CATIE: Programming Connection. Shared Experience, Stronger Programs
On Sunday, January 20, 2019 SRCHC’s 955 Queen Street East location had a flood that resulted in extensive damage throughout all floors of the Health Centre.
Everyone at SRCHC is pulling together to deal with the immediate impact of the flood, particularly focused on safety, servicing the community and re-building, which we anticipate will take 4-6 weeks.
We have been lucky to have the support of community partners who are helping us find spaces to run programs and services until the building construction is complete.
We still ask that if you have an appointment at 955 Queen St E., or are attending a group at 955 Queen St E., please visit our website https://www.srchc.ca/events/ or call 416-461-1925 for more information.
What is a Consumption and Treatment Services (CTS)? How is it different than an Overdose Prevention Site (OPS) or Supervised Consumption/Injection Site (SIS/SCS)?
Overall, these services are all quite similar. The main differences between CTS, OPS, and SIS/SCS are the expected duration of the sites, the different services they are each able to offer and which level of government (federal or provincial) approves the site to operate.
From January to June 2018, Ontario had an Overdose Prevention Site (OPS) program. This program was established to allow the rapid establishment of servicesto help address the overdose crisis. Agencies wishing to open an OPS only had to apply to the Ministry of Health and Long-Term Care for both exemption approval and funding. Exhaustive community consultation was not a requirement, nor were renovations. Supervised Injection/Consumption Services are more permanent and require a more onerous application to the federal government for an exemption under the Controlled Drugs and Substances Act (CDSA), in addition to applying to the province for funding.
In terms of service delivery, only OPS allow peer-to-peer assisted injection for people who use drugs but who cannot self-inject. OPS are also lower barrier because they had fewer reporting requirements which meant fewer intake questions for service users. Both OPS & SIS/SCS provide people with a safe and hygienic place to inject or consume pre-obtained drugs in the presence of trained staff who provide sterile equipment and safe disposal, overdose intervention and/or reversal, and safer drug use education. On-site primary care, mental health supports and referrals to health and social services (including treatment) have been part of both models in Toronto. Toronto currently has 5 OPS and 4 Supervised Injection/Consumption Services. South Riverdale CHC operates both a SIS/SCS (“keepSIX”) and OPS (Moss Park).
Consumption and Treatment Services (CTS) are the new terminology/model developed by the provincial government in November 2018. The CTS model encompasses and combines both OPS and SCS/SIS. The CTS model includes all of the services of an OPS/SCS/SIS with the exception of peer-to-peer assisted injection (which is not currently –permitted by sites with federal exemptions). The CTS model requires that each agency go through the federal exemption process, for each service site. All existing OPS and SIS/SCS must reapply under the new model and there will be a cap of 21 sites across the province. The CTS model has an emphasis on treatment (substance use counselling, referrals to methadone/suboxone providers, detox, and residential treatment programs); however, these services and/or pathways to treatment have always been available to SCS and OPS service users and are part of the harm reduction continuum of care. With CTS, more rigorous data collection and compliance measures are required, including more comprehensive enforcement and audit protocols. In addition, CTS have restrictions about how close these services can be located from one-another (not less than 600m) and require letters of support from nearby schools and child care centres.
What is the Moss Park Overdose Prevention Site (OPS)?
In August 2017, in response to a dramatic spike in overdose deaths in the area, a group of harm reduction volunteers set up a tent in Moss Park to support and care for people who use drugs. The volunteer OPS received an outpouring of public support from people who congregate in the park, local social service agencies and the general public. When the Overdose Prevention Site program was formally established by the Ministry of Health & Long-Term Care in January 2018, the Moss Park group transitioned to this new model. The Moss Park OPS now operates indoors near Queen & Sherbourne as a satellite service of South Riverdale Community Health Centre. The Moss Park OPS has a harm reduction supply distribution area, an intake/waiting area, six injection tables and a post-injection observation space. The service has operated 6 days per week since July 3/18 from 12 to 6 pm and has been staffed by nurses, overdose prevention workers (people with lived expertise of drug use) and community health workers. The Moss Park site has a daily average of 60 visits for consumption and 48 additional visits for supplies, support and referrals. 56 overdoses were reversed in its first 5 months of operation.
