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Hope Through Strength: Exploring the Impact of Sanctum 1.5

Within the heart of Saskatoon, Sanctum 1.5 stands as a beacon of hope, providing unwavering support to pregnant women navigating the complexities of HIV-related challenges and potential child apprehension. In collaboration with an interdisciplinary team of scholars and women with lived experiences, Sanctum’s transformative ‘Hope Through Strength’ project embarks on a four-year journey, seeking to unearth the profound impact of Sanctum 1.5. This article delves into the innovative application of Social Return on Investment (SROI) as a powerful tool employed by the Hope Through Strength research team. 

About Sanctum 1.5  

Sanctum 1.5 is a program run by Sanctum Care Group in Saskatoon, SK that provides wrap-around care for pregnant women living with, or at risk of, HIV and/or at risk of infant apprehension by the child welfare system. Sanctum 1.5 is a 10-bed residence for women and their babies, with physicians and nurses providing care in-house, that offers up to three months of prenatal care and three months of postnatal care, along with one year of follow-up support. Between its October 2018 launch and June 2023, 126 mothers with 128 babies had successfully completed the program. 

The Hope Through Strength Research Project 

In 2020, an interdisciplinary team of diverse scholars and women with lived experience partnered with Sanctum Care Group on a four-year CIHR–funded research project entitled Hope Through Strength. The Hope Through Strength project explores how Sanctum 1.5’s model of care (trauma-informed, harm reduction, person-centred, wholistic and collaborative) impacts women’s lives through the program’s phases of stabilization, recovery, and successful transition to community. 

Many of the women at Sanctum 1.5 have experienced substance use, homelessness, and Intimate Partner Violence.  The goal is really to help the moms stabilize, support them on their recovery journey, and then walk alongside them as they transition back into the community, explains Lynette Epp.  

Project Components 

Lynette is a research coordinator of the Hope Through Strength team at the University of Saskatchewan with extensive community-engaged research experience, facilitating implementation of interrelated three-phased project activities centering on understanding and communicating the impacts of Sanctum 1.5. The research has several overlapping and iterative phases, including a quantitative component, drawing on Sanctum 1.5’s client data to identify patterns of change over time. This includes the number of mothers able to keep custody of their babies, since one of the main objectives of the program is to prevent children from going into the child welfare system. It also includes statistics about the mothers’ substance use supports, housing stability status, and the types of community supports they have accessed.   

SROI analysis and Social Value Principles in Hope Through Strength 

Another phase of the project draws on SROI (Social Return on Investment) analysis and Social Value Principles. It focuses on outcomes linked to prenatal and postnatal care, involvement with Child and Protective Services, harm reduction, and housing. The Hope Through Strength project will provide an evidence-base that supports the current programming and possible future expansion provincially and beyond.  

Lynette and her colleagues Arianna Berthold and Holly McKenzie were encouraged by their project lead, Professor Sithokozile Maposa in collaboration with project co-PIs Ms. Katelyn Roberts (Executive Director of Sanctum Care Group), Drs. Alexandra King, Amanda Froehlich Chow, Erika Penz, and Alana Cattapan, to take the Level 1 and Level 2 Social Value and SROI training courses offered by Social Value Canada. This training has informed and strengthened the project implementation of SROI in their research. 

Putting stakeholders at the heart of the SROI  

A key aspect of the research is to describe “the story of change” in SROI parlance. It draws on individual interviews and sharing circle conversations/focus groups with mothers who have been through the program to understand what changes they experienced.

How could you do any sort of evaluation if you’re not talking to the people whose lives are affected by what’s going on, Lynette says.

In fact, one of the key strengths of the project is having women who are graduates of Sanctum 1.5 employed as community research associates with Hope Through Strength to provide insight and guidance into all aspects of the projects. 

The team recently held two focus group sessions and engaged with moms around the following question: ‘Here’s a list of all the changes we heard people identify, which ones have you personally experienced? Which ones are most important to you? Which ones do you think would be most important to other moms who have been through the program,” explains Lynette. This stakeholder-centered process involving the program’s clients has helped the researchers rank the changes in order of importance to the moms, and identify which changes are most frequently experienced. The next step is for the team to determine the monetary value of the program’s impacts using financial proxies which will highlight the importance of placing value on outcomes such as having the confidence to access care. However, the team recognizes other outcomes, such as not being separated from one’s baby, cannot be adequately or appropriately captured or communicated using monetary terms.  

