Community Collaboration: COVID-19 Pandemic

At SRCHC, we work to maximize positive community action through collective impact. During the last year, this has meant being nimble, thoughtful and collaborative in order to reduce the transmission of COVID through testing, support for outbreak management in congregate settings, help for individuals and their families who test positive for COVID, and vaccinations for community members.

In March, 2020, our team came together with staff from community health centres and Michael Garron Hospital (MGH) to host regular meetings for staff working in shelters and other congregate living programs. In a pandemic, knowledge is power; we helped organizations develop plans to reduce the spread of covid through infection, prevention and control measures. We also visited sites with suspected COVID cases to test residents and provide outbreak management support. When vaccine became available, the SRCHC team worked with our partners at MGH to provide mobile, low-barrier vaccine clinics in some of the highest risk settings in east Toronto.   Kate Mason, Research Coordinator, organized the outreach and Bernadette Lettner, RN, rode her bike, motorcycle or camper van to bring COVID-19 vaccine to shelters, group homes, supervised injection sites and other congregate settings.

Coordination support, teamwork and partnership development have allowed SRCHC to build programs quickly with support that is easy for community members to access. In November, to help reduce the spread of COVID, we starting working with a team at MGH to run pop up COVID assessment sites. We hosted 25 drop-in clinics and tested over 860 people. During this time, we received a grant from MGH to develop a program to provide case management support to those individuals testing positive for COVID. The case management team members came from four organizations: East End Community Health Centre, The Neighbourhood Organization, SRCHC and MGH. Many of the members have never met in person but, over the last five months, they have worked over Zoom to plan the program. We have a sense of shared purpose that, as COVID recedes, we will get back to better.   As one partner noted, “We have been able to leverage different funding pools and resources to extend the care network and reach more people in need of support. The work we have done around the COVID Response Team has laid the foundation for other work.”

As well, the team provided regular phone check-ins, connecting clients to contactless food and grocery delivery such as those available at The Neighbourhood Organization and the Scarborough Centre for Healthy Communities. It helped assess clients’ financial needs to assist them with government supports like the Canada Recovery Sickness Benefit. 98% clients who completed an evaluation said that the supports they received helped them to better cope with their COVID diagnosis and 97% said the project helped them to self-isolate. One client noted, “It was … absolutely fantastic! I was very impressed and I cannot speak highly enough. My friend lives in a different neighbourhood and did not receive any followup. Groceries being dropped off was a life saver. No reason to have to leave the house – absolutely brilliant! Life was a little more pleasant and reassuring, being able to ask questions no matter how ridiculous they might be.  Also, very educational as well. I learned a lot that I did not know about! Thanks a million!”

To learn more about the program, see:

https://ethp.ca/newsroom/theyre-not-alone-how-ethps-covid-19-case-management-program-is-easing-self-isolation-for-individuals-diagnosed-with-covid-19

Substance Use and Mental Health

On Wednesday, March 11, 2020, the World Health Organization announced a global pandemic. On the following Monday, March 16, 2020, one day before the Ford government declared a state of emergency, the world as we knew it shifted and the way in which clients were able to access services at South Riverdale changed dramatically. For those most affected by health inequities, social injustices and systemic oppression, such as community members/service users connected to the Substance Use and Mental Health (SUMH) programs, the added impact of COVID has been complicated.

In the face of adversity, our commitment to innovative care, cutting-edge approaches and health equity only deepened with the alignment and expansion of our services. Committed to offering dignified, meaningful and relevant care, the newly-formed SUMH team offers a continuum of service and support for individuals impacted by substance use. Many are also impacted by other challenges including mental health concerns, poverty, discrimination, criminalization and homelessness. Programs under this team’s umbrella include: consumption and treatment services (keepSIX and Moss Park), the Hepatitis C program, COUNTERfit harm reduction programming (mobile delivery, satellite sites, east Toronto outreach project, Common Ground group programming, and women’s harm reduction) and, most recently, the safer supply program.