What is keepSIX Supervised Consumption Service?
keepSIX opened on November 27/17 at SRCHC’s Queen St East location after a very long consultation and program planning process. keepSIX is open at the same time as the rest of the Health Centre from Monday to Friday. keepSIX is a small-scale service with a daily average of 14 visits. In nearly one year of operation it saw over 400 unique visitors, supervised over 2,800 drug consumptions and reversed 8 overdoses. keepSIX is also staffed by nurses, health promoters and harm reduction workers (who have lived expertise). keepSIX means “got your back” and is an homage to Raffi Balian, founder of SRCHC’s COUNTERfit harm reduction program (established 20 years ago) and lifelong advocate for people who use drugs.
Will SRCHC apply to have Moss Park OPS and keepSIX SCS be established as CTS?
Yes. Applications were submitted for both sites to the Ministry of Health and Long-Term Care in December 2018. There will be no change to the number of service users that each site can accommodate at any one time but there may be an expansion of hours (if funding is approved). A federal exemption request was submitted for Moss Park OPS to the federal government in August and is still pending. The federal exemption for keepSIX was recently renewed for a period of 3-years.
Why do we need these services?
Unfortunately, the overdose crisis continues to get worse and we need services like these more than ever. Recently released data estimates that 11 to 12 people die per day from overdose across Canada. In 2017, 308 people died from overdose in Toronto (the most recent time period for which we have data). This represents a 66% increase in deaths compared to 2016 and a 125% increase in deaths compared to 2015. The Moss Park neighbourhood has been described as the epicentre of the overdose crisis in Toronto by Toronto’s Medical Officer of Health. The proposed CTS at our Queen St location is the only service of this kind east of the Don Valley.
Is there ongoing opportunity for community input?
Engaging with the local community and providing opportunities to raise any issues or concerns has always been important to South Riverdale CHC. If you would like more information or have questions, please contact us. The contact person for Moss Park site is Jen Ko who can be reached at 416.303.4453 or email@example.com. For information about the keepSIX supervised consumption site, please contact Julia Barnett at 416-461-1925 x 356 or firstname.lastname@example.org. keepSIX has a monthly open house from 8:30 to 9:30 am on the first Wednesday of each month. Moss Park also has bi-monthly Open House events, with the next one scheduled for January 23, 2019 from 9 am-11 am. Contact us for more information.
‘When people come here they feel safe’: Finding sanctuary at the Moss Park Overdose Prevention Site
Site aims to save lives, but also gives users a sense of community and purpose
“I’ve lost 11 friends this year … most people don’t lose that many in a lifetime.”
Dave Gordon reflects on the toll drugs have taken on the people in his life as he sits at the Moss Park Overdose Prevention Site sketching in his notebook. He’s been on and off opioids himself for decades.
“I don’t want to lose any more friends.”
More than 9,000 people have died from accidental overdoses in Canada since January 2016 — 2,000 of them in the first half of 2018 alone, according to numbers released by the Public Health Agency of Canada.
While Canada struggles with a relentless and deadly opioid crisis, places like the Moss Park site in Toronto offer help. They allow people to bring their drugs inside and safely use them under the supervision of trained staff.
CBC News was granted rare access to spend some time at the government-sanctioned Overdose Prevention Site and meet people who work there, as well as those who use it.
Gordon knows what’s driving the grim statistics around opioids only too well. He has overdosed, and described it as, “the most horrible feeling in the world. Feeling like my life was slipping away. I had no control.”
He now spends his time at the Moss Park site — partly to use safely, but also because it’s a place to be with friends and it has allowed him to re-discover his love of drawing.
Gordon is also giving back, handing out harm-reduction safety kits in the neighbourhood to help others in the community.
I’m trying to pay society back for my mistakes.– Dave Gordon
“I’m trying to pay society back for my mistakes.”
The Public Health Agency of Canada says 72 per cent of accidental overdose deaths this year involved fentanyl. And a lot of them happen when people use drugs alone.
“So when people come here they feel safe. They feel supported,” says Sarah Greig, an overdose response worker at Moss Park. “They don’t feel shamed and blamed and stigmatized, as they have been by their family, by some health care providers and by some social service providers.”
