Social Entrepreneurism in Mental Health: Examining the Scalability of Top Tier Social Innovators

Proof of Principle

This proof of principle strategy was used in Toronto in a 2011 project funded by the Population Health Improvement Research Network.¹ Using a rigorous search process informed by that of Ashoka and a multiple case study design, the key practices underlying the effectiveness of five high-impact services for transgender, Aboriginal, immigrant, refugee, and homeless populations were determined.² This project, which involved a collaboration between the Centre for Addiction and Mental Health, Ashoka, and MaRS Social Innovation Generation, proved successful in identifying a common model of implementation and operation. Despite differences in specific intervention and populations served, these exceptionally innovative groups work in very similar ways. The research team takes a similar, albeit more thorough and informed, approach in this innovation.

Project Objective

This project explores two questions:

1. Can a core, common set of implementation and program delivery characteristics be identified in the work of social entrepreneurs making inroads in mental health in low income countries?

2. Can these core characteristics of social innovation be integrated with business and technological innovation to create a strategy that will enhance similar work in other contexts? 

Target Program Population: Social Innovators and Consultants

Ashoka’s Network of Fellows

Through Ashoka’s existing network of Fellows, the team accessed social innovators who are addressing mental health in low and low-middle income (LMIC) countries. Ashoka currently has 38 Fellows working specifically in the area of mental health, of whom 29 are working in 10 different LMIC countries. Having been screened through Ashoka’s rigorous selection process, each of these individuals has demonstrated significant social innovation. They have built large amounts of social capital around a solution that is embedded within their communities in a manner that is sustainable and holds promise of transferability to other contexts.

While all relevant Fellows were approached to engage in conversations about methods for replication and scaling, five were identified for in-depth case studies through a purposeful sampling strategy. As our effort is one of determining common components of implementation, the team sought maximum variation considering (i) approach, (ii) target population, and (iii) geographic location. Six participants were sought to allow for depth of investigation within the time and resources available through the seed grant. Considering the methodology employed, this sample size should prove adequate to inform the questions of feasibility raised in this project.

Key Informants from Team’s Networks

Through the team’s respective networks, additional international key informants were identified from related business, social, and technology innovation sectors who were able to speak to the questions and inform the scaling strategy that will grow from the findings.

This process – generating a priority list and connecting with Fellows and key informants to assess interest and conducting preliminary interviews to assist in guiding the content of the inquiry – has taken four months to complete.

Project Methods

For the case studies, the team used an instrumental approach, or one in which the case is used to provide insight into a particular broader issue. This was undertaken within a participatory framework  – seeking a maximal involvement of the Fellow and their colleagues in the generation of metrics and methods. Specific areas of inquiry included:

1. A detailed history tracking the trajectories and turning points in services offered, service structures/models, goals and values, integrity of implementation, leveraging support, and relationships with stakeholders and supporters.
2. Inquiry into the roles and activities of key people within the organization and external partners, though a careful examination of the specific aims and activities of the people involved in the service. Implicit to this line of investigation will be a close study of the “theories of action” of the participants – the individual’s understanding of how their activities lead to the outcomes that they are seeking to attain.
3. Examination of their relationships within relevant systems (service, corporate, government, cultural norms) – how they are positioned, how leverage is achieved or blocked, and the flow of information, people, and resources into and out of the organization from these systems. Understanding the contextual ‘circumstances’ of the intervention will likely prove as important to testing scalability as understanding the intervention itself.³
4. Evaluation of the impacts of their work from the perspectives of all stakeholders. The impacts, intended and unintended, will be examined at individual, family, community, and systems levels.
5. Resource Analysis. In concert with a consideration of the impacts of the organization the team will examine the resources it requires, both social and economic and, as applicable, assess the business model being applied.
6. Information and Communications Technology (ICT) Systems Analysis.  The team will consider any current and potential future uses of ICT by the Fellows, assessing how use of ICT could enhance the efficiency and scalability of their approach.

The strength of the case study design came from its triangulation of data sources, which included:

1. Semi-structured interviews with past and present service leadership, direct service staff, recipients of the services, and key partners. The lines of inquiry of these interviews were developed in partnership as a function of the participatory research process.
2. Study of impacts, comprised of some data collection from project/service recipients and use of existing data.
3. Review of key documents (i.e., annual reports, newsletters, websites, newspaper articles, academic studies). Such documents, along with providing important information about the development and operations of services, were an important source of information about the outcomes of the services (e.g., number of individuals served; reports of impact both quantitative and qualitative; financials). 
4. Ethnographic observation of activities of the organization (e.g., meetings of members, presentations to the public, advocacy activities, etc.).
5. Key informant interviews informed the case study from design to analysis. Tapping the extensive networks of the team’s collaboration across social (including other Ashoka Fellows), business, and technology innovation domains, the content of the inquiry was informed by a series of online forums at the beginning of this period. Preliminary findings were brought back to these same forums to assist in refining inquiry, framing findings, and synthesizing an integrated strategy for scaling these approaches (the key output of the study).

For each of the case studies, a grounded theory approach to data collection took place in which the data collection process and data analysis proceeding simultaneously, allowing for frequent opportunities for refining the structure of the findings through increasingly targeted inquiry. Three steps were be taken to maximize rigor in the analysis and to establish the credibility and trustworthiness of the findings:

1. Recognizing the importance of a very rich source of data in multiple forms that allows for triangulation by source (staff, leaders, partners) and type (field notes, verbal description, documents).
2. Engaging participants in discussion about the emerging categories to ensure trustworthiness in the analysis.
3. Using multiple coders. Interviews with other key informants will undergo the same method of data analysis.