With the emergence of COVID, services disappeared that had previously provided a modicum of dignity, safety, respite and refuge for people who are street-involved or unhoused. Community drop-ins, food programs, shower and laundry programs, washroom facilities and libraries across the city closed their doors. Deemed “essential services” by the organization and adept at staying responsive, we suited up in gowns, masks and face shields, and quickly adapted to provide safe and supportive care in a rapidly changing environment that demanded physical distancing and social isolation.

Over the course of this year, our two sites for consumption and treatment services (CTS), keepSIX and Moss Park, have worked tirelessly to try to save lives by reversing an unprecedented number of overdoses and by offering client-centred care, reducing the burden of stigma and promoting dignity for individuals who use drugs. The CTS teams, including service users, have been unrelenting and fearless advocates for local and systemic change: providing deputations to decision-makers, showing up at encampment sites to offer support, providing onsite drug checking to identify tainted supplies, mobilizing teams to respond to community overdoses, and participating in a range of community partnerships and research initiatives.

For people in the shelter system, the burden of COVID has also been disproportionately high. Many people who are unhoused choose to avoid the cramped and unsafe shelter system, and homeless encampments have popped up all over the city. We are opposed to the dismantling of the encampments and will continue to advocate for people’s right to live in tents as long as permanent housing is not available. We lobbied for the use of hotel rooms, sitting empty, as a safer alternative to shelters and homelessness and will continue to advocate for permanent housing – not warehousing – that prioritizes people’s health and safety. Through the shelter hotel program, service users have access to an interim housing option with a range of services, including harm reduction supports and overdose response services offered by members of our harm reduction team who continue to advocate for the expansion of these services throughout the city-wide program.

While in-person group programming for Hepatitis C ground to a halt with COVID, the program moved to a virtual platform to maintain connections between community members and continued to offer individual support. Despite the barriers, this year saw 55 treatment starts. And the safer supply program, the newest addition to the SUMH team, launched in 2020 in response to the national overdose epidemic. The program connects people who use opiates to prescribing clinicians, case management support and nursing services with the goal of improving health outcomes and reducing risks associated with a toxic drug supply.

Prior to COVID, service users were facing a host of challenges and barriers including devastating losses and harm from an opioid epidemic that has caused skyrocketing increases in preventable death. Our service users and staff have been dealing with unending trauma and grief, and COVID added another layer of complexity to an already difficult situation. The pandemic has made social inequities much more apparent. Yet, community continues to come together to share space, to make noise, to demand change, to show solidarity, and to grieve the tremendous toll that the dual pandemics have taken on us. Despite it all, we are still hopeful for positive change and are committed to working towards that.

Chronic Disease & Community Health

This year, the pandemic has amplified and widened health inequality gaps, especially among racialized communities and seniors. It has highlighted important issues such as social isolation, lack of access to healthcare, low digital literacy, precarious housing, food insecurity and mental health challenges. Newcomers, immigrant seniors, ethno-racial communities with language barriers and people living with multiple chronic conditions were among those at higher risk of the consequences of these inequalities.

The Community Health and Chronic Disease programs at SRCHC quickly changed gears to phone-based contact, virtual support and groups. Personal protective equipment, public health protocols and enhanced cleaning and infection control allowed us to provide acute care to clients and community members as well as Allied Health and Health Promotion programs. In order to maximize client and staff safety during the year, a hybrid model of both in-person and virtual care was provided. Phone or video assessment and followup were available; additionally, in-person services were offered based upon the complexity of the condition, barriers to access and risk of adverse effects from COVID-19 exposure. The demand for service remained consistent with most people preferring in-person followups along with virtual supports.

The Diabetes Education Community Network of East Toronto (DECNET) remained active in order to maintain the well-being of those impacted by Type 2 diabetes. DECNET provided appointments for urgent foot assessments, foot care and counselling appointments. Via phone or video, education, support and care were provided.

