Building a Harm Reduction and Substance Use Continuum of Care

We are in the midst of increased overdose fatalities and the restructuring of services for folks using the homeless shelter and services systems with the call for the embedding of harm reduction services everywhere.  This moment was used to request that the Toronto Region enable us to release this review report as it holds great insights on strategies for the work we are currently doing. To view the report and the full press release, please click the links below:

REPORT RELEASE Building Harm Reduction Substance Use Continuum of Care Review

Harm Reduction Continuum of Care TCLHIN March 2018

South Riverdale CHC launches program to connect clients with cell phones during COVID-19 crisis

Leslieville-based organization working to ‘bridge the digital divide’ and help 1,500 get a fully functional phone or tablet

BY JOANNA LAVOIE   //  TORONTO.COM
Not being able to afford a mobile device shouldn’t be a reason why someone can’t access healthcare and other vital supports and services during the COVID-19 pandemic.

With more than half of its clients living on less than $25,000 a year, the South Riverdale Community Health Centre (SRCHC) experienced this reality first-hand recently when one under housed individual who makes use of the community-based organization’s harm reduction services at Moss Park exhibited symptoms of COVID-19 and was sent for testing at a nearby assessment centre at St. Michael’s Hospital.

But without a cell phone, there was no direct way for the hospital to contact this individual to discuss their test results. Fortunately, staff at SRCHC had a good relationship with this person and were able to locate the individual to discuss healthcare needs.

This all-too-common situation is what inspired SRCHC, which serves those living in an area roughly bounded by Lake Shore Boulevard East to O’Connor Drive and from Coxwell Avenue to the Don Valley Parkway, to recently reach out to technology partner QoC Health for some cell phone donations. That organization’s CEO, Sarah Sharpe, suggested SRCHC launch a device drive and offered their expertise to staff members so they can scrub any information from donated devices.

Launched just over two weeks ago, the #DeviceDrive is aiming to immediately collect and distribute 1,500 new or used activated cell phones/tablets with chargers for its highest-priority clients, those who are most at risk for complications from COVID-19. These devices will allow marginalized and socially disconnected clients to attend virtual medical appointments, receive COVID test results, access group-based programs, get information on available resources, and connect with their loved ones.

Ideally, the centre would like to give 5,000 of its most vulnerable clients a fully functional mobile device.

So far, SRCHC has only received 61 phones and 68 SIM cards and is appealing for donations.

“This project really came about because we needed to find a way to get devices to our clients. … We want to at least give them an option to pick up the phone and call someone,” said Surkhab Peerzada, SRCHC’s regional manager of chronic disease.

“We needed to do something and we needed to do it as soon as possible.”

Since the onset of the COVID-19 pandemic nine weeks ago, the South Riverdale Community Health Centre has moved most of its programs and services online, however a high percentage of the people that have typically accessed them are homeless, under-housed, and on a fixed income and don’t have a functional cell phone, tablet, or computer.

“We really want to bridge that digital gap,” said Peersada, who is co-chairing the device drive with Andrea Laing, the organization’s communications manager.

“Unfortunately, these cracks in the system are much more evident since the outbreak.”

Anyone able to donate either a new or used device with a charger can drop drop it off at 2 Gower St., just off Dawes Road, or 955 Queen St. E., just east of Carlaw Avenue. Don’t forget to factory reset your device, especially if it’s an Android or Apple product.

Broken devices including those with cracked screens or frayed wires, devices that are more than five years old, devices with poor battery life like those that need to be plugged into power to work, and SIM locked devices that cannot be factory reset are not being accepted.

Monetary donations, which will be used to buy SIM cards and short-term data plans to activate the devices, are also greatly needed.

Visit www.srchc.ca/devicedrive or email at devicedrive@srchc.com for more details.

Joanna Lavoie

by Joanna Lavoie

Joanna Lavoie is an award-winning, bilingual journalist with more than a decade of diverse experience. A graduate of Ryerson University’s Journalism Program, she is a breaking news reporter for toronto.com.

