Combining the World Café and the Deliberative Democratic Evaluation: A Win-Win Strategy

Abstract

The current emergency response for substance users experiencing homelessness is not adapted to their needs. This has led to the revolving door phenomenon and to issues of collaboration between involved organizations. This study aims to demonstrate the relevance from the participants’ perspective of: 1) the World Café; 2) the deliberative democratic evaluation; and 3) combining these two methods as part of a qualitative study aimed at improving emergency response to substance users experiencing homelessness in Montreal. Thirty-four people participated in an intersectoral World Café guided by the principles of deliberative democratic evaluation. Twenty-three participants responded to a questionnaire regarding their satisfaction, effects of their participation, and adherence to the principles of deliberative democratic evaluation (inclusion, dialogue, and deliberation). We performed descriptive statistics and a thematic content analysis. Ultimately, the respondents were satisfied with the activity and several said they gained new knowledge and improved their network. Roughly half of the participants shared that their participation influenced their representations and their future practices. Our findings suggest that combining deliberative democratic evaluation and World Café is relevant to providing rich qualitative data, gaining systemic insight, and having an impact on our communities (e.g., improving intersectoral collaboration, professional’ attitudes and practices).

Improving the Response to People Experiencing Homelessness and Psychoactive Substance Use in Montreal: A Systemic and Intersectoral Perspective

“…A cross-sector TRIAGE activity was conducted to prioritize solutions (step 3). This type of activity focuses on group consensus decision-making by selecting solution paths most likely to improve, in this case, the emergency response offered to people experiencing homelessness and PSU (Albert et al, 2014;Alunni-Menichini, 2020;Gervais & Pépin, 2002;Harvey & Holmes, 2012).…”

“…The interactive phase consisted of seven steps (see Figure 1). The activity began with a knowledge transfer activity (Figure 1: 1), which was a summary presentation of the results of the first two phases of the needs analysis, the needs assessment and solution assessment (Alunni-Menichini, 2020;Alunni-Menichini et al, 2020). The identification of solutions was presented in the form of key concepts and concrete examples, as suggested by the project advisory committee.…”

“…According to participants, an important limitation of those without medical support is their numerous admission criteria to avoid any risk of withdrawal with complications. However, according to several studies, the majority of users do not require an acute care episode in the hospital emergency room (Alunni-Menichini et al, 2020;Ross et al, 2013;Smith-Bernardin et al, 2019). One possible solution is to rely on the assessment and monitoring of withdrawal during admissions, a role usually performed by medical staff, rather than on predefined criteria (Klein et al, 2018;Ross et al, 2013;Smith-Bernardin et al, 2019).…”

“…Some tools can be used to facilitate coordination between services, in particular the individualized service plan (ISP), which makes it possible to bring to the same table all the actors and organizations likely to contribute positively to the person's situation (Douglas, 2014). The ISP is often used by homelessness teams in Quebec (Alunni-Menichini, 2020;Ménard & Simard, 2013). Since the TRIAGE activity, such positions have been opened in various jurisdictions, including the Montreal police department.…”

“…Considering the barriers to access that people experiencing homelessness who use psychoactive substances face and the limitations of emergency services, it is essential to identify solutions to improve the emergency response offered to these people from a global perspective. This article is part of a larger study aimed at improving the emergency response to people experiencing homelessness and psychoactive substance use (Alunni-Menichini, 2020). This article presents the results of the prioritization of solutions to improve the response to the people experiencing homelessness and PSU from the perspectives of emergency service providers, homelessness people, and other stakeholders in Montreal.…”