed by religion and 

spirituality, and give equal recognition to these approaches in its policies, norms, 

 

organizational culture and services. 

 

Identifying Assets and Needs 

Becoming culturally competent requires asking families and clients about their service 

needs – where theirs are not being met at the moment, where culture is not being 

considered and accounted for, where discrimination exists- and then asking them 

what they would like to see happen. They will give you the answers you need (Head 

of care, Kush Supported Housing and Outreach Services, London, England; see 

Appendix for Case Study). 

To make sure that the organization identifies assets and needs, we recommend that agencies: 

■■ 

■■ 

■■ 

ask service users and family members about their immediate mental health and addictions 

needs but also about their strengths and broader needs. Include their economic, political, 

cultural, religious and social strengths and needs. 

evaluate programs, policies and services to determine the current levels of cultural 

competence and anti-oppression. Involve all relevant stakeholders in assessing and 

collectively analyzing the results. 

regularly research and evaluate the agency, services and programs to identify the needs, 

wishes, satisfaction levels, and service outcomes of racialised and ethnic minority service 

users and family members. 



To integrate families and communities in identifying assets and needs, we recommend that agencies: 

■■ 

ask family members about what supports they need and what supports they could provide. 


To strengthen community involvement in identifying assets and needs, we recommend that agencies: 

■■ 

consult community groups and individuals with expert knowledge of the communities being 

served, and build partnerships with them. This will allow the agency to make sure that 

services are driven by the service user’s needs and preferences, and developed and delivered 

in a culturally competent manner. Partnerships may be formal (as members of an advisory 

committee) or informal (ad hoc); the key is that they allow for regular, ongoing 

communication and input from the ethno-racially diverse service users, family members and 

communities served. 

Human resources: management, policies and practices 

“ ” 

Since I do not speak English and I cannot read or write it is important to me to have 

someone who knows my language. My worker helps me with so much and she is very 

patient (Service User). 

Hiring a few ‘minority’ staff does not make an organization culturally competent. 

Cultural competence demands equitable resource allocation – the equitable 

distribution and overall direction of an organization’s resources, combined with the 

accountability of systems and institutions (Housing Provider). 

Is the agency’s hiring of ethnic and racial minority staff meeting the real needs of 

these communities or are they just hiring ethno specific staff as spokes in the wheel? 


Sensitive staff make a difference. Staff who have been trained on anti-oppression 

and are able to intervene in situations when someone has made a homophobic or 

racist remark and can deal with it (Service User) 

Training needs to go from the top to bottom of the organization… Our frontline 

personal support providers are culturally diverse. We need to start with training the 

board, and management (Service Provider). 

Staff training around cultural competence should not just be about cultural tourism 

but promote understanding of mechanisms of inequality (Service Provider). 


To make sure that human resources support anti-oppression and cultural competence, we recommend 


■■ 

■■ 

■■ 

■■ 

■■ 

 

require staff at all levels to participate in cultural competence and anti-oppression training. 

Gear ongoing training to both frontline workers and management. 

focus training for management and board members on organizational and policy issues. 

provide agency staff, housing and support workers training in: 

½½ 

½½ 

½½ 

½½ 

½½ 

½½ 

identifying and dealing with internalized racism among service users; 

refugee and immigration policies, procedures and resources; 

dealing with abuse (particularly of women); 

dealing with trauma (particularly relating to war and conflict); 

religious diversity; and 

family therapy techniques. 

budget time and resources to cultural competence and anti-oppression training. 

provide ongoing opportunities for staff to have professional development in these areas by 

attending conferences, seminars, workshops, so that the agency can remain up-to-date on 

advances in cultural competence and anti-oppression theory and practice. 

 

Agencies in the Greater Toronto Area that cannot immediately afford to finance 

diversity training can join RENT (Resources Exist for Networking and Training) and 

access training for free (for more on RENT visit www.housingworkers.ca). 

We also recommend that agencies: 

■■ 

■■ 

■■ 

■■ 

■■ 

■■ 

formally orient and train new staff about the agency’s anti-oppression and cultural 

competence policies and practices. 

make it possible for agency staff members to participate in important community events 

within the communities they serve. 

use cultural competence and anti-oppression principles of equity to inform the recruitment, 

hiring and orientation of volunteers and staff at all levels of the organization. 

nurture and promote staff continuity, since establishing and maintaining rapport is critical to 

maintaining trusting relations with communities that have low levels of trust for the mental 

health and addictions system. 

do not rely on having diverse front-line workers alone, as proof of cultural competence. 

Remember that cultural competence requires a transformation of organizational structures, 

policies and services. 

place job advertisements in media outlets that are accessible to, and frequently used by, 

diverse racialised and ethnic minority communities. 


■■ 

■■ 

■■ 

■■ 

■■ 

■■ 

base hiring decisions on criteria that, in addition to professional competencies, include 

cultural and linguistic competency and anti-oppression as core requirements. Remember that 

while ethno-racial background and language skills are critical human resource considerations, 

they should not be viewed as guarantees of a person’s cultural competence. Cultural 

orientation and upbringing may vary significantly among members of an ethnic group. 

in hiring, consider social and cultural proximity of potential service providers to service 

users. Remember that proximity is not limited to ethnicity, race and language but also 

includes issues of class, ability, religious background, gender, immigration, mental health/ 

addictions experience and status. 

in considering language proficiency during hiring processes, include the ability to 

understand and communicate in different dialects within an ethno-racial group. 

when hiring support workers consider hiring individuals that are not professionally 

recognized and accredited but who have other competencies, including cultural/linguistic/ 

anti-oppression competency. Give these candidates on-the-job training, and adequate 

supervision and support. This is especially important in some of the smaller and more 

recently-established racialised and ethnic minority communities with few accredited 

professionals available to service their community. 

remove barriers that make it difficult for foreign-trained professionals to find work, such as 

“Canadian experience”. 

make sure that racialised and ethnic minority staff are not relied upon to represent the views 

of entire communities, nor held to be exclusively responsible for realizing an agency’s 

cultural competence and anti-oppression mandate. Make sure that accountability for this 

work rests with the agency leadership and management. 


To allow service users voice and choice, we recommend that agencies budget time and resources that allow 

front-line workers to: 

■■ 

■■ 

empower their clients, and 

give their clients meaningful and culturally-relevant choices 


“ ” 

Staff who you can look up to as role-models, people who’ve been consumers before 

is important (Service User). 

We need more family counsellors available (Service User). 

Many of our staff are immigrants/refugees themselves and have accessed the system 

themselves (Sojourn House staff; see case study in Appendix). 


To integrate families and communities, we recommend that agencies: 

■■ 

■■ 

hire service users and family members with some mental health training and experience 

among the communities served as staff and volunteers. Train these individuals to train other 

service users and family members as in a peer leadership model of service provision. 

hire social workers and community development workers to help service users integrate into 

the community. 


“ ” 

Train people in the community as volunteer mental health workers. Volunteer 

training sometimes attracts people who are in the closet about their mental health 

and is a way of doing health promotion…Ask them: what would you like to learn? 

Then provide them with whatever assistance they may need. The participants can in 

turn go on to become health promoters and help to facilitate further volunteer 

training and health promotion… This is also a way of addressing human resource 

limitations (Hong Fook staff member). 

Due to language barriers, in some cases we use case-managers to help clients 

communicate with housing providers. We also use interpreters. We need to develop 

partnerships for language services (Housing Provider). 


■■ 

■■ 

offer volunteer training sessions in addictions and or mental health care to all members of 

the community. Discuss topics selected by the participants themselves. This can help promote 

health, educate the public about mental health and addictions, and reduce the stigma. 

develop partnerships with ethno-specific agencies to increase service user’s access to 

culturally and linguistically competent staff. 


To offer holistic support, we recommend that agencies: 

■■ 

hire staff who practice alternative healing traditions, and who can address broader social 

determinants of health. If agencies cannot hire these individuals, make sure that service 

users have access to them. 


Service: access and delivery 

“ ” 

Cultural background is so much a part of who you are. If you lack understanding of a 

person’s cultural norms and background you will not understand that person. 

Understanding makes for better service (Housing Provider). 

Our intake process is not accessible. The questions we ask in some cases screen people 

out of the assessment process and screen people in. All the questions we ask -how 

culturally appropriate are they? I say this as a housing provider and we’re guilty of 

this…I don’t think we’ve thought about our process. We need to monitor people 

doing intake to see if it’s an inviting process (Housing Provider). 

Spanish speaking people listen to specific community radio stations. It would be great 

if information was available through those channels (Service User). 

When I came to Canada…I didn’t know where to go, where to get information…. 

Provide information and resources to newcomers so they can find out what services 

are available. Newcomers need to know how to get these services (Service User). 

The paper signing in application is meaningless for a lot of consumers in our 

community because they are not literate most times and have to entirely rely on staff 

to do the paper work and for advice(Service Provider). 

To make sure that services are accessible and delivered in ways that are anti-oppressive and culturally 

competent, we recommend that agencies: 

■■ 

■■ 

adapt services and programs to meet the unique and specific needs of diverse racialised 

and ethnic minority service users. Target and design different services and programs for 

diverse groups. 

when referring prospective tenants to housing, ask the service user and their family about 

their cultural preferences and norms. Consider the service user’s ethno-cultural background 

in the referral, and respect their cultural preferences and norms about housing and living 

arrangements. 

To make supportive housing programs and services more accessible to service users from racialised and 

ethnic minority communities, agencies can: 

■■ 

develop a targeted outreach and information strategy. Disseminate information about 

supportive housing programs and services through: 

½½ 

½½ 

½½ 

‘ethnic media’ such as community T.V. and radio stations, newspapers, internet sites and 

bulletin boards; 

community-based organizations such as immigrant and settlement agencies, ethnospecific 

community-based mental health agencies, ethno-specific, cultural and religiousbased 

agencies; 

places of public assembly including community centres and places of worship; and 


½½ 

frequently-used public services and institutions such as hospitals, mainstream mental 

health and addictions agencies, shelters, Ontario Works and Ontario Disability Support 

Program (ODSP) offices, police and court services. 

collect information about who is accessing the system and how they get referred for service. 

■■ 

9 

■■ 

■■ 

■■ 

■■ 

■■ 

develop intake procedures that are faster, more efficient and culturally competent. To do this 

agencies can: 

½½ 

½½ 

½½ 

½½ 

½½ 

½½ 

½½ 

advocate for a centralized application process for all supportive housing providers; 

make sure that application forms are available in diverse languages; 

make sure that staff help service users fill out forms, especially where literacy may be a 

barrier. Staff should verbally translate the questions and answers on the form; 

make the intake screening process more culturally sensitive and competent so that 

cultural differences in communication styles, health concepts, and appropriate lines of 

questioning do not exclude people from particular communities; 

minimize the number of times service users must retell traumatic stories and 

experiences during the screening process; 

adopt more lenient intake criteria; 

–– 

–– 

Allow service users without official identification papers to use services. This means 

adopting a ‘Don’t ask, don’t tell’ policy. 

Admit service users who do not have a formal diagnosis, since stigma in many 

racialised and ethnic minority communities prevents many from getting formal 

diagnoses. 

use ongoing research and review to check that the intake processes, procedures and 

criteria allow equitable access to programs and services. 

make sure that agency policies and practices are committed to linguistic competence and 

service accessibility. More specific best practice recommendations include ensuring the 

availability of: linguistically competent staff; translated organizational materials and forms 

in the first languages of the consumer(s); translation and interpretation services when/ 

where required. 