Two-eyed Seeing approach and Indigenous perspectives 

Lynette and her interdisciplinary team of colleagues know that they also need input from a wider group of stakeholders, including the communities in which the moms are based. An estimated 80-90% of Sanctum 1.5’s clientele identifies as Indigenous, and the research project is framed through an etuaptmumk (Two-eyed Seeing) lens, which brings together Western and Indigenous perspectives and approaches. This informs all aspects of the project. Indeed, the HTS team has established a Community Guiding Circle comprised of mothers with lived experience, Indigenous Elders and Knowledge Holders, community partners and health and social services experts to provide guidance to the project team. One of the needs that many of the women have expressed is opportunities to learn from cultural teachings. In response, the project has co-created Arts and Cultural activities, led by HTS’s cultural facilitator, to provide additional cultural learning opportunities to the women involved in the project.   

Scaling Sanctum 1.5’s Model of Care 

The final component of the research considers what core elements of Sanctum 1.5’s model of care might be applicable in other settings where perinatal moms are in need of additional support. This ‘scale and spread’ component recognizes that different locations will have different needs that will necessitate modification of aspects of the program, but that the aspects central to Sanctum 1.5’s successes could be implemented successfully elsewhere. This process will also be informed by organizations running similar programs elsewhere, including H.E.R. Pregnancy Program in Edmonton which has also conducted an SROI analysis. 

Benefits of SROI for Sanctum 1.5 

Lynette expects that the SROI will provide Sanctum 1.5 with a “thorough understanding of how the programs is working, and what the moms’ life-changing experiences are.” It will enable Sanctum 1.5 to describe what social impact and savings the program is generating for government funders. It will also tell the broader story of change, the stories of the women who have experienced life changes due to Sanctum 1.5 which, says Lynette, “really helps the community understand how valuable and how necessary these supports are and how they’re meeting a need.” Finally, in another stage, the team hopes to explore how the conventional SROI approach could be integrated with etuaptmumk (Two-eyed Seeing), bringing together Western and Indigenous perspectives and approaches to ensure that the values and priorities of Indigenous clients, communities and partners are reflected through an adapted, culturally relevant SROI. 

On the value of SROI training  

Translating their SROI training into real world research has been an important learning experience for the team.

It’s been a good challenge to try to think creatively about how we’re going to access the information we need and how and when to know if you have enough information, says Lynette.

Team members with lived experience have also helped to add an in-depth understanding of contextual details that inform success stories. The team is also conscious of the importance of not overclaiming and being transparent about the study’s limitations. 

Lynette is grateful for the guidance she’s received from SVC’s lead trainer, Stephanie Robertson. She also looks forward to having more members of the HTS team take part in SROI training soon.

Having them trained up in the Level 1 conceptual understanding of SROI, and its objectives, and how it differs from other valuation methods, is going to be very useful for us to have principle-based conversations and make better decisions together, she says. 

Recommendations for other organizations 

Lynette advises that anyone contemplating “any sort of evaluation for any sort of organization” should consider the Level 1 Introduction to SROI course.

It gives you an understanding of what SROI is about and why it’s important to consider the impact of change beyond just a financial return on investment,” she says. 

Because it really is asking the value-added question, who else is affected by the work we do? And in this day and age, I feel like there’s a responsibility on corporations and not-for-profits and government to be able to understand the effects of their decisions — not just for themselves or for their intended beneficiaries, but on others.

She recommends Level 2 Social Value and SROI training for anyone who is thinking of conducting an SROI analysis. Understanding what an SROI entails enables one to make a compelling case to a board or decisions makers about what the benefits are, she says. And it is critical for anyone who has decided to conduct an SROI to help ensure that the principles are applied properly and consistently.  

I just see such a need and opportunity for organizations to be able to have good information about what’s working, what’s not working, and what they can take to funders, supporters and partners and say, ‘Look, we are doing the very best we can with the resources available. We’re not just counting how many people are coming through the door, but we are maximizing the impact we’re having on people’s lives.’