Email: jlavoie@toronto.com Facebook Twitter

Hepatitis C Treatment Program at Moss Park Consumption and Treatment Service

Integrating hepatitis C care into an overdose prevention service

We are happy to announce that CATIE has published an article on the Hepatitis C Program at Moss Park.

Thank you everyone for the team effort in helping us put this article together. We’re happy with how it turned out, and it will be a great model for other programs around the country to learn about integrating hepatitis C and harm reduction services.

Hepatitis C Treatment Program at Moss Park Consumption and Treatment Service

“Since Covid began, we’ve seen the highest number of overdoses since 2017”: What happens when the opioid epidemic meets a global pandemic?

“Since Covid began, we’ve seen the highest number of overdoses since 2017”: What happens when the opioid epidemic meets a global pandemic? – Jason Altenberg, April 14, 2020

I’ve worked at the South Riverdale Community Health Centre for 15 years, and I just took over as CEO in January. It’s a heck of a time to be starting a new job. We offer health services to the city’s most vulnerable people: newcomers to Toronto, people who living in poverty and who use drugs, and the homeless community. More than half of the people who come to us are low-income, and two-thirds are living with mental illness. On an average week, more than 500 people come here for communal meals.

We’ve also been in a sustained crisis for years: our job is to keep people alive through the opioid epidemic. We provide a safe place where people can use drugs under the supervision of nurses and doctors, where they can access medical advice free from judgment, and where they can access naloxone kits, safe disposal supplies and clean syringes and pipes, and that work keeps them alive. We usual deliver harm-reduction supplies, too, in unmarked cars to people’s homes or coffee shops anywhere from Lake Ontario to Eglinton Avenue East, and from Victoria Park Avenue to the Don Valley Parkway. I have a long history with my staff: some of us have been through other outbreaks together, like H1N1 and SARS. I don’t know that I’ve had time to absorb it yet. We’re just trying to keep moving.

We’ve been watching Covid-19 since January, and making plans with an infectious disease specialist, focusing on implementing measures that would help keep people out of the hospitals. We have a respiratory therapist who is running a primary-care asthma program and getting people access to nicotine replacements. Our diabetes program is still running, because those are people at high risk for Covid-19 complications. We’re doing insulin initiation and adjustment over phone and video, and we’re still doing wound care in-person. For homeless people who don’t have phones, we’re accepting in-person drop-ins at the health centre for medical and social support. And we’re doing everything we can to keep our safe-consumption sites fully operational. It’s our job to keep people who are using drugs alive and ensure they don’t get Covid-19. Somehow we have to do both at the same time.

We run two safe consumption sites: one in Moss Park and the other in South Riverdale. Along with supervised injection services, we provide harm-reduction supplies like naloxone kits, drop-in nurse practitioner services and a hepatitis C clinic. We’ve had to cut down our hours, and we’re seeing people more slowly because of social-distancing rules. Before, these spaces were built by our members and decorated with paintings by the community. Two weeks ago, we turned the sites into scenes from a science-fiction movie. We had to. We separated the booths and taped up plastic tarps everywhere, to keep people safe and distant from one another. Our staff are wearing full protective gear. It looks like a field hospital. People are freaked out and distrustful: these are people who have been criminalized and stigmatized for years, so when the services start to feel like policing, that’s hard for them to take. And it’s hard for our staff, too. Some people are grateful, and thank us for giving out cloth masks and bagged meals. Others have told us it’s weird, that the space doesn’t feel like theirs anymore.

Every day, we approach each client in scrubs and masks to take their temperature. We have screeners asking questions at the door now, and every time someone shows up, we have to ask whether they’ve travelled out of the country, even if we asked them the same question the day before, and even though it’s utterly unlikely based on their life circumstances. To the clients, it feels like discrimination. To be able to socially distance is a privilege, but I know people are trying to respect the rules as much as their circumstances allow. One man is camping near a pavilion on Lakeshore Boulevard, and set himself up just outside the caution tape so he wouldn’t violate the bylaw, instead of setting up underneath the shelter. Another man tested positive for the virus and refused to go back to his shelter so he wouldn’t infect his friends; he slept on the streets instead.