½½ 

NB: Agencies should not assume literacy amongst their clients and thus inquire as to 

how information may be best communicated. 

subsidize the cost of transportation and give service users honoraria for participating in 

agency events and capacity-building activities. 

offer culturally diverse and appropriate foods for service users and family members, when 

food is provided. 

use a range of strategies to reduce the stigma of mental health issues. For example, offer 

peer volunteer training sessions as a way to attract people with mental health or addictions 

9 This study revealed that primary pathways to supportive housing include emergency public services (in particular the hospital and 

shelter system, and secondarily, police stations, prisons and jails), ethno-specific community-based mental health programs and 

agencies (namely organizations like Hong Fook, Access Alliance, SAFE and immigrant and refugee serving agencies), ethnic media, 

informal networks of support such as places of worship and informal word-of-mouth referrals from family and peers. 



issues. This approach does not require individuals to publicly acknowledge their issues, and 

helps to overcome stigma. This approach has been used by Hong Fook (see Appendix A (2)). 

They have also developed a peer support training manual that deals with mental health and 

addictions issues. The manual is distributed to community members who need not identify 

themselves as mentally ill or addicted. 

“ ” 

In some organizations, clients are not allowed opportunities for meaningful 

participation, such as the provision of child care, honorarium or tools to help them 

learn about the organization and how they can access and participate in decision 

making (Service Provider). 

To ensure voice and choice in service, we recommend that agencies: 

■■ 

allow service users from culturally diverse backgrounds to give meaningful input into 

developing and evaluating programs and services. 


To integrate families and communities in services, we recommend that agencies: 

■■ 

■■ 

offer services with extended hours, to accommodate service users’ work schedules and 

family commitments. 

provide childcare support while service users are using services or meeting with service 

providers. 



“ ” 

Across Boundaries has partnerships with many agencies. Settlement agencies refer 

clients that are dealing with immigration, settlement, adaptation and integration 

issues…We are also a member of OCASI (Ontario Council of Agencies Serving 

Immigrants) and work with churches, religious organizations, social groups and 

tenant associations (Across Boundaries staff member). 

I like to see more education for people of my culture so they can understand mental 

illness. Mental illness needs to be looked at like any other illness, such as cancer 


Educate from within not from above…Education must be done within communities 

by community members. That is, communities educating their own…That’s the best 

way to address the stigma issue (Service Provider). 

I think the mosque needs to teach about mental illness. Everyone goes there and 

they listen (Service User). 

I wouldn’t know any services if there was no Hong Fook [a Toronto-based mental 

health association that addresses mental health concerns in the East and Southeast 

Asian communities]. I wish that if I were at the hospital, they would tell me. I didn’t 

know the system and services. Maybe there should be more outreach to more Chinese 

agencies/services (Service User). 


■■ 

■■ 

■■ 

■■ 

■■ 

partner with community groups and leaders to hold educational workshops and events in 

the community. These events will help reduce the stigma of addictions and mental illness. 

ask members of the targeted community to help develop, and to deliver, these events. This 

will increase the legitimacy, impact, and cultural relevance and competence of the 

educational initiatives. 

form service partnerships with ethno-specific community-based mental health agencies and 

other community-based agencies serving the target community such as immigrant and 

settlement agencies, and organizations serving specific ethnic or religious groups. These 

partnerships will help agencies disseminate information about supportive housing programs 

and provide more culturally competent, anti-oppressive programs and services. 

offer information and training about mental health, addictions and supportive housing 

programs to religious and spiritual care providers such as priests, imams and rabbis. 

ask religious and spiritual care providers to educate supportive housing providers about the 

religious and spiritual perspectives, ideals and norms of service users from their faith 

community. 



To offer holistic supports in services, we recommend that agencies: 

■■ 

■■ 

make sure that services incorporate and recognize non-western and religious or spiritualbased 

approaches to health. 

make sure that services are informed by a strength-based, recovery perspective. 

Best Practice Recommendations for the SYSTEM 

This final section deals with policies, practices, procedures and initiatives that are beyond the immediate 

power and scope of any single agency on its own. It outlines the changes needed on the systemic level to 

effectively develop anti-oppressive, culturally competent supportive housing. 

The section begins by focusing on access, funding and support issues, before proceeding to examine 

broader best practice recommendations, under our four principals sub-headings, relevant to considerations of 

anti-oppression and cultural competence in supportive housing, 

NB: It should be noted that because the stakeholders involved in the process were not from the systemlevel, 

the following sections should not be considered exhaustive of possible recommendations in this 

domain. 

Our best practice recommendations for this section fall into the following categories: 

■■ 

■■ 

access; and 

funding. 

“ ” 

It is the responsibility of the funders and policy makers to set up the system in such a 

way that ensures services and administration practice cultural competence (Service 

Provider). 

The government says they only fund agencies that serve everybody. What that really 

means is not serving ethnic minorities (Ethno-specific Housing Provider). 

The Ministry (of Health) has not been big on supporting ethno specific. Our funding 

has not increased since 1982. Only non-ethno-specific programs have been able to 

grow since then (Ethno-specific Housing Provider). 

In the mid 90’s when the NDP was in power, there was a strong belief in culturally 

competent services. That commitment and belief has since disappeared with the 

subsequent governments (Housing Provider). 

Supportive housing costs much less than keeping people in hospitals or emergency 

housing. It also reduces the use of costly emergency services. The Ministry of Health 

needs to invest more funding (Housing Provider). 

Information that’s available in English and French should be available in other 

languages consistently and reproduced every year. It’s the government’s responsibility 

to provide it federally and provincially (Service Provider). 


Access 

Here is how various stakeholders could improve access to the system: 

Emergency services, including hospitals, shelters and police services, could provide information about 

supportive housing in appropriate languages, since many racialised and ethnic minority service users enter 

supportive housing through emergency services. 

Local Health Integrated Networks (LHINS) and all other appropriate government bodies should 

support a centralized supportive housing database. The database would include information about vacancies 

and wait lists. It could also include tenant demographics, as long as tenants were given a choice about divulging 

this information. The database can help place tenants, increase the efficiency and transparency of the placement 

process, and identify service trends and needs. 

Social housing wait lists should give priority to people with mental health or addictions issues. 

The federal government should 

■■ 

■■ 

■■ 

develop a national housing policy which commits funding to the building of new affordable 

housing, and supportive housing, in mixed income settings. 

consider housing to be a human right. 

provide housing to people who do not have status as citizens, immigrants or refugees. 

The provincial government should 

■■ 

■■ 

■■ 

translate the Residential Tenancies Act into multiple languages. 

provide housing to people who do not have status as citizens, immigrants or refugees. 

allocate funds for coordinated access such as a centralized application system and process. 

Funding 

We recommend that governments: 

■■ 

■■ 

■■ 

■■ 

■■ 

■■ 

■■ 

increase funding and support for ethno-specific community-based mental health agencies 

and supportive housing programs. This should be core, multi-year funding. 

increase funding and support for capacity building, training and evaluation around issues of 

cultural competence and anti-oppression for housing and support services. 

make diversity, cultural competence and anti-oppression practices a funding priority. This 

focus should be reflected in the mandates of funding agencies in relation to housing. 

create and fund a centralized language service that includes interpretation and translation 

services, and make this agency’s services available to all publicly-funded agencies, including 


tie funding for supportive housing to cultural competence and anti-oppression benchmarks 

and standards. This will make sure that all supportive housing programs and services are 

universally accessible, and equitable, and that agencies use standard forms of accountability. 

fund ongoing research and evaluation initiatives about issues of access, equity, cultural 

competence and anti-oppression. 

support further research to develop more precise and detailed tools to evaluate cultural 

competence and anti-oppression work by supportive housing providers. 


■■ 

■■ 

■■ 

■■ 

support further research that establishes a stronger evidence base for cultural competence 

and anti-oppression best practice. 

support further research to identify how ethnic and racialised service users and family 

members in supportive housing access services, and what barriers they face. 

remove barriers that make it difficult for foreign-trained professionals to find employment in 

the sector, such as requiring Canadian experience and not recognizing foreign training and 

credentials. 

change zoning laws and reduce licensing fees for group homes to make it easier for 

individuals from communities with few resources to establish group homes for members of 

their community. 


“ ” 

Public housing planners should give poor people more ‘choices’, and not force people 

to accept lifestyles that they would not choose for themselves (Service User). 

What we need is income support so we can live in a community of choice. Help us 

meet our rent…You can choose your own destiny when you rent. You should have 

choice. (Service User). 

Our voice should also be included in the political structure. The funding that social 

services depend on to move forward in such (culturally competent) directions comes 

from the government. Without advocacy work with policy makers, very little will be 

achieved (Service User). 

To increase voice and choice, we recommend the following systemic changes: 

■■ 

■■ 

■■ 

Forums and decision-making bodies at all levels, including within government, should 

include racialised and ethnic minority service users and family members. 

Governments should expand income support programs so that racialised and ethnic minority 

service users face fewer financial barriers and have more options for housing and support. 

Funding and policy frameworks should be expanded to support: 

½½ 

½½ 

½½ 

a greater diversity of housing models so that service users have meaningful options. 

These models can exist along a continuum from high to low support, from culture or 

gender-specific to integrated, from abstinence based to harm reduction model and from 

single rooms to family accommodations; 

the ‘Housing First’ model and approach, which makes housing an unconditional human 

right, regardless of phase of recovery; and 

rent supplement models in which funds for rent are tied to the individual service user 

rather than the building in which they live. This model gives service users more housing 

options and helps prevent ghettoization. 



“ ” 

Many of our consumers need to graduate to independent housing but cannot afford 

to. The waiting list in social housing is so long. They are prevented from progressing 

because of availability. We need affordable housing to keep them flowing along the 

continuum. ODSP is not enough (Housing Provider). 

We need increased availability of housing stock that could fit a whole family using 

the rent subsidy model. Right now, rent subsidies only go so high, and therefore 

many can’t rent housing with more bedrooms because the cost is out of reach 


To integrate families and communities, we recommend that governments make the following changes: 

■■ 

■■ 

■■ 

■■ 

■■ 

Make funding for family and service user peer-based initiatives a priority. Give these groups 

the resources they need to function effectively. 

Implement a national housing policy and plan that will direct construction of affordable 

housing units, including some that accommodate larger families. These units allow service 

users to move along the continuum from high support housing towards independent living 

in the community. 

Change rooming occupancy laws. This will make it easier for large families to find housing, 

and recognize that there are cultural variations in what is considered acceptable room 

occupancy. Current laws that make it illegal for male and female children over the age of 

five to share a room are keeping many families out of otherwise habitable homes. 

Remove the cap on rent subsidies. Instead, co-relate the subsidy amount to family size. This 

will make it possible for larger families to afford multi-roomed units. Current rent subsidy 

limits make it very hard for supportive housing providers to find families that can afford 

multi-roomed units. 

Increase the amount of money invested in adult learning and English as a Second Language 

classes, and increase the subsidies for students attending these classes. English-language 

competency is essential for community integration. 