Greig says the people who come to Moss Park are more like friends, and they are building a community.
The overdose prevention site began as an unsanctioned, volunteer-run outdoor tent in Toronto’s Moss Park. It had over 9,000 visits and reversed more than 200 overdoses between August 2017 and June 2018.
After becoming a satellite of the South Riverdale Community Health Centre, the site received provincial funding and an exemption through the provincial OPS program, allowing it to move indoors in July this year.
Since then, it has had thousands more visits — over a hundred a day — and reversed more than 50 overdoses.
The future of these sites remains uncertain, however, as local and provincial governments grapple with their pros and cons and who will fund them.
Moss Park’s government funding is set to expire on Dec. 24. The organizers have re-applied, but the province is imposing stricter regulations on where overdose sites can operate, which could jeopardize the Moss Park operation.
The fact that the site might be shut down worries Akosua Gyan-Mante.
“We need more places like this,” says the 26-year-old, a regular at Moss Park. “I don’t want to die alone in an alley.”
Gyan-Mante never thought she would be a drug user — growing up in B.C. in a home with a loving father, she had dreams of being a doctor. She moved to Toronto six years ago, started college and had a son.
Then things fell apart. She began injecting heroin and fentanyl this summer after her boyfriend introduced her to it.
“I’m lonely and depressed, and it makes me feel better,” Gyan-Mante says, explaining that drugs help numb the emotional pain.
She overdosed at the site this past October. Greig was there to reverse it.
We need to nurture people and we need to point out people’s strengths instead of just identifying their weaknesses.– Sarah Greig
“We need to nurture people and we need to point out people’s strengths instead of just identifying their weaknesses,” Greig says, adding that people use drugs for a wide range of things.
“This is my support system right here … [the hope that this] shitty existence will get better,” says Gyan-Mante as she hugs Greig, wiping a tear from her eye.
“It [the site] is giving me a fighting chance. It gave me life. It’s giving me another day, another week, another month of being OK.”
Far from just a place to use drugs, the site also offers a hot meal provided by donations, a warm place to hang out during winter, and information on support services if people want them.
The site operates from noon to 6 p.m. and is closed on Mondays.
“I hate Mondays,” Kevin Drake says as Greig watches him use heroin. “I’ve been to different sites. And this is the best.”
Drake says he has overdosed 15 times in his life. But when he is at Moss Park, he does not feel shame.
Instead, it’s replaced by pride. He is known as a guy who is always cleaning up, mopping floors and organizing the space, making sure it looks its best.
“I do worry, but I use Fentanyl … that’s why I come here. That’s why I choose not to do it by myself. Because here — you’re guaranteed to leave here alive.”
The site offers safety, and it also harbours stories of hope.
Drake got a job shortly after CBC’s visit. Gordon is being asked to speak at universities about his experiences, to help find solutions to community drug issues. Gyan-Mante is hoping to reunite with her son permanently.
And that hope is exactly the point of these sites, Greig says.
“When I reflect and I think about what I’ve been doing for the past decade, a lot of it is actually nurturing people and pointing out their worth. Convincing people that they are worthy of love and affection, and that they can do anything that they want to do.”
Please see this story released by CBC News on how the Moss Park OPS aims to save lives and give drug users a sense of community and purpose:
Statement from SRCHC CEO, Lynne Raskin:
“We take the safety and well-being of our community very seriously and do not tolerate violence from any of our staff – on or off the job.
We are deeply concerned and saddened by the allegations that one of our harm reduction peer support workers has been allegedly involved in an assault. Upon learning this news, we took immediate steps to ensure the safety and well-being of our clients and community members. We notified our staff and partners of the incident and launched our own internal investigation. The individual will not be working during this investigation.
South Riverdale Community Health Centre has offered health services in Toronto for more than 40 years and harm reduction services for more than 20. We know how valuable peer support workers are to our programs’ effectiveness for vulnerable people. That is why our peer support workers are provided with intensive training, one-on-one supervision, and are held to a high standard of personal integrity.