The spaces that create any kind of normalcy in our clients’ lives have disappeared overnight. The libraries are closed, the drop-in centres are closed. The spaces they would go for a cup of coffee or a sandwich or to use the bathroom are closed. The things that would allow them some semblance of basic dignity are just not available. People are more desperate. People are hungry. We’ve seen more fights breaking out between clients. Two weeks after those closures, on March 31, the city had the highest number of opioid overdose responses since the crisis started in 2017. I wasn’t surprised at all. This is the new normal. The needs in the community are the same, but resources are scarcer. Drugs are harder to find right now, and they’re more expensive. Some of our clients are buying from new dealers, and the potency is incredibly unreliable. Just last week, there was a strange overdose warning: four people ended up in the hospital with opiate overdoses after using what they thought was crack cocaine. That’s very unusual. Covid-19 hasn’t hit the homeless and street-involved community with full force yet; this is not a community that travels, so it will emerge later. When it does, it will hit hard.

We’ve had to explain to people that we’re making these changes—adjusting and reducing our hours, changing our spaces—because we love them and we want them to be here in three months. We know that if we could offer people a predictable safe supply, overdoses would go down dramatically, overnight. We’re hoping to get funding to offer an individualized safe-supply care plan for anyone who is eligible. That may involve picking up a prescription for high-potency hydromorphone at a pharmacy on a daily basis, or supervision by a consumption site. On the Downtown Eastside in Vancouver, they’re moving on this. It’s a solution that makes self-isolation possible. We’ve seen the system respond with incredible speed, recognizing where the rules we have in place don’t make sense. There has been resistance, but innovation always has resistors. We have a proposal in to Health Canada right now, and I’m optimistic.

I’m worried about the compounded nature of the epidemic and the pandemic. I worry that we will lose people that we otherwise wouldn’t have. It’s in my head all the time. We’ve been hearing about other deaths in the community, people dying in stairwells who would normally be somewhere else, like at one of the city’s nine safe consumption sites. The horrible thing we’re trying to reconcile is that if we don’t continue to re-engineer how we’re offering our services, we could spread Covid-19 through the community, which would be horrific. We’re doing this crazy balancing act. As we pivot to prevent this virus, the social isolation and distancing are creating other harms. They’re necessary and they’re predictable. They’re also brutal, and we need to be ready to respond to them, too.

As I go to work every day, I stop at the drug user’s memorial project. It’s a monument on Queen Street East, an eight-foot copper flame, where people come to honour the memory of their friends who have died. I start every day there, stopping to see what someone has put in front of the memorial the night before. And now, every day, I have a lump in my throat about how many people we are going to lose because we aren’t able to be there for them.

ETHP announces new role to bridge mental health services between hospital and community

ETHP announces new role to bridge mental health services between hospital and community

With more than 25 years of experience working in mental health and addictions services, Raj Sohi is well positioned to take on East Toronto Health Partners’ (ETHP) first shared directorship role. On April 27, Raj began his new role as Director of Mental Health and Substance Use at Michael Garron Hospital (MGH) and South Riverdale Community Health Centre. Previously, Sohi served as the director of mental health and addictions services at MGH.

The new position supports ETHP’s vision of creating a system without discharges and providing more seamless access to services for those living with mental health and substance use challenges in East Toronto.

“There are so many opportunities for us to work better together,” says Sohi, who spent 12 years leading mental health services at the Centre for Addiction and Mental Health. “By integrating patient pathways between hospital and community, we eliminate unnecessary barriers that so many of our clients face when navigating a complex health and community care system.”

East Toronto is comprised of approximately 300,000 people living in 21 diverse neighbourhoods, with five Neighbourhood Improvement Areas, including: Thorncliffe Park, Victoria Village, Oakridge, Flemingdon Park and Taylor-Massey. East Toronto has higher mental health and addictions needs than the Toronto average. Taylor Massey has one of the highest youth mental health Emergency Department utilization rates in the city.