We also recommend that funding and policy frameworks be expanded so that they support: 

■■ 

■■ 

■■ 

family-based supportive housing models. This means more family-only buildings, in shared 

settings, and more floating supports for service users who live with family members in the 

family home; 

supported housing models in which service users are housed in regular housing that is 

integrated and dispersed in the community; and 

supportive housing models that feature partnerships between public and community-based 

supportive housing providers and private landlords. One example is the head-lease model in 

which the supportive housing provider supplements market rent. 



“ ” 

When individuals are hospitalized, workers should look at their situation and help 

them to get housing. I was discharged from the hospital and had nowhere to live. I 

threatened to kill myself. The hospital should look at people’s situations. Do they 

have money? Do they have somewhere to live?…I was thrown out without any help 


Services are fragmented. You are sent to different places for the same issue 


In my training as a Community Social Worker I did not get any training or 

information on how to work with other cultural groups, e.g. Somali, Canadian 

Native (Service Provider). 

The Ministry of Health and the City and provincial government are not linking…The left 

hand doesn’t know what the right hand is doing…The system is too compartmentalized. 

There needs to be a system in place among different types of housing providers. Levels 

of government need to communicate better (Housing Provider). 

To increase community development on the system level, we recommend that: 

■■ 

■■ 

■■ 

■■ 

■■ 

■■ 

■■ 

The supportive housing system to become more integrated, under the leadership of LHINS. 

Different levels of government consult with housing and support providers, service users 

and family members about the best ways to increase collaboration and coordination among 

different levels of government and the various ministries and departments that address 

issues of housing, health, and immigration. 

The supportive housing sector to develop a coordinated supportive housing strategy and 

framework that is informed by a shared set of values, principles, and standards, which 

include cultural competence and anti-oppression. 

LHINs should increase funding and support for community-based mental health agencies, 

programs and services with a cultural competence, anti-oppression mandate that serve 

racialised and ethnic minority service users and family members. Such services provide a 

key source of early intervention and are important pathways that lead racialised and ethnic 

minority service users to supportive housing. 

Governments increase funding and support for education initiatives geared towards reducing 

stigma about mental health and addictions in racialised and ethnic minority communities. 

Post-secondary education programs in health, mental health and addictions should include 

more anti-oppression and cultural competence issues in the curriculum, and engage more 

deeply with these issues. This will better prepare future health practitioners to work with 

Canada’s culturally diverse populations. 

Secondary and post-secondary education programs in health, mental health and addictions 

should actively recruit racialised and ethnic minority students. 



“ ” 

The prevalence of the medical model restricts the ability of staff/organizations to 

utilize alternative models of service and different approaches (Service Providers). 

To offer holistic support, we recommend that the Ontario government: 

■■ 

■■ 

■■ 

Allow OHIP to cover the costs of alternative, non-western, healing methods and 

complementary therapies. 

Subsidize the cost of ‘talk therapies’ for low-income service users. 

Support a paradigm shift within the mental health care system away from an emphasis on 

institutional-medical models of care towards holistic, recovery-based models of health 

promotion that emphasize the role of social and cultural determinants of health. 

We recommend that all levels of government should fund and support employment and education 

programs geared towards re-integrating service users into the workforce. 

We recommend that public and professional bodies in Canada recognize the training, skills and 

educational attainments of immigrant service users, and allow for more equitable accreditation. A key source 

of distress and mental illness for many racialised and ethnic minority service users is chronic underemployment. 


Part 5: Appendices 

Appendices 63

Appendix A: Case Studies 

Appendix A (1): Case Studies from the United Kingdom 

As part of the key informant interview process, we interviewed four international supportive housing providers 

in London, England, distinguished by their attention to the specific supportive housing needs of racialised and 

ethnic minority service users. Those interviewed included: Cashain David, Director of Care Services, Ujima 

Housing Association; James Mwesigwa, Manager, Frantz Fanon House; Pat Quarcoo, Manager, Easmon House; 

Kofi Sunu, Head of Care, Kush Supported Housing and Outreach Services. Descriptions of these four programs 

are included in this section. 

General Observations 

The ethno-specific housing programs in London, England had the support of local council and government 

authorities as they were widely acknowledged to achieve better health outcomes for Black and Minority Ethnic 

(BME) service users. They were also seen as being more cost effective in the long term because they keep 

people out of costly emergency services and in the community. The operators of these services argued that 

while cultural competence measures in the mainstream are absolutely necessary, the consistent failure of the 

mainstream to adapt their services to the needs of minorities, combined with the high levels of distrust of 

these services by BME service users, made it equally necessary to establish culturally-specific housing programs 

and support services. Kush and Ujima Housing providers and workers also stressed the fact their supportive 

housing programs ultimately increased their clients’ access to, and integration into, mainstream services and 

resources, while building stronger, healthier, more productive citizens. 

Ujima Housing Association 

Background 

Ujima is a Swahili word that means “working together”. Ujima is one of the largest Black housing associations 

in Europe. It was founded in 1977 by a small group of Black housing workers who were concerned about the 

housing needs of young, single, Black men and women. Ujima has a head office in Wembley, 13 project bases 

and 180 employees who work across 20 London boroughs with a number of needs (Elderly Care Services, 

Mental Health Services, Low-Cost Home Ownership, General Needs Housing, Special Needs Housing, Housing 

for Single Homeless, Refugee and Other Vulnerable Groups). 10 It is the largest provider of specialized 

accommodation for Black elders and Black people living with mental health issues. Ujima now owns and 

manages nearly 4500 general and special needs properties as a non-profit registered social landlord. Ujima 

Mental Health Services accommodates 46 residents living in five Registered Care Homes. Another 30 people 

live in Ujima’s Supported Living schemes where people requiring a lower level of support receive help 

managing money and finances, registering with a General Practitioner, claiming welfare benefits, accessing 

10 http://www.ujimahousing.org.uk/info2.cfm?info_id=34181 


interpreting or translation services, and education and training. People in Registered Care Homes may graduate 

to Supported Housing or to independent housing, depending on their needs. After 18 to 24 months of intensive 

support, Ujima supports residents to apply for more independent housing within the private sector, the local 

authority or within Ujima. When tenants move out of an Ujima Supported Housing Hostel they can continue 

to receive some support from their Supported Housing Officer until they settle into their new home. 

General Features of Ujima Registered Care Homes 

Care homes provide twenty-four hour (24hr) Care and Support and emphasize rehabilitation. Care homes are 

well-known for delivering culturally competent, sensitive and targeted services to African and Caribbean 

service users, many of whom other providers deem to be ‘difficult to manage or place’. The homes use a 

holistic approach in caring and supporting service users by addressing their cultural, spiritual, physical and 

personal mental health needs. Cashain David, Director of Care Services at Ujima, further mentioned the 

following best practices in place at Ujima Supportive Housing facilities: 

■■ 

■■ 

■■ 

■■ 

Staff are culturally competent and ethno-racially representative. They know the cultural 

backgrounds and communication styles of service users; 

Staff know about the programs and resources available within the ethno-racial community, 

because they are immersed in these communities; 

Staff are able to effectively communicate in service users’ different dialects (ex. patois and 

standard English); 

The décor and environment in the housing reflects the cultural background of service users. 

For example, the on-site library includes relevant reading materials, and the daily activities 

and food are in keeping with the cultural preferences of service users. 

Frantz Fanon House 

Background 

Named after the famous Caribbean psychiatrist and writer, Frantz Fanon House was established in 1999 by 

Ujima Housing Association in partnership with Greenwich Social Services. The project focuses on young Afro- 

Caribbean men who have spent long periods of their lives in secure psychiatric hospitals. The service builds 

on the ‘core and cluster’ model of housing. It is made up of a Registered Care home, which provides high level 

rehabilitation-based supports for 10 young men upon release from the hospital, and six one-bedroom supported 

houses (Bloomfield Court) which provide single people with the opportunity to live semi-independently with 

minimal support. Each tenant in Frantz Fanon House has his own furnished bedroom. Staff supervise cooking 

and cleaning. 

In an interview, the manager of Frantz Fanon House, James Mwesigwa, identified the following 

challenges and best practices: 

Problems & Challenges 

■■ 

■■ 

Many clients at Frantz Fanon have been misdiagnosed and over-medicated because of 

racism and a lack of understanding of the root causes of the clients’ mental health issues. 

While white patients who lapse often arrive at the hospital in an ambulance, Black patients 

who lapse are more likely to be brought in by the police. 

Appendices 65

■■ 

■■ 

■■ 

Black clients generally have less formal and informal supports than their white counterparts. 

The bio-chemical basis of mental illness is exacerbated by racism and socio-economic 

marginalization. 

Second generation Afro-Caribbean young men are less trusting of, and more frustrated with, 

the mainstream mental health care system than more recent newcomers. The main issues for 

newcomers revolve around culture and language rather than racism, disempowerment, 

marginalization and alienation. 

Illness and wellness, especially for second and third generation Black males, are affected by 

identity issues and complexes such as internalized racism, not having their identity and 

experience recognized, and having their cultural identity (in)validated. 

Best Practices 

■■ 

■■ 

■■ 

■■ 

■■ 

■■ 

■■ 

Provide culturally appropriate food, activities and indoor games such as dominos. 

Offer individualized attention and a one-to-one staff-user ratio; assign each tenant their own 

individual caseworker. 

Set up partnerships and links to other ethnic and mainstream agencies and programs in the 

community. 

Recognize that vocational and educational supports and skill building play a key role in the 

recovery process. 

Link tenants to a Black peer support group in Greenwich which brings together BME clients 

to discuss how to cope and support one another 

To minimize power struggles with support providers, use representative staff from the same 

background as service users. Many of the young men do not trust nor like being told what to 

do by White professional staff in positions of power. They are less likely to resist and 

subvert the treatment process when support providers are from the same background. This 

allows Frantz Fanon program workers to be stricter and to have residents respect the house 

rules. 

Create communal spaces. 

Easmon House 

Background 

Located in Wandsworth, South London, Easmon House, was named after a psychiatrist and community activist 

from Sierra Leone who worked in the London area. He advocated for culturally sensitive approaches and 

targeted services. Easmon House offers accommodation for nine Black men and women who need Mental 

Health supports. The accommodation is located over four floors. Staff provide 24-hour support including two 

members of staff awake at night. 

In an interview, the manager of Easmon House, Pat Quarcoo, identified the following challenges and 

best practices. 



■■ 

■■ 

■■ 

■■ 

■■ 

Mental health issues are not detected until they reach crisis proportions, because of stigma 

and the denial of mental illness. 

Most staff are first-generation Africans looking after second and third generation 

Caribbeans. The different generational and acculturative experiences and outlooks 

can cause misunderstandings and miscommunication, even though all concerned 

share Black skin colour. 

The demand for targeted supportive housing is much greater than the supply. 

Service users feel neglected, misdiagnosed and discriminated against by the mainstream 

mental health system, which many distrust. 

Often, illness is related to ‘culture conflict’, which can exacerbate or instigate the onset 

of illness. 


■■ 

■■ 

■■ 

■■ 

■■ 

■■ 

■■ 

■■ 

■■ 

■■ 

■■ 

■■ 

Food should be culturally appropriate, and the physical and social environment should be 

culturally sensitive. 

The organizational culture should be consistent with the cultural background of service users. 

Culturally competent staff should be from the same racial backgrounds as service users. 

Staff should understand racism and other issues faced by service users. 

Organizations must pay attention to intra-ethno-racial diversity in programming and hiring. 

Support staff and services engage the broader social determinants of health; combine clinical 

and social determinant models of health practices. 

