Co-designing recovery together – Addressing homelessness, addictions, and social inequity in rural Ontario, Canada

Background: The Oxford Ontario Health Team (OHT), Woodstock Hospital, and a network of community partners developed the Oxford Homelessness Addiction Recovery Treatment Hub (HART Hub), which was approved in 2025. The HART Hub supports people experiencing homelessness, addiction, and mental health challenges who face barriers due to the lack of locally coordinated care. Community advisors shaped the HART Hub from proposal through implementation. Engagement methods were targeted to marginalized populations to meet people where they are.

 

Approach: A caregiver community advisor with deep knowledge of local challenges, played a key role throughout the HART Hub planning and implementation. The Oxford OHT’s organized group of volunteers with lived and living experience and caregiver's identified co-design as the primary engagement method and collaborated to develop the process, materials, and recruitment strategy prioritizing inclusion, accessibility, and trauma-informed practices.

 

A population matrix guided recruitment to ensure diverse representation. The community advisor and engagement staff worked together to co-design the recruitment process, interactive sessions, plan the share back of what we heard to participants and implement feedback.

To reach people where they were, the engagement leads partnered with community organizations to host sessions and support recruitment through a co-design roadshow model. Sessions were held across Oxford County in familiar spaces such as employment services, shelter day space, and supportive housing units.

Food and honorariums were provided, and community-developed stories from focus groups guided journey mapping and prioritization exercises.

When we learned that people living in local encampments were not attending co-design sessions, we partnered with outreach workers to conduct oral surveys with those individuals. This ensured voices were heard from each segment of the population matrix.

 

 

 

Results: Seven co-design sessions were held, engaging 80 participants including people with lived and living experience, community members, care partners, and front-line staff. Twelve additional surveys were completed with encampment residents.

 

Deductive thematic analysis identified that participants desired: (1) A central, accessible location for services, (2) support for basic needs (food, hygiene, safety, primary care) built into all pathways, (3) Access to timely mental health and addiction counselling, (4) housing services including transitional and sober living options, (5) emotional support for families, caregivers, and community relationships. Each session identified unique themes, such as mobile services for rural areas.

The engagement leads translated all themes into potential actions. HART Hub project teams, including their community advisors, report back on progress to ensure accountability. This process developed trust among co-design participants, identified systemic gaps, and created a shared vision for integrated mental health and addictions care that reflects the lived realities of those using the HART Hub.

 

Implications: Reducing inequities starts with listening to those most affected. This method shows that early, embedded engagement leads to more responsive systems. Key strategies included using a population matrix to guide recruitment, partnering with trusted organizations, and adapting methods to reach encampment residents. The co-design roadshow offers a practical model for underserved communities through relationship-based engagement. This approach can be applied in other contexts by meeting those you need to engage where they are.