For the past several months, Sohi has helped propel integrated mental health and addictions services forward in East Toronto by serving as the lead for two ETHP workstreams including: Youth mental health and addictions and adults with needs related to substance use and addictions. Sohi also supported the development of the Oakridge Health and Harm Reduction Hub, a three month pilot project that ran from February to April.

The goal of ETHP is to better connect health care sectors, including hospitals, community, home and primary care, in addition to other health care providers, to make it easier for clients and families to receive more integrated care close to home.

“This shared directorship role represents the next important step in our journey to create an integrated health care system that places patients at the centre of their care,” says Mark Fam, Vice President, Clinical Programs at MGH.

“SRCHC is excited to expand Raj’s shared directorship role to include operational oversight and support of SRCHC’s teams, strengthening the collaborative approach between SRCHC and MGH. This work is a natural progression of the partnerships being built as part of the East Toronto Health Partners and will drive deeper integration of services to our most marginalized clients in their communities,” says Jason Altenberg, Chief Executive Officer, South Riverdale Community Health Centre.

This article is brought to you by ETHP Communications Staff

Bridging the Digital Divide

There is no denying that the pandemic has made all of our lives more challenging. Please imagine surviving this pandemic without a phone or a device that keeps you connected to the news, resources, health care and your loved ones; this is the reality for many marginalized clients. Based on a 2019 client survey results, more than 50% of SRCHC clients have an income of less than $25,000/year.

South Riverdale Community Health Centre (SRCHC) is putting out this call to action for donations of used cell phones and chargers. They will give these cell phones to clients in need and support their connections. Clients need phones to attend medical appointments, receive COVID test results, participate in group-based programs to promote social connections, as well as access information and support. “Clients need a way of connecting to holistic health and social services virtually to increase positive health outcomes”, says Jason Altenberg, CEO of South Riverdale Community Health Centre.

SRCHC is in need of used cell phones, SIM cards and chargers in working condition; please visit the website for more information www.srchc.ca/devicedrive. Donation bins are located outside our 2 Gower St. and 955 Queen St. East locations. For people who want to help, but do not have a used cell phone, we are looking for monetary donations to connect the phones to plans; please visit the SRCHC Canada Helps website.

Pregnant woman in pink tshirt using a cell phone

 

What’s in Toronto’s Drug Supply? Results from Samples Checked by Toronto’s Drug Checking Service: October 2019 – March 2020

Overview of Toronto’s Drug Checking Service

People who use drugs in Toronto have long advocated for access to drug checking in an effort to reduce the harms associated with using drugs from the unregulated supply. In 2017, Health Canada responded, funding multiple drug checking services across the country with the primary goal of preventing overdose. This included funding a drug checking pilot in Toronto.

Toronto’s drug checking service launched in October 2019 and offers free and anonymous drug checking using mass spectrometry technologies (gas- and liquid-chromatography). These lab-based technologies offer detailed information about which drugs are found in each sample, along with some information about how much of each drug is present. Coordinated by the Centre on Drug Policy Evaluation, this drug checking service provides people who use drugs with timely and comprehensive information on the composition of their drugs, helping them to make more informed decisions. This drug checking service also helps to uncover the contents of Toronto’s unregulated drug supply.

Samples are collected at three frontline harm reduction agencies in Toronto, including Parkdale Queen West  Community Health Centre (Queen West site), South Riverdale Community Health Centre, and The Works at Toronto Public Health, where supervised consumption services are offered. However, this drug checking service is available to everyone and is not limited to clients of supervised consumption services.

Accepted samples include substances (a small amount of powder, a crushed bit of a pill, blotter, or a small amount of liquid) and post-use paraphernalia (a used cooker or filter, or leftover liquid from a syringe). Samples are transported to a nearby laboratory at the Centre for Addiction and Mental Health or St. Michael’s Hospital where they are analyzed. Results are available within the next business day or two and are communicated to clients by harm reduction staff in person or by phone. Along with these results, clients receive tailored harm reduction supports, guidance, and referral to services (e.g., supervised consumption, naloxone training, primary health care, etc.).