Admit users on a trial basis. Give prospective tenants the opportunity to stay overnight or on 

weekends so that both sides can decide if there is a ‘fit’. 

Individualized attention and one-to-one ratio of staff to users; each tenant is assigned their 

own individual case worker. 

Weekly activity program is flexible, and planned for each individual. 

Partner with and link to other ethnic and mainstream agencies and programs in the 

community. 

Provide support on-site, day and night. 

Offer self-contained bedrooms and communal space. 

Provide meals, but give residents the option of cooking their own food at a weekly 

‘community kitchen’. 

Appendices 67

The Nile Centre, Kush Housing Association 

Background 

Kush Housing Association is based in Hackney, in North East London. It provides homes and solutions 

primarily for people of Black and minority ethnic origin. Kush supports 750 households in street properties, 

small schemes and housing within larger developments. Kush also provides supportive housing and floating 

support services in 4 London boroughs to clients with mental health and HIV/AIDS issues. 

Kush Housing operates the Nile Centre, which is based in Hackney. The centre is a unique alternative to 

the hospital for Afro-Caribbean people living with mental illness. The Nile Centre provides response services 

to African- Caribbean people in mental health crisis in order to prevent unnecessary hospital admissions. 

Services at The Nile Centre include a respite accommodation for 2 to 3 weeks, outreach and home-based 

support, counselling and therapy. A transitional supportive housing program has existed for 9 years. Its goal is 

to reduce the disproportionate number of Afro-Caribbean patients in hospital, and to help rehabilitate and reintegrate 

these clients back into the community. The Nile Centre has nine beds and 8 staff members: a Program 

Director, 2 support workers, 2 team leaders, and 3 residential mental health workers. There are also 2 alternative 

therapists on contract. Tenants in temporary respite care at the Nile Centre may graduate to independent Kush 

housing units, where they may receive floating supports. Kush has 27 clients supported in units they own, and 

it provides floating supports to another 78 clients in units it does not own. 


■■ 

Afro-Caribbean clients are over-represented in hospitals 


■■ 

■■ 

■■ 

■■ 

■■ 

‘Black on Black’ supportive housing program and staff reduce client mistrust and 

resentment, which is ‘half the battle’. Having representative staff establishes trust and sociocultural 

proximity and provides service users with positive role models with whom they can 

identify. It also enables service providers to effectively engage family members and 

successfully partner with community organizations (including churches and mosques). 

Targeted, culturally specific services have ultimately led to increasing integration into 

society: “We contribute to the mainstream by enabling them to better meet their service 

obligations and requirements” (Kofi Sunu). 

Staff and services are culturally competent: consider key role of culture in the way mental 

health is understood, along with the importance and value of the extended family, ancestors, 

and the influence of culturally specific taboos and stigma. 

Address experiences of racism and issues around cultural identity and internalized racism in 

the recovery process. 

Complementary therapies employed in the recovery process include reflexology, talk therapy, 

aromatherapy, massage therapy, and creative therapy. An herbalist is also available for 

consultation. Art and music are integrated into the recovery process. 


■■ 

■■ 

■■ 

Educational and vocational supports provided which have been found to be key to health 

promotion and resilience. 

Counsellors are trained in family therapy and family members are involved and supported in 

the recovery process. 

Research illustrating greater cost effectiveness of targeted services helped turn the tide in 

favour of publicly supported culturally specific, targeted services. 

Appendix A (2): Case Studies from Toronto 

As part of the key informant interview process, six supportive housing facilities were visited including Sojourn 

House, Chai Tikvah, Nishnawbe Homes, Yee Hong Centre – Aw Chan Kam Chee Evergreen Manor, Rainbow 

House and Caritas (see program descriptions and interviewees below) 

Sojourn House 

Background 

Sojourn House is the largest refugee shelter in Toronto and has been in existence for 13 years. The new 9 storey 

facility on Ontario Street contains both a shelter with 50 beds spread over two floors (2nd and 3rd floors), and 

52 transitional housing apartments spread over four floors (4th to 7th floors). The transitional housing units 

include 24 bachelor units, half of which are inhabited by ‘separated youth’ (age 16-24), and 16 two-bedroom 

family units, which house families of 3 and 4. There is no time limit on the length of stay in transitional 

housing. The new building, funded by the City of Toronto with funds from the Federal Supporting Community 

Partnership Initiatives (SCPI), features a rooftop terrace, garden, residential dining room, outdoor children’s 

playground, and recreational space. Sojourn House receives per diem funding from the City of Toronto and 

from Hostel Services and private and corporate donations. Staff are on-site 24 hours. 

Among the support services provided to refugees are counselling, assistance in the re-settlement process 

and help in navigating the complex government process to acquire landed immigrant status and eventually 

Canadian citizenship. Specific programs that help these women, children and men stay in Canada and build 

secure, productive lives include: 

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■■ 

■■ 

■■ 

■■ 

Settlement counselling 

Liaison work with government and non-governmental agencies 

Cultural orientation to Canada and Toronto 

Referrals to ethno-cultural groups and community centres 

Assistance in identifying transferable skills and identifying appropriate educational 

opportunities 

Follow up and outreach once a refugee has resettled into the community 

■■ 

11 


■■ 

■■ 

Anti-racist/feminist organizational framework and full day staff training 

Community development in the home through circulation of Sojourn House newsletter, and 

use of communal space for group activities 

11 Paragraph section taken from the Sojourn House website, http://www.sojournhouse.org/. 

Appendices 69

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■■ 

■■ 

■■ 

■■ 

■■ 

Tenant representation on strategic planning committee as well as on Board of Directors, 

which consists of board members, staff, a shelter resident and transitional housing resident. 

Advisory council also does focus groups with tenants. Integrating people into the 

organizational structure has fostered a sense of ownership and community. 

Outreach workers stay in touch with graduates for up to 6 months following their transition 

out of transitional housing (having a minimum 1-month follow-up requirement). 

The integrated holistic service model is what most distinguishes Sojourn House. There are 

some 14 support staff on-site, including an on-site transitional housing coordinator, 2 

housing workers, 5 settlement counsellors, a trauma counsellor, a child and youth program 

worker, and case supervisors and social workers for higher need service users. 

Many staff and volunteers are former refugees and/or service users themselves. 

Integration of shelter and transitional housing increases efficiency, since management, 

located in the same building, can oversee 2 programs simultaneously. 

Clients have had SCPI-funded access to language services, including translation and 

interpretation services (though these are now in jeopardy along with SCPI funding). 

Shelter accommodates non-status individuals. 

Chai Tikvah Foundation 

Background 

The Chai-Tikvah Foundation provides support services for psychiatrically disabled adults in Jewish residential 

settings to enable them to lead lives that are more productive. The Foundation offers 24-hour support to 

8 people in a group home setting. Chai Tikvah was founded in 1983 by a ‘group of parents whose adult 

children had nowhere to turn in the community for support and services. A prime mover behind the group 

was Rabbi Joseph Kelman, who attempted to remove the stigma of mental illness by noting that even King 

Saul suffered from depression and a mental breakdown.’ 12 Chai Tikvah works closely with Jewish Family and 

Child Service and receives 100% of its funding from Ontario’s health ministry. Residents receive 24-hour 

support, cook their own meals, and clean up and run errands in an effort to promote independence. 


■■ 

■■ 

■■ 

Strong links with Jewish social service agencies and community organizations, which help 

to facilitate outreach to the community. 

Anti-discrimination policy in place. 

Regular community development activities and peer support programs both within and 

beyond the home, which help build a sense of community and integrate tenants into the 

wider community. Social activities include ‘Club Simcha’, which meets at the group home 

and provides service users an opportunity to socialize with each other. As well as a weekly 

‘Bagel Club’ funded by the Jewish Federation of Greater Toronto, which, weekly hosted in a 

12 Citing Ron Csillag, ‘Chai Tikvah supports those with mental disorders’, originally posted July 2, 1998, http://www.cjnews.com/ 

pastissues/98/july2-98/health/health.htm. 


■■ 

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■■ 

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■■ 

■■ 

■■ 

community centre, brings tenants together with other members of the community over 

lunch, involving them in various structured activities. Such peer support networks have 

proven to be very valuable. 

Tenants ‘rule the roost’: Weekly house meetings held in which tenants decide upon the 

week’s activities. 

Availability of a culturally familiar and sensitive environment that meets orthodox standards. 

Home observes Jewish traditions, Sabbath, holidays and provides kosher foods, with two 

dishwashers and two sinks on-site, to facilitate kosher observances. 

A Rabbi is consulted as a support provider and brought in to the home on occasion, to 

discuss with tenants issues and concerns. Learning process is two ways, with religious 

leaders being educated about mental health by support staff, and support staff being 

educated about religious matters and health perspectives. 

Housing is across the street from a synagogue and located within a predominantly Jewish 

neighbourhood. 

Family treated as a ‘second client’; very involved in the support planning and recovery 

process. 

Currently working on a ‘consignment’ employment project, which would enable tenants to 

work from home and sell creative products at community events. 

Staff, many of whom are not Jewish, are trained and educated on cultural competence. 

Staff continuity has helped to maintain ongoing trusting relationships. 

Staff trained in parenting since many service users are parents. 

Nishnawbe Homes 

Background 

Nishnawbe Homes is made up of thirteen houses across the city, that provide housing for Aboriginal women 

and men 18 years of age and older. The houses are designed to promote a co-operative lifestyle among tenants. 

This also creates an extended family in each household. The apartment building is designed for singles or 

couples (11 units), small families (4 units), with one barrier free unit. The apartment complex is also designed 

to promote a family community within the urban setting of Toronto. 

It is the purpose of Nishnawbe Homes Inc. to provide safe, secure housing for the Native homeless and 

under-housed in Toronto and to do so in concert with similar organizations throughout North America. 

Nishnawbe Homes works toward a housing situation that develops equity for both the corporation and the 

residents. It also develops within the housing units, a strong sense of community and support in the context of 

Native cultural values and one that encourages an environment that is alcohol and drug free. 13 

13 First two paragraphs directly quote Nishnawbe program self description at http://www.cfis.ca/nish.html. 

Appendices 71


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■■ 

■■ 

■■ 

Communal living arrangements combined with private individual bedrooms, provide tenants 

with both privacy and a source of community and mutual support. Tenants share tasks and 

operate ‘as if’ family. 

Prospective tenants are interviewed by existing tenants to determine degree of ‘fit’. 

Rent geared to income. 

Holistic approach to support services: root causes of addiction engaged in recovery process, 

which incorporates and addresses issue of cultural identity, racism, and socio-cultural 

alienation. 

Traditional/community healing methods and healers employed in recovery process and 

found to be generally more effective than professional care providers, who often lack an 

understanding and appreciation of underlying issues fueling contemporary addictions. Ideal 

situation is to have support workers who are both trained professionals and who have 

knowledge of traditional holistic healing methods (though there are very few with such 

qualifications). 

Having socially and culturally aware and representative support providers from the same 

community saves service users from having to continually explain their life struggles and 

histories and prevents re-dramatization. 

