Toronto’s Crescent Town gets a new food hub at Harmony Hall

In early 2019, South Riverdale’s 2 Gower Street location became a partner site of Community Food Centres Canada (CFCC), a national organization that’s driving the development of community food centres across the country. Prior to this, SRCHC was and remains a Good Food Organization with CFCC with the goal of improving food security for people in our communities and creating an accessible and healthy food system. Our location at 2 Gower Street also hosts the Harmony Hall Centre for Seniors program.

In addition to our community food security programs, where space is provided for community to come together to make and eat healthy meals, we are now going to grow, cook, share, and advocate for healthy and accessible food for all as we expand our food programming.

With funding from CFCC, we have renovated the kitchen facilities at the 2 Gower Street location. This welcoming space for Harmony Hall and community members enables them to come together, and learn to cook and garden. Their health, and the general health of the community, is improved through healthier food choices. In addition to an enlarged, renovated kitchen, the hall was given energy efficient lighting, an updated ceiling, and new windows. We also redesigned and rebuilt the upstairs storage and washroom areas to make these spaces more accessible and energy- and water-efficient.

Along with other community food centres across Canada, South Riverdale CHC is increasing access to healthy food, empowering people to acquire food skills, and creating opportunities for people to become engaged in their community.

keepSIX, SRCHC’s supervised consumption service (SCS) at our 955 Queen St. E. location, has been open for a year and a half. In July, 2018, SRCHC also began operating the Moss Park Overdose Prevention Site (OPS) at a stand-alone location on Sherbourne St., just south of Queen. SRCHC operates two of the six consumption services in east Toronto. These services have had over 13,000 visits and have reversed 270 overdoses (the vast majority at Moss Park).  As if this life saving work were not enough, the dedicated teams (overdose response workers, nurses, and community health workers/health promoters) at each location provide counseling and crisis support, health care, referrals, their lived experience and expertise on safer use techniques and a vital space for safety and community. The team shares responsibility for maintaining the flow and safety of these services, including responding to overdoses.

What’s A Typical Day at keepSIX? Here’s a Glimpse:

Opening

keepSIX opens at 9:30 and the first service users arrive shortly after. Staff have already been getting things set up for the day: preparing syringes of naloxone, checking the oxygen monitoring equipment and making coffee.

Morning

The first visit of the day is Bob.*  Bob was also the first person to use at keepSIX and comes every morning. Although he has his own place, he comes to the SCS because he doesn’t feel judged for his drug use here and knows that he’ll be taken care of if something goes wrong. Bob is a service user rep on the community liaison committee, made up of a range of community members, which meets every two months or as- necessary. He reports that the last meeting was good, there are no major community concerns and everyone seems really positive, eager to help and supportive.

Mid-morning

One of our health promoters is at Moss Park OPS to provide an Indigenous sharing circle to support service users. Both keepSIX and Moss Park see a large proportion (between 30-55%) of Indigenous clients. Having access to these kinds of cultural practices in harm reduction spaces is vital.

Mid-day

By noon, keepSIX has had 20 people use the service. Visits to the SCS have doubled in recent months, as have overdoses.

Afternoon

An SCS staff-person notices that the person at booth two has slouched over and breaths appear infrequent. Other team members are called to help with the assessment. Everyone agrees that we should monitor the person’s oxygen levels with the pulse oximeter. Levels are low so the oxygen tank is brought over. The harm reduction worker holds the oxygen mask in place while the health promoter keeps track of vital signs. Providing oxygen is almost always the first step in providing overdose care and, in this case, is enough to support respirations until the service user is able to be roused 20 minutes later. The service user heads into the chill space for a snack and to chat with the harm reduction worker who will continue to assess for any signs of distress.

Late afternoon/evening

Toward the end of the day, Bernadette, SRCHC’s Hep C treatment nurse, stops by to offer rapid hepatitis C testing to service users. A service user comes in, ready to try detox. The nurse starts making phone calls and is able to find a treatment spot after several tries. We give the service user a taxi chit to ensure transportation. Meanwhile, the health promoter is providing some informal counselling to someone who recently learned they have HIV and tells them about community resources they can access.

Closing

By the end of the day, there have been 40 visitors. A day in this service can be stressful and hard, but it is just as often a positive and happy space where people find community, safety and a brief break from the war on drug users.

*Name changed to protect privacy.

The Midwifery and Toronto Community Health (MATCH) Program provides access to high quality, perinatal, reproductive and sexual health care for all people, regardless of OHIP status, at South Riverdale Community Health Centre.