By establishing friendly calls with clients, weekly online support groups, exercise classes, and information sessions throughout the year, Harmony Hall Centre for Seniors and Harmony Community Food Centre checked in on isolated seniors at home. Food security needs were supported by grocery gift cards, delivery and meals. Harmony Community Food Centre, also established a seasonal affordable food market, open to all. Addressing food insecurity, a weekly, freshly-made take-out meal was available. The Community Food Centre offered live, online community kitchens for all ages in which participants received ingredient kits. The seniors’ transportation program continued to provide seniors with rides for medical appointments and expanded to assist with drop-offs and pick-ups of essential items. Enhanced support and more frequent programming for Chinese seniors was provided by our Grand Cafe program, moving from a monthly to weekly schedule.

Community-based programming and environmental health promotion work continued, virtually in most cases, to help those who are socially isolated gather in a safe (virtual) space. Programs included client parenting support, a Muslim womens’ social, a “dental bus” supporting staff and clients, monthly meetings across southern Ontario on climate action, the bike repair clinic, mindfulness tours to the Art Gallery of Toronto and the Royal Ontario Museum, and movie screenings. We recognized that there are many people who are not comfortable or adept with digital usage, or cannot afford its associated costs (computer, cell phone, reliable internet). Through our “Phone Drive” campaign, we have provided some with cell phones, allowing access to services and contact.

One of the lessons provided by the pandemic is that, even if our teams do very different tasks, we are all in this together. It became clear over the year that unity was needed more than ever to support clients facing social, economic, mental, emotional and physical barriers, especially those living in poverty and/or with chronic health conditions. The Community Health and Chronic Disease programs have shone during difficult times; we have learned that support from family, friends and our networks is essential to our well-being. We look forward to identifying even better ways to facilitate access to healthcare by continuing to address the social determinants of health and by utilizing a new, “hybrid normal” of both virtual and in-person care.

 

Integrated Primary Care

South Riverdale CHC’s pursuit of integrated health care is as old as the organization itself. However, a process which culminated in its most recent structural reorganization took shape in 2020. This led to the creation of integrated primary care services that support midwifery, clinical and social services.

 

Our primary care team uses the Rainbow Model. The model is for health care planning, health services integration, and a guide for mathematical modelling of workflow during service integration. It is a part of the essential functions and activities, and administrative support structured around primary care service delivery. The goal is to support accountability and evidence-based decision-making so that access to high quality service is ensured for priority communities. Our day-to-day operation remains rooted in our shared vision, mission and values.

 

2020 challenged health systems generally, and the primary health care system particularly, in unprecedented ways. It has forced health services to think differently, work more closely together, and adjust their approaches to the delivery of care. At SRCHC, we have leveraged rapid feedback models and the use of evidence to find the best interventions for improving patient outcomes.

 

As a learning organization, our team meets on a regular basis to plan, reflect and improve our practice. Meeting twice-monthly, the clinical team brings together nurses, physiotherapist, chiropodists, respiratory therapist, midwives, nurse practitioners, social workers, dietitians and physicians to discuss issues around health care. The meetings are used to share best practices and facilitate conversation around emerging health concerns. Working together, we address the needs of those with chronic/acute respiratory health challenges, homebound patients, and those with geriatric care needs. As a team and with our partners across the system, our goal is to ensure the best patient experience.

 

Our practice of integrated care enables us to effectively and efficiently identify and remove barriers to service. For example, many of our medically complex and socioeconomically vulnerable patients have lost some (if not most) of their important support services due to COVID-19 closures. As the first point of contact with our clinical care team, our registered nurses have taken on greater engagement and more in-depth case management for some of these clients in collaboration with nurse practitioners, physicians and allied health professionals.

 

The integrated primary health team at the centre, along with our infectious disease specialist, has become an integral part of our effort to maintain safe and accessible service during the pandemic. The team has taken on leadership roles and participates in a variety of relevant committees continuing to inform and support COVID-related efforts.

 

Additionally, the SRCHC Integrated Primary Care team is working on a post-COVID recovery strategy that builds on the lessons and practices that have worked during the pandemic. Some ideas include looking at revamped clinical spaces, ways to deliver service to where people are at, and consideration of population growth.

Board and CEO Message

Liz Jantzen, Board Chair and Jason Altenberg, CEO

The past year has presented many challenges, much grief and too many losses. But there have also been moments of hope, innovation and strength.