Yee Hong Centre – Aw Chan Kam Chee Evergreen Manor 

Background 

Officially opened in October of 1994, Yee Hong Centre provides Chinese seniors and seniors from other cultural 

backgrounds including South Asian, Filipino and Japanese communities, with culturally and linguistically 

appropriate services – as they enjoy healthy, independent and dignified lives. Through the nursing home, nonprofit 

housing, and community centre, thousands of seniors benefit from these services – everyday. 14 

Directly owning and managing a social housing complex, the Yee Hong Centre – Aw Chan Kam Chee 

Evergreen Manor at 2319 McNicoll Avenue in Scarborough, Yee Hong provides a continuum of health and social 

services designed to enable Chinese-Canadian seniors to live independently and ‘age in place’ as long as possible. 

The Yee Hong Centre – Aw Chan Kam Chee Evergreen Manor complex of housing visited includes 130 units of 

seniors’ apartments (comprised of 112 one-bedroom units and 18 two-bedroom units), surrounded by 26 units of 

three-bedroom townhouses. A section of the apartment complex functions as independent supported housing, 

which enables seniors to live independently in the community as long as possible while receiving floating 

supports. Support services funded by the Ministry of Health and Long Term Care include personal care, light 

homemaking and timely response to emergencies. The adjoining wing of the building functions as a long-term 

care facility. The multi-service building also features a large community centre and enclosed outdoor courtyard, 

where daily programming occurs, which is open to the wider community on a fee basis. Yee Hong Centre also 

provides floating support services to residents of Villa Elegance (1883 McNicoll Ave, Scarborough) on a fee-forservice 

basis. 15 

14 Taken from Yee Hong website: http://www.yeehong.com/centre.html. 

15 This is a joint project between Yee Hong Centre and Tridel. Services include 24-hour response to medical emergencies, health 

monitoring, social & recreational activities, meals-on-wheels, personal care and light homemaking (http://www.yeehong.com/ 

community_services/supportive_housing/index.html). 



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Availability of culturally and linguistically competent and representative staff familiar with 

culturally specific communication styles and norms of behaviour. 

The provision of culturally appropriate programs and services, include meals and snacks. 

Examples include daily Tai Chi every morning, Christian and Buddhist religious services onsite, 

celebration of Chinese holidays, Chinese interior décor, on-site library stocked with 

Chinese reading and audio-visual materials, access to Chinese cable TV and daily newspapers 

in the lounge. Culturally appropriate food is deemed especially important. For example, wine 

and cheese and cold drinks offered in mainstream long-term care facilities are culturally 

distasteful for many Chinese seniors, who neither eat cheese, drink wine nor cold drinks 

(warm drinks being the norm for elders, according to traditional medicinal principles). 

Located in the heart of the Chinese community in Markham. Chinese-run strip mall right 

next door featuring a variety of services, restaurants and grocery stores. Key to success of 

Yee Hong is not only physical comfort but also surrounding community and culture. 

Family treated as ‘client’ and involved in decision-making processes. Surrounding 

townhouse units, reserved for seniors and family members, enable service users to stay near 

to elderly family members in the adjoining long-term care facility. 

Multi-service environs with holistic supports, including personal care services, access to 

meals on wheels and on-site access to medical specialists, including nutrition counselling 

and monitoring, physiotherapy and occupational therapy. 

Over 14 social, recreational, therapeutic and religious programs are available daily that 

encourage social interaction and help build a strong sense of community. Day programming 

is open to all in the community, which further facilitates community integration and 

networking, as does resident participation in events hosted in the wider community and at 

other nursing homes, including The Baycrest Centre and Villa Colombo. 

Large common spaces, including community centre and courtyard, facilitate and enable 

community gathering and building. 

Continuum of care model, which enables tenants to age in place, and receive supports as 

needed, while staying within the community of peers as one moves from lower to higher 

support units. 

Supports de-linked from units, which allow flexibility of use of units, depending on need. 

Option to cook own food or have meals provided (care of adjoining nursing home kitchen). 

Maintain links and partnerships with ethnic community and mainstream services and 

organizations. Culturally targeted service ultimately found to strengthen residents integration 

into wider society. 

Appendices 73

Rainbow Boarding Home 

Background 

In the 1980s, the community voiced serious concerns about the living conditions of consumer/survivors 

housed in boarding homes, mainly in the Parkdale area. Habitat Services was established in 1987 to address 

these concerns. 

The City of Toronto, the Ministries of Community and Social Services, Health and Housing, the 

Municipality of Metropolitan Toronto and the Supportive Housing Coalition discussed strategies. They 

developed the concept of using a contract to standardize services and improve housing standards in boarding 

homes. The details were worked out by consulting with consumer/survivors, advocates, representatives of the 

provincial and municipal governments, mental health workers and boarding home operators. The result was 

the Habitat Model. 16 

The Habitat model, which is unique in Ontario, is based on a contract between Habitat Services, a nonprofit 

agency, and the owners of private sector boarding and rooming houses. Compliance with the contract is 

ensured by monitoring. Habitat pays a per diem subsidy to the owners. Each Habitat-funded home has a 

Liaison Worker assigned to it by Habitat Services who works with the boarding homeowner and operator to 

ensure that they are meeting the contract requirements and standards. The Liaison Worker also facilitates 

‘Tenant/Operator Dispute Meetings’ which may be requested by the home operator when there is an issue of 

concern that might affect a tenant’s housing. In addition to the services provided by the homeowners and their 

staff, Habitat Services or Comprehensive Rehabilitation and Mental Health Services (COTA) provide on-site 

support services for tenants. 

The Rainbow Boarding Home is owned and operated by Joyce Chung who has operated a boarding 

home in the Parkdale area for the past 20 years. The Rainbow Boarding Home houses 20 tenants, 2 per room, 

with a total of 10 rooms. The second floor is female only, and the top floor is male only. While not planned as 

a culturally specific or targeted boarding home, the home naturally evolved into one due to the Chinese 

cultural origins and contacts of the owner-operator, who speaks Cantonese. Many of the tenants in this 

boarding home are Cantonese speaking, and the dominant culture of the home is Chinese. 

Support services at Rainbow Boarding Home are provided by COTA, a not-for-profit agency, which 

provides services to people with serious mental health challenges living in the community. Two COTA 

Community Site Support (CSS) staff supports tenants at Rainbow Boarding home, who: 

■■ 

■■ 

■■ 

■■ 

Visit each house regularly, 1 to 3 times per week. 

Deliver services that support and enrich each individual housing setting, based on the 

assessment and identification of needs. 

Facilitate group activities/events, which foster tenant engagement/participation, the 

development of social networks, and skill acquisition (e.g., Art Group, Music Group, Sports 

Group, Social Club, Dances, Large Group Excursions etc) 

Provide individual support to tenants in the areas of community orientation, linking to other 

services and professional supports, situational dispute/problem resolution and informal 

counselling. 

16 First two paragraphs directly quoting Habitat Services official website and self-description at http://www.habitatservices.org/ 

History.htm. 


■■ 

■■ 

Establish and maintain ongoing supportive relationships with all those living and working in 

each housing setting. 

Boarding home tenants may also have their own case managers, workers, or nurses who 

visit them in their homes from time to time. 


■■ 

■■ 

■■ 

■■ 

■■ 

The environment is culturally familiar and sensitive. Chinese food is offered daily to 

residents in the home, provided by two former local Chinese restaurant owners and cooks. 

Chinese cultural customs observed within the home and Chinese cable TV and newspapers 

available to tenants. Medicinal Chinese herbal teas provided to tenants, along with 

alternative, traditional, non-prescription home remedies such as Tiger Balm. 

Owner-operator and liaison worker (until recently) speak Cantonese. 

Tenants plan monthly social activities, which take place within and beyond the home. 

Family involved in decision-making processes. 

Interior décor informed by Chinese cultural aesthetic. 

Caritas 

Background 

Caritas was begun by an Italian priest (Fr. Carparelli) in 1980, in collaboration with a group of parents and 

families, in response to absence of culturally appropriate, holistic programs and supports available for people 

suffering from addictions in the Italian community. The Caritas Project is informed by a ‘Therapeutic 

Community’ (TC) model, which emphasizes the importance of community and peer supports, self-help, and 

an orderly, structured daily routine in a residential facility removed from drug-related environments, where 

tenants may be re-socialized in an ‘alternative family’like community of peers. Residents progress through 

treatment stages in accord with demonstrated progress and personal responsibility, receiving increased 

privileges and social responsibilities as they progress. This TC philosophy is reflected in the vision of Father 

Gianni Carparelli, as featured on the Caritas website: 

I tried hospitals, clinics, social workers, priests.... but I discovered that anyone afflicted 

with drug related problems suffer in a strange way. It is an illness not only of the body, 

but of the mind and of the spirit as well. It is the whole personality and life itself that 

withers away…In order to lend a hand, what is needed is more than a clinic or a short 

rehab program. It requires a family of friends, a new environment, a little discipline, a 

restructured life-style. 17 

Providing a structured ‘mock family’/‘mock society’ like residential environment, where individuals are 

made responsible for their own well-being and that of their fellow residents, Caritas describes itself as ‘a 

school of life’ in which individuals learn to live with others and themselves without the use of mood altering 

drugs or substances. Programming is based on a ‘tough love’ abstinence-based approach. The Ministry of 

Health funds day programming and public donations fund the rest of the registered charity, which runs a 

25-month cycle program. Caritas rents three houses in the city and one on a country farm setting in King City. 

17 http://www.caritas.ca. 

Appendices 75


■■ 

■■ 

■■ 

■■ 

■■ 

■■ 

Incorporation and support of family in recovery process deemed critical to success of 

recovery plan. 

Weekly support group held for family members, which is conducted in Italian. 

Traditional Italian/European cultural values and morals inform behavioural norms and 

expectations (e.g. emphasis on family, respect, responsibility, eating together etc). 

Many of the staff are former Caritas residents themselves which has been found to reduce 

the communication gap between staff and service users, while promoting trust and 

confidence in the recovery plan. Having staff that residents can identify with, has been 

further found to have an important role modeling effect, as staff becomes important ‘identity 

change agents’. 

Work therapy is employed as a means of providing vocational and educational training to 

residents, along with a sense of responsibility and discipline. 

Individual and group therapy sessions engage underlying ‘root causes’ of addictive 

behaviour. 


Appendix B: Glossary Of Terms 

Client-centred: an approach to working with people ‘where they are’ rather than ‘where they should be.’ With 

this approach, clients are allowed to set their own goals while receiving support and assistance (CMHC 

2006:45). 

Complementary Therapies: A (1995) British report by Sharon Jennings exploring the uses of complementary 

therapies in mental health settings provides three possible definitions of complementary therapies: 

■■ 

■■ 

■■ 

Incorporating a broad range of therapies (some 150 in all) employing various methods but 

which have in common the promotion of the individual’s own healing capacities; 

Sharing common principles such as using a broader definition of ‘health’ which not only 

represents the absence of symptoms but necessitates a spiritual well-being; working 

holistically with mind, body and spirit; 

Unscientific, unconventional, not medicine and linked to folklore (Jennings 1995:64; cited in 

Safe Haven Report 1998:66); 

Consumer: An individual who has, or has had at some point in his/ her life, a personal mental health issue 

and had used formal or informal mental health services. (Mental Health Consumer Advocacy Network Nova 

Scotia and the Self-Help Connection, 1992) 

Continuum: Called a continuum of supports in Canada and continuum of care in the US (also the staircase 

model in Sweden), this approach conceptualizes the move from homelessness to stability as a series of stages 

starting with outreach and moving through a range of programs such as drop-in centres, shelters and safe 

havens, residential programs and various forms of housing in increasingly more independent and lesssupervised 

settings (CMHC 2006:45). 