Every two weeks, results from samples checked are combined and disseminated with the goal of communicating information about the composition of Toronto’s unregulated drug supply. To receive these reports directly, sign up by emailing drugchecking@cdpe.org.

This drug checking service is being scientifically evaluated to understand its impacts on the health and well-being of people who use drugs in Toronto. To learn more about the methods and aims of the evaluation, read the study protocol and rationale.

Centre on Drug Policy Evaluation [https://cdpe.org/oct2019-mar2020-drug-checking-services-results/]

READ FULL REPORT:

Centre on Drug Policy Evaluation. April 14, 2020. What’s in Toronto’s Drug Supply? Results from Samples Checked by Toronto’s Drug Checking Service: October 2019 – March 2020

Information on the Coronavirus for Patients and Visitors

To see all of our recent COVID-19 news and SRCHC Centre Updates

If you think you have Covid-19 coronavirus symptoms or have been in close contact with someone who has it, use this self-assessment to help determine if you need to seek further care, click here

South Riverdale CHC is actively screening for the coronavirus in person and over the phone for one-on-one appointments. This means that our staff will be asking you questions to ensure that we support clients.

UPDATES FROM ALL LOCATIONS OF SRCHC

The Health of Clients and Staff is Our Priority

Due to the Coronavirus:

  • 955 Queen St E. is open for essential urgent care only (treatment) and the distribution of food and harm reduction supplies.
  • Consumption Treatment Services: Moss Park (134 Sherbourne St.) is open Tuesday-Sunday 4-10pm (last call at 9:15pm) and keepSIX (955 Queen St. E.) is open Monday-Friday 10am-6pm (last call at 4:30pm)
  • We screen all clients with appointments or using CTS at the front doors of 955 Queen St. E. and 134 Sherbourne St.
  • Home visits are being conducted for clients who still require support, clients are being screened accordingly.
  • We are offering urgent counselling and social work services over the phone, please connect with your clinician.
  • We are developing ways to provide support for clients who are food insecure and/or socially isolated.

Cancellations/Closures:

  • ALL groups; programs; drop-ins; non-essential meetings and walk-ins.
  • DECNET programs at 1245 Danforth Ave. Unit 2 & 3, please call 416-461-9042 for more information
  • Harmony Hall Centre for Seniors (2 Gower St. & Crescent Town Club), please call (416) 752-0101
  • Choose Health For more information, please visit www.selfmanagementtc.ca or email choosehealthtc@srchc.com

If you have an appointment at SRCHC or are visiting our Consumption Treatment Services, we ask for your cooperation in letting us know if you have:

  1. Returned from travel outside of Canada in the last 14 days?
  2. Any contact with someone who has been diagnosed with Covid-19?
  3. Any of the following symptoms: fever, cough, difficulty breathing, shortness of breath, rash?

COVID-19 ASSESSMENT CENTRE IN EAST TORONTO:

The COVID-19 Assessment Centre at Michael Garron Hospital (MGH) is now open and seeing patients by appointment only 416-469-6858. The Assessment Centre cannot be accessed from inside the hospital. The entrance is located on the Northside of the building off Mortimer Ave., west of the Emergency department (see map on this page).

IF YOU ARE WORRIED YOU MIGHT HAVE COVID-19 CALL:

Telehealth Ontario: 1-866-797-0000
24 hours/day,
7 days a week
Toronto Public Health Coronavirus Information Line: 416-338-7600
8:30 am-8 pm
Monday-Friday,
10 am-6 pm weekends

More information:

Health Canada Coronavirus Information Service: 1-833-784-4397

WHO Advice for the Public:

Includes myth-busters about coronavirus, instructions on when and how to use surgical masks, basic prevention strategies.

Health Canada Coronavirus Website:

Information about Coronavirus in Canada, Canada’s response, and travel advice for those planning or returning from travel.

Ontario Ministry of Health Novel Coronavirus Website:

Guidance for Ontarians about COVID-19, provincial-level public health response, and testing. Coronavirus information sheet about coronavirus in many languages.

Public Health Ontario Website:

Instructions for how to self-monitor, self-isolate, how caregivers should self-isolate, how to clean surfaces, etc. Available in multiple priority languages.