Launched during the fall of .2018, MATCH prioritizes care for people who sometimes face barriers in accessing midwifery care that meets their needs. MATCH serves vulnerable communities such as new immigrants to Canada, visible minorities or people of colour, Ontario residents who don’t have OHIP insurance, people who are using drugs, people with low income, queer and trans folks, young or single parents, and people who are homeless or under-housed.

MATCH is a team of four registered midwives who join multidisciplinary primary care teams at South Riverdale Community Health Centre and Regent Park Community Health Centre; these teams include doctors, nurses, nurse practitioners, social workers, physiotherapists and others. MATCH midwives also provide care and services at Michael Garron Hospital, The Toronto Birth Centre or at the client’s home.

MATCH midwives are experts in sexual and reproductive health and are committed to providing respectful midwifery care to all people, particularly people living in complex situations. Guiding the sexual and reproductive health care that midwives at MATCH provide is a philosophy that patients/clients should have freedom of access and freedom of choice to decide if, when and how often they want to have children.

Since MATCH started accepting clients with due dates in February, 2019, the midwives have cared and are caring for 32 clients. Most receive pregnancy care and/or postpartum care but others are seen for pregnancy counseling and case management around abortion care. One client needed only to access the multidisciplinary team for immunizations. So far, MATCH midwives have attended seven births, one at the Toronto Birth Centre and six at Michael Garron Hospital. They are expecting to deliver nine more babies before the end of summer, 2019.

DIABETES EDUCATION COMMUNITY NETWORK OF EAST TORONTO (DECNET)

Based on a 2011 study conducted by St. Michael’s Hospital, 85% of people experiencing homelessness have at least one chronic health condition and more than 50% also experience mental health challenges. We often speak of “hard to reach” communities yet, for many, it is the traditional programs and services that are not reachable. As a result, many high-risk individuals go undiagnosed and untreated. A critical component of our cross-organization strategy lies in grounding our work where, how and when it is most relevant for those who are most at-risk for a range of chronic diseases

This past year, the Diabetes Education Community Network of East Toronto (DECNET), offered diabetes programs and services at more than six community locations where people who are precariously housed/homeless congregate, many of whom are also impacted by mental health concerns and/or substance use. Locations included Heyworth House, Mustard Seed, 416 Community Centre for Women, Nellie’s Shelter for Women, Warden Woods Community Centre (Out of the Cold program) and Oakridge Community Recreation Centre. The 21 community workshops and talks reached more than 128 individuals from these at-risk communities.

DECNET health care providers and peers with lived experience go where people are living to facilitate engagement and to reduce barriers. Along with the Canadian Diabetes Risk Questionnaire (CANRISK), screening and diabetes education, access to nutritious food is a vital component of this work. For example, at Nellie’s Shelter a six-week series was held with Cantonese and Mandarin interpretation for 45 women accessing the HerShare program. During these diabetes prevention workshops, offered by our outreach worker and diabetes prevention peer leader, 45 CANRISK assessments were completed. Keeping services relevant to reflect current life circumstances and complexities, all of our outreach is provided on a drop-in basis using a harm reduction approach; this gives individuals the option to participate when, how and if they feel ready. Through our participation in the Homeless Connect Toronto event in October, 2018, an additional 123 individuals experiencing homelessness received some connection and information about our diabetes services.

Within the SRCHC clinical team, similar outreach initiatives took place. Regular drop-in foot care during Outreach Clinic hours, annual flu clinics in local shelters and ongoing primary care in partnership with the Red Door Family Shelter are a few examples of how this work happens. In terms of new initiatives, in the fall of 2018, Michael Garron Hospital received funding to reduce the burden of “winter surge” on emergency department visits. In addition to increasing the hospital’s capacity, funds were given to partner community agencies so that hospital use was avoided. SRCHC was provided funding so that nurse practitioners could work in east Toronto shelters and drop-ins and, over six weeks, was able to provide urgent episodic care to the New Hope Shelter and the Mustard Seed.

Innovation and knowledge transfer are also important aspects of SRCHC strategic planning across teams as we continue to support and enhance the health of equity-seeking groups. Engaging in research advancements is one strategy. In early 2019, team members participated in the Homelessness and Diabetes research project led by researchers at St. Michael’s Hospital. Discussions are ongoing around how to better understand our program approaches in order to influence, in meaningful and respectful ways, the health outcomes for this community.