Culture refers to the evolving ideas, values, beliefs, practices and institutions of a social group that serve as a 

common point of reference for members self-identifying with that group and cultural tradition. Culture, in this 

view, is not a stable object of knowledge or ‘thing’ rigidly determining people’s behaviours, but rather is a 

resource that individuals and groups use to make sense of the world. Culture is also a realm of the political. 

Individuals with different social positions within a ‘culture’ may interact with, and interpret, the accumulated 

meanings and institutions of their culture(s) in different ways. They may also participate in multiple cultural 

systems and have multiple cultural identities, all of which are subject to ongoing interpretation, negotiation 

and transformation. The ways in which culture shapes behaviour and perception often goes un-recognized by 

individuals, especially where culture has become dominant and hegemonic (i.e. naturalized as the ‘common 

sense’ way to see and do things). 

Cultural racism refers to “racism that is deeply embedded in the value system of a society. It represents the 

tacit network of beliefs and values that encourages and justifies discriminatory actions, behaviours, and 

practices” (Henry and Tator 2006:348). 

Domain refers to a “major content area in which issues of cultural competence need to be addressed” (Siegel, 

Haugland, & Davis Chambers, 2002; cited in Olavarria, Beaulac, Bélanger et al 2005b). 

Appendices 77

Diversity refers to the unique characteristics that all of us possess that distinguishes us as individuals and 

identify us as belonging to a group or groups. Diversity transcends concepts of racialised groups, ethnicity, 

language, class, socio-economic status, citizenship status, gender, faith, family structure, sexuality, age and 

mental and physical ability (Hasting Institute as cited in BC Ministry for Children and Family, 2001). Cultural 

diversity is fluid and dynamic. Each one of us may possess different sets of these characteristics throughout 

our life span and the meaning or significance of these characteristics is dependent on the historical, social, 

cultural, economic and political contexts we live in. (Toronto Public Health Administration Manual Policy, p.6, 

October 22, 2001). 

Emergency housing includes shelters and hostels. It is set up as temporary housing for people in crisis. The 

people who use shelters and hostels generally have no home or their homes have become unsafe (e.g., people 

who are living on the street, refugees or new immigrants awaiting housing, women who have been abused). 

Many shelters provide services to specific groups of people: women only, families, women and children, single 

men only or youth). (CAMH 2003, Challenges and Choices: Finding Mental Health Services in Ontario, p.102) 

Ethnicity: An ethnic group, or ethnicity, refers to human population groups who identify themselves as 

members of a distinct cultural grouping, on the basis of such factors as presumed common genealogy, ancestry, 

language, cultural practice and/or nationality. 18 The boundaries, traditions and cultural practices defining 

ethnic groups are subject to continual negotiation, interpretation and transformation over time, being ultimately 

defined by those individuals and groups of individuals who identify themselves as belonging to a particular 

ethnic group. 

Ethnic Minority: The term ‘ethnic minority’ refers to individuals from communities who share a cultural 

identity as members of an ‘ethnic group’ that is other than that of the dominant, white Canadian population. 

‘Minority’ does not relate to population size, but to relations of power in society: ‘minority’ groups having less 

power in society than ‘majority’ or ‘dominant’ groups. 

“Housing first”: the direct provision of permanent, independent housing to people who are homeless. Central 

to this idea is that clients will receive whatever individual services and assistance they need and want to 

maintain their housing choice. The housing is viewed primarily as a place to live, not to receive treatment 

(CMHC 2006:45). 

Institutional Racism: Refers to “policies, practices, and procedures of various institutions, which may, directly 

or indirectly, consciously or unwittingly, promote, sustain, or entrench differential advantage or privilege for 

people of certain races” (Henry and Tator 2006:55). 

Minoritized: refers to the social, political, economic and cultural conditions that relegate specific groups of 

people into “minority” status even when they may be a demographic majority (i.e. people from non-White 

ethno-racial groups are a demographic majority globally and in Toronto, but are viewed as a “minority” group) 

(Zine 2002). 

18 Ethnic groups range between those more kinship-based, such as those historically (and problematically) classified as ‘tribes’, and 

those more strictly territorially-based, as in the example of national ethnicities (for example, German, Italian, French etc). 


NIMBY: Not In My Back Yard—an acronym used to denote opposition by local communities to the 

introduction of facilities deemed undesirable (e.g., waste storage facilities) or housing for certain populations 

(e.g., homeless persons). Perceived negative impacts on the community that can be cited include physical 

effects (e.g., loss of open space or increase in traffic) as well as financial implications (e.g., decrease in 

property values) (CMHC 2006:46). 

Organizational culture refers to “the basic assumptions driving life in a given organization” (Thomas 1991:13), 

and the “pattern of assumptions and beliefs deeply held in common by members of an organization” (Nolan et 

al. 1993:34), which ultimately determine ‘the way business is done’ within an organization (Bernard 1998:33). 

Policies include such things as “a mission statement, program goals, hiring practices, and advocacy efforts” 

(Olavarria et al. 2005a:36). 

Positionality: Refers to the social position of individuals and groups in the social structure (i.e. along race, 

class, gender lines etc), drawing attention to the ways in which social position shapes social experience, and 

often perception. 

Practices relate to “the activities done by direct service staff such as assessments, treatment planning, and 

outreach, and by activities that concern administrative personnel such as recruitment, retention of personnel, 

networking with leaders of cultural communities, and program development and implementation” (Olavarria 

et al. 2005a:36, citing Mason & Braker, 1995). 

Race: Race is a social reality, and not a biological fact. The definition and description of race – who belongs in 

what racial category and on what basis - varies historically, being a social construction related to struggles 

over power (as suggested by the concept of racialisation). Skin colour has historically been, and continues to 

be, a most prominent and visible marker of race in North America, and the global context. 

Racialised: The term racialised refers to individuals and communities classified as a racial group by members 

of society in ways that impact their individual and group experience and well-being, socially, culturally, 

economically, and politically. The concept of ‘racialisation’ draws attention to the process by which racial 

categories arise and evolve over time, versus accepting race as a biological reality. Racialisation becomes racist 

when racially identified groups are attributed with additional negative characteristics, which then become a 

basis for discrimination and social exclusion. 

Appendices 79

Supported housing differs from supportive housing. With supported housing, the support worker provides 

care and services from outside the home. People living in supported housing tend to need much less support 

and can live more independently than people in supportive housing. Supported housing could be a social 

housing coalition or any other housing environment that provides staff from a community agency. Support 

workers could be: 

■■ 

■■ 

■■ 

visiting homemakers who come in for about an hour a day to help with chores like laundry 

and cleaning (This service is not easy to get.); or 

case managers or support workers who spend most of their time helping the client with 

living skills, such as learning to use the local transit system or learning to cook, prepare a 

budget and shop; or 

nurses who give medication and provide support and counselling (CAMH 2003, Challenges 

and Choices: Finding Mental Health Services in Ontario, p.102). 

Supportive Housing: In the broad sense, as used in this report, supportive housing refers to a broad range of 

housing options linked to a variety of support services. It may be scattered-site or congregate; “housing ready” 

or “housing first;” “wet,” “damp” or “dry;” transitional or permanent (National Health Care for the Homeless 

Council 2003) (CMHC 2006:20). Support services in supportive housing, in this broad sense, may be linked or 

de-linked from housing. In the more narrow use of the term, when contrasted with ‘supported housing’, 

‘supportive housing’ refers to housing where there are support workers in the home who work for the housing 

provider. The support varies depending on what you need. There could be no support, on-call support, weekly 

or daily support or 24-hour-a-day support. To get into supportive housing, as a service user (there being other 

kinds of supportive housing tenants), you need to meet certain conditions: Have a diagnosis of a mental illness 

for a minimum length of time or have been admitted to a psychiatric facility a minimum number of times or 

for a minimum amount of time. Most supportive housing (e.g., a boarding home, a group home or a co-op) 

involves sharing living space. However, there are some apartments where you can live on your own (CAMH 

2003, Challenges and Choices: Finding Mental Health Services in Ontario, p.101-102). 

Transitional housing: Time-limited housing (e.g., two to three years) often with support services and the 

expectation that the residents will move on to independent and permanent housing (CMHC 2006:46). 

Visible Minority: The Employment Equity Act defines visible minorities as “persons other than Aboriginal 

peoples, who are non-Caucasian in race and or non-White in colour.” The Act specifically includes under this 

category: Chinese, South Asians, Blacks, Arabs and West Asians, Filipinos, South East Asians, Latin Americans, 

Japanese Koreans and Pacific Islanders (cited in Zine 2002). 


Appendix C: Evaluation Tools & Other Resources 

Appendix C(1): Cross et al. Cultural Competence Continuum Scale 

Source: Cultural Competence Continuum Scale, Cross et al., 1989, cited in Lecca et al., 1998 

Stage of Cultural Competence 

Cultural Destructiveness 

Cultural Incapacity 

Cultural Blindness 

Cultural Precompetence 

Basic Cultural Competence 

Advanced Cultural Competence 

Characteristics of an Organization at Each Stage of Cultural Competence 

The organization presents attitudes, policies, and practices that are destructive 

to cultures and to individuals within those cultures intentionally. Programs here 

present culture/race-based oppression, forced assimilation, or even genocide. 

The agency does not intentionally seek to be culturally destructive. However, it lacks 

the capacity to help people of minority groups since it remains biased, believes in 

racial superiority of the dominant group, and assumes a paternalistic posture 

toward the perceived ‘lesser’ cultural groups. Discriminating practices, subtle 

messages that people of minority groups are not wanted there, and generally lower 

expectations for clients of these groups are present in such an organization. 

Services are provided under the belief that all people are the same and that 

ethnicity, race or culture makes no difference. Therefore, approaches used with 

the dominant culture are assumed to work as effectively as with other 

populations. Although this ethnocentric view is not ill intended, services are 

rendered useless to all but the most assimilated people of minority groups. The 

ethnocentrism of the agency is reflected in the attitudes, policies, and practices. 

It is characterized by the desire to deliver high-quality, culturally relevant services. 

Driven by the awareness that the organization has weaknesses in the services 

provided to specific populations, the agency takes multiple steps to improve its 

services. Innovations in service approaches, hiring diverse staff, and the initiation 

of culturally relevant training for their workers are some examples. A danger at 

this point is either a false sense of accomplishment or failure with regard to 

service approach that prevents the agency from moving forward. 

The agency is characterized by the acceptance of and respect for difference, 

continuing self-assessment regarding culture, careful attention to the dynamics 

of difference, continuous expansion of cultural knowledge and resources, and 

adaptation of their service model in order to better the needs of the 

community. There will be ongoing dialogue and input from the ethnic 

communities at all levels of the organization and an external network with 

other formal and informal supports from communities that they serve. 

The agency is acquiring new knowledge by developing new interventions, 

evaluating and disseminating the results of demonstration projects for 

examination by the stakeholders, and experimenting with changes in its 

organizational structure that support the cultural values and beliefs of the people 

whom they serve. 

Source: Cross, Cross, Barzon, Dennis & Isaacs 1989 in Sue et al., 1998 

Appendices 81

Appendix C(2): CAMH Organizational Diversity Scale & Measures 

Source: Diversity Plan: Centre for Addiction and Mental Health. KPMG Consulting, July 2000. p.22 & 25. 