The alleged acts in this incident do not reflect our values; we are committed to building a community where all people are safe and treated with dignity.” –Lynne Raskin, CEO, South Riverdale Community Health Centre
About South Riverdale Community Health Centre
South Riverdale Community Health Centre has been providing healthcare services to the community of south east Toronto for over 40 years. SRCHC has acquired an outstanding reputation for community inclusion and programming, innovation, and excellent clinical services. The Centre has been invited to present and engage in presentations, planning, and research regarding harm reduction locally, nationally, and internationally.
Newcomers and Family Team Cheering Station
Thank you to the 50 people who braved the cold and to support the runners with cheer sticks, posters, whistles, noise makers, drums and pom poms! We are proud to share that we came in as one of the top cheering stations.
A unique program matches community volunteers with newcomers interested in getting to know the City and it’s people – on bikes.
Riverdale health workers promote need for overdose prevention sites
‘The crisis touches everybody,’ says program co-ordinator at keepSIX consumption site
Harm reduction outreach worker Tave Cole (left) demonstrates how to properly administer naloxone during International Overdose Awareness Day at the South Riverdale Community Health Centre. – Justin Greaves/Metroland
Natalie Kallio is the program co-ordinator with keepSIX supervised consumption services at South Riverdale Community Health Centre. – Justin Greaves/Metroland
Outreach workers at a supervised drug consumption site in south Riverdale demonstrate how to use a naloxone kit. – Justin Greaves/Metroland
To mark International Overdose Awareness Day on Aug. 31, the South Riverdale Community Health Centre (SRCHC) held an event to raise people’s awareness about the opioid crisis, celebrate volunteers and grieve the lives lost.
“The crisis touches everybody. And as it goes, it’s going to affect more and more people,” said Natalie Kallio, program co-ordinator with keepSIX supervised consumption site at SRCHC.
The Government of Canada website states that there were 3,987 apparent opioid-related deaths in 2017, of which 1,125 cases were recorded in Ontario.
Tave Cole, a harm reduction outreach worker at the facility, said the number was “staggering.” It’s completely preventable if people have access to safe spaces and if there is less stigma attached to drug use, she said. Given that 92 per cent of the deaths were accidental, knowing how to use naloxone kits — nasal sprays and injectables — can prevent opiate overdose and help save lives, she said. At the event, Cole gave a demonstration on how to use the kits with the help of a dummy, as well as handing the kits out.
Becks Dudlay came to the event to show her support. Dudlay, who is originally from Alberta and is clean now, said overdose doesn’t just happen to drug addicts. “It has nothing to do with addiction. It has to do with people getting bad drugs on the weekend. All it takes is one bad batch and your life can be over,” she said, adding that she carries a naloxone kit everywhere with her.
Another attendee, Cameron, who did not want to share his last name, said it’s the community’s responsibility to “make sure that everyone stays alive” and “get past the shame and stigma.” “That’s what kills people more than anything,” he said.
The naloxone kit training is part of SRCHC’s efforts to reach out to community members and enlist their help. Other activities include regular needle patrols.
The keepSIX supervised consumption site opened in the Leslieville neighbourhood back in November of last year, while the COUNTERfit Harm Reduction Program has been around for 20 years. According to Kallio, the facility connects people who use drugs to other health and social services, makes sure that they have safe supplies to use, and that all of their supplies are disposed of safely. She added that they also provide referrals to detox or treatment centres, and try to help those who require housing. Keeping supervised consumption and overdose prevention sites open is essential.
“(Dealing with) discarded needles … we can work together to address. But preventing death is a pretty important thing for every community. That will be our priority and hopefully we’ll be able to continue operating as we do,” she said.
BEING FULLY ELECTRONIC MEANS:
- There are NO paper charts for clients. All your information – clinical notes, referrals, correspondence and other documents are scanned and stored in your Electronic Client Record (ECR).
- We will use a standardized process for booking appointments, checking you in when you arrive for an appointment etc.
WHAT DOES THIS MEAN FOR YOU?:
May 17-23 we will transition to our new electronic client record software.
During this time :
- We will be able to book same day appointments
- We will ask you to call back if you want to book appointments for later in May/June
For the first couple of weeks after we start using the new ECR:
- You may have longer wait times for routine appointments.
- We will have more same day appointments available during this time.
- The new ECR – PS Suite should be up & running by Wednesday May 23, 2018
If you have questions please do not hesitate to speak to any of the medical reception staff on the 2nd floor.