Toronto Public Health Website:

Information on risk of coronavirus in Toronto, advice for protecting yourself, city-level public health response, and who to call for help.

 

Beach-East York Neighbourhood Voice: East Toronto groups form community-focused health-care network

East Toronto Health Partners is one of 24 in Ontario

By Joanna Lavoie, Beach-East York Neighbourhood Voice

A new integrated health-care network is now up and running in East Toronto.

Ontario’s Minister of Health and Deputy Premier Christine Elliott officially named the Toronto East Ontario Health Team, East Toronto Health Partners as it’s being called, as one of the first of 24 new health teams in Ontario. The announcement was made last month at the future home of the new Thorncliffe Park Community Hub.

According to a release, the new east-end health team is part of the Ontario government’s plan to “build a connected and sustainable health-care system centred on the needs of patients.”

“This is an exciting time for health care in Ontario as we finally break down the long-standing barriers that have prevented care providers from working directly with each other to support patients through their health-care journey,” Elliott said in a release.

“Together with our health-care partners, the Toronto East Ontario Health Team will play an essential role in delivering on our commitment to end hallway health care,” she added.

The new team consists of six anchor partners, all of whom have a long track record of working together. They are Michael Garron Hospital, Providence Healthcare, South Riverdale Community Health Centre, VHA Home HealthCare, WoodGreen Community Services and East Toronto Family Practice Network, which is the voice of 260 primary care physicians in East Toronto with the support of a number of organizations with similar offerings.

Some health and social services provided by the new health team include primary to acute care, food security, supportive housing, home-based health care and community support services, long-term care, birth and end-of-life, and settlement and employment.

For the last two years, the community-based groups that make up the new Toronto East Ontario Health Team have worked to develop what they’re calling a “Network of Networks” that aims to build a “model of seamless care” for the community. This fall, they combined their resources to come up with a comprehensive plan to provide community-based health-care services during the winter surge.

“We are incredibly proud of our partners and grateful for the collaborative work we are doing together to build a better, more integrated health-care system for patients, clients and families,” said Anne Babcock, WoodGreen Community Services’ president and CEO, in a release.

“It takes the creativity, flexibility and commitment of everyone involved to transform the delivery of local care to our communities.”

Board of Directors CEO Announcement

Monday, December 9th, 2019

Dear SRCHC Community Partners and Supporters:

After consultation with staff, community partners and other stakeholders, as well as conducting a national search, the Board of Directors of South Riverdale Community Health Centre is pleased to announce the appointment of Jason Altenberg as the agency’s Chief Executive Officer. He will assume his responsibilities on January 16th, 2020. The board believes that Jason has the right balance of knowledge, experience and expertise that make him an ideal candidate to lead SRCHC in our rapidly evolving and changing health care environment.

Jason has worked for over 25 years in east Toronto and is an innovative, strategic leader who has dedicated his career to reducing barriers to access and improving health outcomes for at-risk communities. He joined the team at South Riverdale Community Health Centre in 2005 and has held a number of leadership positions within the organization, starting as Primary Care Manager and most recently worked as the Director of Programs and Services. Jason’s leadership has helped SRCHC to expand harm reduction services, develop safe consumptions and treatment sites, support clinical leadership in high-quality inter-disciplinary teams, engage research partners as well as build a network of service delivery partnerships that address improving population health. A collaborative and consultative leader, Jason has demonstrated that healthy, thriving communities where everyone belongs are built with the collective effort of staff, community health centre partners, community organizations, service users and members.

We would also like to acknowledge and thank Shannon Wiens and Jason Altenberg who effectively worked together to jointly lead the organization over the last five months, during a time of significant operational and system level change.

As Jason begins working in this new role he is committed to championing the community health centre model of health, focusing on health equity and social justice and working within east end of Toronto to create a health care system that provides high quality, holistic care that reduces health disparities for at-risk population and underserved communities.

Please join us in congratulating Jason to his new role as CEO.

Sincerely,

Steven Little
Chair, Board of Directors