Appendix C(3): Standards and Indicators of Organisational Cultural Competence 

Source: Olavarria et al. 2005b, Organisational Cultural Competence: Self-Assessment Tools for Community Health and Social Service Organisations, p. 22-26. 

Domain Sub-Domain Standard Indicator(s) 

Organisational Norms, 

Principles, and Policies 

Commitment to 

CC in policies 

1. Mention of CC in mission statement 

and mandate 

2. CC policy statements and code 

of conduct 

3. Implementation and monitoring of 

CC policies 

4. CC plan for organisation 

5. Person named responsible and 

accountable for CC within organisation 

6. Leadership committed to CC organisation 

7. CC in budget 

The organisation has adopted a mission statement and mandate 

that explicitly incorporate a commitment to cultural competency 

The organisational has policy statements, a code of conduct, and/or 

other relevant procedures related to organisational CC 

The CC policies have been effectively implemented and the 

organisation is monitoring the implementation of the CC policies 

The organisation has an organisational plan for CC. The 

components of the strategic plan should include: objectives, 

strategies, implementation plan naming lines of responsibility and 

timetable, dissemination plan, oversight method, and management 

accountability 

A person has been named responsible and accountable for CC 

within organisation 

The leadership is committed to organisational CC 

The organisation has committed funding for organisational activities 

related explicitly to cultural competency 

CC advisory 

committee 

8. Composition of staff, community, 

consumers, and family members on 

advisory committee 

9. Frequency of meetings 

10. Function of committee 

11. Reporting to leadership 

12. Implementation of committee’s 

recommendations 

There is an advisory committee for organisational cultural 

competence whose members reflect the racial/ethnic characteristics 

of the catchment area by staff, community, consumer, and family 

committee members 

Indicate the frequency of CC advisory committee meetings 

List principal duties of CC advisory committee 

The CC advisory committee reports periodic written documents to a 

named person or department at the executive leadership level 

The CC advisory committee’s recommendations are implemented 

Appendices 83


CC activities 

within 

organisation 

13. Review of CC activities 

14. CC included in client satisfaction and 

organisation improvement procedures 

15. Formal CC complaint mechanism in place 

that is itself CC, for staff and consumers 

16. Staff, volunteers, and consumers aware 

of complaint mechanism process 

17. CC evaluation conducted 

CCHC regularly reviews the performance of CC activities 

CC questions are included in client satisfaction and organisation 

improvement procedures 

A formal CC complaint mechanism is in place for staff and 

consumers (e.g. grievance procedures available in languages other 

than English and in format reflecting stakeholder literacy levels). 

The CC complaint mechanism is culturally competent and effective 

Stakeholders are aware of complaint process 

An organisational evaluation of CC has been conducted 

in the last # years 

CC climate 18. Commitment of staff to CC 

19. Culturally sensitive and welcoming 

physical environment 

20. Signage, reading materials, etc, are 

culturally appropriate 

Staff are committed to organisational and interpersonal CC 

– Displays pictures, posters, artwork and other décor that reflect the 

cultures and ethnic backgrounds of clients served 

– Brochures and other printed materials in reception areas are of 

interest to and reflect the different cultures and ethnic 

background of client population 

– Printed information takes into account the average literacy levels 

of individuals served 

– Multi-media resources reflect the cultures and ethnic background 

of client population 



Asset and Need 

Identification Research 

related to CC 

21. Awareness and knowledge of target 

population and their needs (population 

based-assessment) 

22. Awareness and knowledge of users and 

their needs 

23. Identification of CC barriers and issues 

24. Ongoing consultation about community 

needs 

– The organisation obtains population level data regarding their 

catchment area population characteristics (e.g., gender, ethnicity, 

religion, education, immigration status, etc) 

– The organisation profiles social resources for the cultural groups in 

its target population (e.g., houses of worship, community leaders, 

community based-organisations, etc) 

– Relationships and partnerships are created with community 

leaders so that knowledge and needs of their communities can be 

shared from a strength base perspective 

– The organisation profiles its service users on population 

characteristics that are important for CC 

– The organisation has systematic ways to collect and aggregate 

data on its users (e.g., gender, ethnicity, religion, education, 

immigration status, etc) 

– The organisation obtains information regarding barriers to services 

– The organisation maintains links to the community that allows it 

to stay attuned to the needs of the community 

Human Resources 

Management: 

Policies and Practices 

Recruitment 

hiring, and 

retention 

25. CC recruitment, selection, and interview 

strategies 

26. Staff composition and representation at 

different levels 

27. Level of cultural experience of staff 

28. Satisfaction and retention level of staff 

by culture 

29. Staff performance evaluation 

– Recruitment strategies include procedures for recruiting bilingual 

staff and staff that have previous experience with particular user 

cultural groups (e.g., recruitment strategies mention that 

bilingualism skill and/or prior experience with any of the cultural 

groups served by the services is desirable, the recruitment process 

is conducted broadly by identifying ethnic specific media outlets 

and community centres, and utilizes the expertise and networks 

of the advisory committee) 

– Staff in the service delivery entity reflect the diversity in cultural 

background of the service users 

– Staff in upper level management reflect the diversity in cultural 

background of the service users 

The level of cultural experience of staff is formally assessed 

Staff satisfaction and retention level statistics are reviewed for 

different cultural groups 

The staff performance evaluation form includes items related to CC 

Appendices 85


Staff training 

on CC 

30. CC training and educational requirements 

31. CC materials distributed to staff 

32. Organisational resources for CC training 

– Staff are required to receive training and education related to 

developing cultural competency 

– New employees are given orientation in CC approaches 

of the service delivery entity as part of their orientation or 

training material 

– Culture/race/ethnicity topics are incorporated into all continuing 

professional education and other training 

The administration selects, develops, and provides materials to be 

used for staff training and education in CC 

(Materials related to CC are distributed to staff) 

Funds are allocated for training and continuing education in CC 

Services and Service 

delivery 

Linguistic 

competence 

33. Service descriptions and educational 

materials in languages of target 

populations 

34. Rights/grievances in languages of target 

populations 

35. Interpretation/translation services 

36. Linguistic competence of interpreters 

37. Linguistic competence of staff 

38. Translation of critical forms, etc to 

languages of target populations 

Service description and materials are available in the language of 

the targeted population. The information should be available in 

different languages and formats and should reflect the levels of 

literacy and education of the audience 

Information on rights and grievance procedures are available in the 

languages and formats accessible to cultural groups served 

Interpreters are available to consumers with limited English 

proficiency for the delivery of services in all languages of cultural 

groups in the service area 

Evidence exists that all interpreters have been assessed for the 

competence of language and culture 

Staff members are available to deliver services in different languages 

and formats, according to the level of literacy and education of the 

target population. 

Forms and other pertinent materials are available in the languages 

and formats accessible to the target population. 



Services 39. Development and Adaptation of services/ 

intervention to improve CC 

40. Hours of operation – weekends/evenings 

41. Transportation assistance 

42. Culturally appropriate services 

43. Services for specific cultural groups 

44. Promotion of CC services and 

service delivery 

45. # of drop-outs/no shows/missed 

appointments 

46. Client satisfaction by CC 

47. Collection of outcome data 

48. Evaluation of services and service 

delivery by CC 

Culture-specific services are developed and adapted by the 

organisation for its users, including the delivery of services in 

different languages and formats that reflects the levels of literacy 

and education of the target population 

Service delivery hours should be adapted to needs of the audience 

Alternative transportation is available for all persons in the 

service area 

The delivery of services targets the different needs of all cultural 

groups in the service area 

Services have been implemented to target the specific needs of the 

different cultural groups in the service area 

Advertisement and promotion is provided in the community about 

CC services 

Data on the # of drop-outs/no shows/missed appointments is 

collected 

Client satisfaction on services is collected 

Outcome data are collected for the services delivered 

CC is included in evaluations conducted of CCHC services 

Community 

Consultation, 

Partnership, and 

Information Exchange 

49. Presence and quality of community 

partnerships 

50. Appropriate partnerships in 

the community 

51. Advocacy-related and community 

building activities 

52. Patient and consumer involvement in 

CC-related activities 

53. Organisational CC progress disseminated 

to consumers and community 

Quality partnerships have been formed within the target area 

Alliances and partnerships have been formed with the different 

cultural groups and organisations in the area, matching the 

target population 

Involvement in advocacy-related and community building activities 

# of patients/consumers involved in CC-related activities 

Advertisement and dissemination regarding the organisational CC 

progress to consumers and community 

Appendices 87

Appendix C(4): A Definition of Linguistic Competence 

Definitions of linguistic competence vary considerably. Such definitions have evolved from diverse perspectives, 

interests and needs and are incorporated into state legislation, Federal statutes and programs, private sector 

organizations and academic settings. The following definition, developed by the National Center for Cultural 

Competence, provides a foundation for determining linguistic competence in health care, mental health and 

other human service delivery systems. It encompasses a broad spectrum of constituency groups that could 

require language assistance from an organization or agency. 

Linguistic competence – the capacity of an organization and its personnel to communicate effectively, 

and convey information in a manner that is easily understood by diverse audiences including persons of 

limited English proficiency, those who have low literacy skills or are not literate, and individuals with 

disabilities. This may include, but is not limited to, the use of: 

■■ 

■■ 

■■ 

■■ 

■■ 

■■ 

■■ 

■■ 

■■ 

■■ 

■■ 

■■ 

■■ 

■■ 

bilingual/bicultural staff; 

cultural brokers; 

foreign language interpretation services including distance technologies; 

sign language interpretation services; 

multilingual telecommunication systems; 

TTY; 

assistive technology devices; 

computer assisted real time translation (CART) or viable real time transcriptions (VRT); 

print materials in easy to read, low literacy, picture and symbol formats; 

materials in alternative formats (e.g. audiotape, Braille, enlarged print ); 

varied approaches to share information with individuals who experience cognitive disabilities; 

materials developed and tested for specific cultural, ethnic and linguistic groups; 

translation services including those of: 

½½ 

½½ 

½½ 

½½ 

legally binding documents (e.g. consent forms, confidentiality and patient rights 

statements, release of information, applications) 

signage 

health education materials 

public awareness materials and campaigns; and 

ethnic media in languages other than English (e.g. television, radio, Internet, newspapers, 

periodicals); 

The organization must have policy, structures, practices, procedures, and dedicated resources to support 

this capacity. 

Developed by Tawara D. Goode and Wendy Jones, 8/00, Revised 8/03. 

National Center for Cultural Competence, Georgetown University, 

Centre for Child and Human Development, 

University Center for Excellence in Developmental Disabilities 


Appendix C(5): Diversity: Ethnoracial Issues and Home / Community Care 

Diversity: Ethnoracial Issues in Home and 

Community Care 

What is diversity? 

Diversity has many dimensions. A broad and 

comprehensive understanding includes religious 

beliefs, cultural traditions, mental and physical 

ability, sexual orientation and class, as well as 

differences in race, language and ethnicity (Elliot, 

1999; Fried & Mehrotra, 1998). This In Focus 

looks at the provision of home and community 

care for ethnoracially diverse communities. 

Why focus on diversity issues in 

home and community care? 

Illness and disease are socially 

constructed experiences. The meanings and 

experiences of illness and disease may vary from 

group to group. As such, providers and users may 

approach health, wellness and community care in 

a variety of ways depending on ethnoracial and 

cultural differences. 