STRATEGIC DIRECTION: Strengthen Organizational Capacity

Accreditation provides an external review of an organization’s operations in relation to accepted standards of good practice and risk management. SRCHC worked with the Canadian Centre for Accreditation (CCA) to conduct a detailed review of our governance practices, operational management, and program and service delivery. We worked for over a year preparing documents, conducting a staff survey and organizing interview teams (Board, staff, clients and volunteers) and preparing for the site visit on February 12-14, 2019.

The final report from CCA appreciated the work undertaken by SRCHC and highlighted the welcome they received here. In their verbal wrap-up, the accreditation team praised the organization as a centre of excellence that lives its mission, vision and values. In particular, the team highlighted the work the organization has done to support clients and improve health outcomes. The final report comments on “The level of client engagement and how it led to innovative co-designed programming that valued and leveraged the client and staff lived experience for the benefit of the community.”

The team also highlighted the organization’s commitment to quality programs, continuous improvement and research. They stressed that “SRCHC has a strong tradition of not only generating research evidence but of also using evidence-informed and evidence-based research throughout its programs and services.”

The CCA congratulated the agency on achieving 79 of 79 standards and has accredited South Riverdale Community Centre for a four-year term. SRCHC thanks the CCA review team and everyone who supported this external review that allows us to tell our community’s story with clarity and confidence.

South Riverdale Community Health Centre has been part of a network of health care providers and organizations for several years. Formed in 2018, the East Toronto Health Partnership (ETHP) agreed to work together to form an Ontario Health Team for East Toronto. In early 2019, the Ontario government announced it was consolidating its local and provincial health networks.

The ETHP group’s partner organizations include Providence Healthcare (Unity Health Toronto), VHA Home HealthCare, WoodGreen Community Services, Michael Garron Hospital, and South Riverdale Community Health Centre as well as primary care partners. On May 15, the ETHP submitted an expression of interest in forming an Ontario Health Team for East Toronto.

The ETHP provides a comprehensive basket of health and social services, tailored to meet changing local needs. Its services range from primary to acute care, food security to supportive housing, home-based to community services, birth to end-of-life care, and settlement to employment. Our partnership is built on a legacy of trust in East Toronto, with a multi-decade track record of delivering “made in East Toronto” solutions together with our partners for more than 20 years.

At the centre of our model are the people we serve who have been involved in the planning and design phases of this process, engaged as active members of the ETHP. As our partnership model evolves and expands, we continue to follow a rigorous and inclusive process of engagement involving East Toronto community members.

In the months ahead, SRCHC is pleased to work with all of our partners to shape and design health care, and to deliver integrated services to those living in our community, and to any Ontarian who wishes to receive care in East Toronto.

SPECIAL PURPOSE FUND

Settling in a new country is a big challenge for many new immigrants. They may need to find a shelter for themselves and their family, get a job, learn a new language, enroll their children in school, find a family doctor and more. Looking for healthy, affordable food gets less priority some of the time. Also, figuring out what to put in a child’s lunch box is a worrisome concern for mothers who are newcomers.

The Crescent Town Newcomer Mothers Healthy Living program of The Neighbhourhood Office was a recipient of an SRCHC Healthy Community Grant for 2018. The program’s objective was to create awareness of healthy living and eating among newcomer mothers, to empower them to keep their families healthy, and to thereby keep their communities healthy.

During eight two-hour sessions, the program addressed and delivered learning about:

• Canada’s food guide and participating in food preparation.
• nutrition facts, including nutrient loss during food preparation.
• how to prepare simple and healthy lunches for school-aged children.

The interactive sessions were conducted by a dietitian for more than 15 families (with a few children also taking part). Feedback from program participants was very positive:

“It was a great opportunity for mothers to talk and share their own experiences and challenges for maintaining healthy food habits. We learned easy preparation of delicious and nutritious food.”

“The sessions were very informative and taught me a lot about the food we eat every day. I found out what carbohydrates and proteins do to my body and that it’s very important to eat a well-balanced meal to maintain a healthy weight and lower the risks of various diseases and complications.”

“The program was important to me because I learned what type of food should be provided during my child’s lunch period at school as well as I learned more about my nutrition.”

“The best part of the workshop was the hands-on practice by the presenter, organizer and participants of preparing healthy lunches. The recipes were easy and delicious, not too expensive but reasonable, hassle-free and full of variety.”

Yasmin Ashraf, Settlement Counselor, said the project helped to empower the newcomer mothers, and this will have a positive impact on the lifestyle of newcomer families in the Crescent Town community.