Canada’s changing population. The 

importance of diversity has become increasingly 

relevant to health and social care providers as 

changes in immigrant source countries to Canada 

is altering the ethnoracial composition of 

communities. 

 

 

 

The Canadian population, including our senior 

population, is becoming more diverse (National 

Advisory Council on Aging, 2005). Between 

1979 and 2000, 3.7 million immigrants arrived 

in Canada and over 50% of them were from 

Asia. 

Canada has over 200 different ethnic groups 

(Statistics Canada, 2003). 

Visible minorities make up 13% of Canada’s 

population and 7% of the senior population 

 

(Statistics Canada, 2007). As our population 

ages, seniors will become more diverse. 

19.4% of new immigrants were 65 years of age 

and over at the time they arrived in Canada 

(National Advisory Council on Aging, 2001). 

Access to home and community care. A 

growing body of Canadian and international 

evidence suggests that ethnoracial and cultural 

differences can hinder or facilitate access to 

health and social care and affect health status 

(Bowen, 2001). For example: 

 

 

 

In Ontario, immigrant seniors from Asia, Central 

America, South America and Africa were less 

likely to use home care services than 

Canadian-born and immigrant seniors from 

America, Europe and Australia (Maurier & 

Northcott, 2000). 

A study examining patterns of Type 2 diabetes 

management among 267 adults found that 

English-speakers as compared to Cantoneseand 

Portuguese-speakers were more likely to 

be better informed about how to manage their 

disease because they were more likely to use a 

variety of information sources (family doctors, 

endocrinologists, diabetes educators, 

publications and media, and relatives or friends) 

(Ryerson University, 2007). 

A 1999 report from the Olson Center for 

Women's Health at the University of Nebraska 

Medical Center noted that the mortality rate 

from breast cancer for women of colour is 31.2 

deaths per 200,000 people compared with 26 

per 200,000 for white women. This may be 

because examining one’s breast is not 

considered appropriate behaviour for Muslim 

women (Farooqui, 2005). 

Appendices 89

There is increasing recognition that health and 

community care often involve multiple factors 

including ongoing communication with client’s 

family and the broader social support network. 

Thus, effective support and care require clear 

communication between providers and clients 

which in turn require understanding the 

ethnoracial context of care. When providers and 

clients do not speak the same language, or, if 

providers are unaware of the client’s cultural 

context, support and care may be compromised 

(Saldov, 1991; Lum et al., 2003). 

A comparison of home health care recipients 

from different ethnic and racial groups found a 

disparity in IADL and ADL outcomes: white 

clients experienced substantially better 

functional outcomes than did home health care 

recipients of other racial and ethnic 

backgrounds (Brega, et al., 2005). 

What is ethnoracially appropriate 

care? 

 

 

 

Ethnoracially appropriate care is sensitive to the 

varying cultural, social, emotional, spiritual and 

linguistic care needs of diverse populations. 

Ethnoracially appropriate care competence is 

the ability of providers to deliver effective 

services to diverse populations. 

There is no widely accepted framework for 

providing ethnoracially appropriate care. While 

there is a recognized need for "inclusiveness 

and equity" for clinical and home and 

community care, there is no single validated 

checklist for ethnoracial and cultural 

competency. 

Organizations are often left to improvise ethnospecific 

programs to meet emerging needs in 

their communities often with few resources for a 

long-term strategic plan. 

How do organizations provide 

ethnoracially appropriate care? 

Cultivate effective communication skills. 

Effective communication skills are essential to 

engage clients, learn about them, identify issues 

and provide appropriate care. For example, Bigby 

(2003) provides a model to help achieve effective, 

culturally competent communications, denoted by 

the acronym LEARN. 

Listen to the client’s perspective. For example, 

among some cultures, “empowerment” and self 

managed care may not be valued and can be 

taken to mean “less care” and “leaving me to 

myself so bad things can happen”; 

Explain and share your perspective; 

Acknowledge differences and similarities 

between two perspectives. For instance, while 

client autonomy and agency is often assumed, in 

some Asian and African cultures, decisions over 

health may be family-centred (Hawker, 2004). 

Recommend a course of care; 

Negotiate a mutually agreed upon plan. 

Information from individuals and families or other 

community agencies and organizations may mean 

that service provision needs to be adapted to 

respond to the needs and preferences of 

ethnoracially and culturally diverse clients. 

Care providers cannot assume that one size fits 

all. Nor can they assume to know an individual’s 

cultural beliefs based on outward appearances, 

language or geographical area of origin. 

Identify and address barriers to access 

through effective outreach strategies. 

Expand outreach strategies utilizing both formal 

and informal networks (e.g., faith groups, social 

clubs) particularly if your client population does 

not reflect the broader population. 

 

 

 

Conduct a twice a year “knock on doors” in the 

community to identify at risk clients. 

Use the grapevine or word-of-mouth within 

ethnoracial groups as an outreach tool. 

Recognize that seniors from ethnoracial 

communities may be unable to participate in 

programs because of care giving 

responsibilities for children. One solution may 

be to offer intergenerational programs. 

2 


Ensure that your diverse client populations feel 

welcomed by the outward appearance of your 

organization with appropriate signage, printed 

materials, symbols and visual images. 

Try innovative methods. An agency that wanted 

to reach women experiencing domestic 

violence in particular communities distributed 

emery board nail-files with the name and phone 

number of the agency in different languages. 

The nail files were widely distributed in places 

such as washrooms and hair salons. 

Broaden the focus of health concerns and 

issues to include those that affect diverse client 

populations because of genetic, social and/or 

cultural factors (Waterloo Wellington Local 

Health Integration Network, 2006). Doing so 

leads to recognizing that some health concerns 

are more prevalent in some ethnoracial 

populations than in others (e.g., bacterial 

meningitis, Sickle Cell Disease, Fetal Alcohol 

Syndrome, HIV/AIDS, Tuberculosis, and Tay- 

Sachs disease). Broadening the focus of health 

concerns will increase early detection of 

culturally-specific diseases, improve access to 

health and community care and health 

outcomes (Central East Local Health 

Integration Network, 2006). 

Use appropriate translators. Engaging 

specially trained volunteers can be a cost-efficient 

means for organizations to bridge communication 

gaps when hiring multi-cultural and multi-lingual 

staff is not economically feasible. 

Friends, family members/children are often used 

as translators. This may be convenient but is not 

recommended because it may: 

 

 

breech confidentiality; 

discourage clients from disclosing critical 

information on private matters, especially on 

sensitive issues where individuals may fear 

isolation or stigma (e.g., HIV status, or sexuality 

issues) particularly in small, tight-knit 

communities; 

 

different meaning, add editorial comments, or 

omit important information; 

place children in stressful situations of having to 

convey information that a parent may not want 

to hear. As well, some topics may be too 

complex for children to fully grasp and children 

may lack sufficient command of language to 

communicate information correctly (Early, 2003; 

Lum et al., 2003). 

Some facilities in Canada and the U.S. are 

currently experimenting with telephone translation 

services. As yet, there are few studies assessing 

the availability, quality, effectiveness and 

standards of these services, particularly in home 

care settings. 

Leverage community resources. There are 

many untapped resources within ethnoracial 

communities that can be used to enhance 

culturally sensitive care. 

 

 

 

For example, a community service agency in 

Toronto linked with field placement offices of 

local universities to recruit social work 

placement students with specific language, 

religious and cultural skills. This strategy 

allowed the agency to enhance its cultural 

competency in delivering services in a cost 

effective way. Some students continued on as 

permanent staff upon graduation. 

A Community Care Access Centre linked 

professional health providers with specific 

language, religious and cultural skills in one 

area to clients in another area to ensure 

culturally competent care. 

A municipal housing provider partnered with a 

community service agency and ethno-specific 

senior citizen centre. As a result, 10 seniors 

from that racial community were able to gain 

access into supportive housing (Meade, 2007). 

Ongoing partnerships with diverse communities 

may also help defray the cost of ethnoculturallyspecific 

social programming in supportive 

housing. 

 

result in misleading translations as 

inexperienced translators may inadvertently 

substitute some words for others that have a 

 

Research comparing the aging experience of 

Cantonese-speaking Chinese and Caribbean 

seniors found that Chinese seniors were more 

3 

Appendices 91

likely to access community support services 

despite poorer English language proficiency 

than Caribbean seniors (Lum & Springer, 

2004). Community Service Agencies 

successfully reached into the well-established 

network of Chinese communities and leveraged 

their strong social infrastructure. As a result, 

individuals obtained support services that they 

would not otherwise access. 

Maximize the use of care management / 

community intervention and assistance. 

Research comparing seniors in social and 

supportive housing suggests that care managers 

were effective in mediating cultural or linguistic 

barriers to facilitate the provision of culturally and 

linguistically appropriate support service 

packages, especially for seniors from small 

emergent ethnoracial communities with relatively 

weak infrastructures. Without care management, 

individuals and their families had to navigate 

programs and services for themselves (Lum, Ruff, 

& Williams, 2005). 

Recognize the importance of multiple 

entry points to service. A number of reports 

emphasize that a single point of entry (e.g., one 

central information referral centre/ telephone 

number) is optimal for clients to access integrated 

health and community care services. People of 

diverse backgrounds may feel more comfortable 

accessing services through agencies that provide 

culturally and linguistically appropriate services. 

The key is that both single and multiple points of 

entry should lead to integrated health and 

community care services. 

Anticipate diversity within ethnoracial 

communities. Ethnoracial communities are 

rarely homogeneous. To avoid aligning with one 

particular part of the ethnoracial community and 

alienating another, care providers may wish to 

find formal or informal community leaders or 

academics that can help identify any internal 

political, religious, class, clan or regional 

cleavages as well as how different communities 

resolve internal conflicts. 

How can I learn more? 

Selected references are available in our 

knowledge bank. As well, watch for our next 

diversity In Focus where we will be looking at 

sexual orientation issues and home and 

community care. 

4 


Prepared by 

Janet Lum 1 ; Jennifer Sladek 1 ; Joseph Springer 1 ; Alvin Ying 1 ; in consultation with Jennifer Clark 1 ; Deborah 

Egan, Community Home Assistance to Seniors; Usha George 1 ; Sujata Ganguli, St. Clair West Services for 

Seniors; Odette Maharaj, Scarborough Services for Seniors; Odete Nascimento, St Christopher House; 

Jane Sutherland Fry, Ontario Association of Community Care Access Centres ( 1 Ryerson University). 

Last Edited 

September 26, 2007 

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6 


Appendix C(6): Evolving Philosophical Approaches of Human Services in 

Multicultural Contexts 

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Appendices 95

Appendix C(7): Comparing Values of Multicultural 

and Anti-Racist Approaches 

Source: Vickers, Jill. (2002). The Politics of ‘Race’: Canada, Australia, The United States. Ottawa, Canada: The Golden Dog Press, 

pp.146-147. Draws on Carl James (1996) Perspectives on Racism and the Human Services Sector: A Case for Change. Toronto: 

University of Toronto Press. 


Appendix C(8): A Model for Diagnosing and Removing Institutional Racism 

Appendices 97

Source: Henry, Frances and Carol Tator (2006).The Colour of Democracy: Racism in Canadian Society (Third Edition). Canada: 

Thomson/Nelson, p.323-324. 


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Appendices 101

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