SRCHC has had to adjust and adapt its operations several times through different waves of the COVID-19 pandemic. Support for our priority populations and communities required timely responses; staff had to work nimbly and make in-the-moment decisions to benefit those who needed essential services and supports. Many aspects of the work, including health care and the maintenance of social connections, have had to shift online. The year’s challenges have been met by stepping up and building innovative partnerships across the organization. We needed to address gaps in food security, mental health, cold weather supplies, digital equity and distribution of harm reduction supplies. Our transportation program has seen a significant expansion in order to drop off food, personal protective equipment and other supplies.

Public health restrictions to prevent coronavirus spread, along with an increasingly poisonous drug supply, have contributed to an overdose crisis in Toronto. A recent report by the coroner’s office revealed that, during the pandemic in 2020, the number of opioid-related deaths among people experiencing homelessness has more than doubled. This year we launched one of Ontario’s first programs for safer opioid supply; it replaces toxic street drugs with prescription opiates, and funding is in place for the next two years.

Also this year, we marked many milestones for our Senior Active Living centres. Our Tamil program celebrated its 20th anniversary and our Bengali program marked 13 years. Both groups, along with our Chinese and English speaking groups, still connect weekly over Zoom.

East Toronto Health Partners (our Ontario Health Team in East Toronto) and our local network of community health centres were strengthened to provide support for the organizations, clients, and communities we serve. We worked collaboratively on outbreak management and crisis support; we are now supporting vaccine rollout and ensuring equitable community access. Much of our collaborative work with our priority populations has focused on congregate living settings (shelters) and high-density neighbourhoods where the risk of catching COVID and being hospitalized is disproportionately high. We are beginning to look forward to recovery and the transformations in policy and practice necessary to create equal, healthier communities.

This year, more than ever, we see how the social determinants of health are linked to the legacy of colonialism, racism, patriarchy and capitalism. This year we have worked on Truth and Reconciliation recommendations and trained staff in Indigenous cultural safety. We’ve made it a priority to start training and workshops on anti-Black racism, as well as enhancing race-based data collection so that we can accurately track health outcomes. We are focused on creating better conditions to support a strong safety net for marginalized communities, with a focus on structural racism.

This year our community has come forward with essential resources to meet the needs of our clients and to support our frontline staff. Despite the challenges and losses, we have seen community and partners come forward like never before, and we feel an immense sense of gratitude. We will continue to provide access and fill gaps where our system has failed our most vulnerable. We will amplify policies and practices that result in health equity and sustainability. And we will demand better than merely “getting back to normal.”

Building Back Better

Written by: Paul Young, Environmental Health Promoter

We are part of the earth’s connected system and on April 22, we celebrated Earth Day in order to raise awareness about how our health depends on clean air, water and soil. SRCHC remembers its past battles to reduce pollution and make South Riverdale a healthier community. However, we still need to work on reconnecting with the planet. Both the United Nations and World Health Organization found that pandemics result from the destruction of nature, including livestock production and illegal forestry. Human health relies on the health of the planet.

Covid-19 has taught us many hard lessons. We learned that lower income groups suffer more deaths and sickness from Covid-19 than other, more well-off groups. Factory, frontline and service sector workers are especially vulnerable. And we learned that governments make a huge difference in pandemic recovery. For example, New Zealand has been back to normal since May of last year.

In Canada, governments introduced unique initiatives like basic income programs, quick-start housing/shelter projects, and expanded networks for walking and cycling. The importance of parks and streets to physical and mental health, especially for people living in apartments, became more obvious. Advocates had asked for these changes for many years and now we see how quickly governments can respond in a crisis. It’s important to let decision makers know that these changes are worth keeping and expanding in order to keep people healthy, housed and independent. We need to “build back better” with a “just recovery.” We can’t solve our problems by repeating the same mistakes of the past.

Reference

https://www.theguardian.com/world/2020/jun/17/pandemics-destruction-nature-un-who-legislation-trade-green-recovery

Drugs: Legal and Regulated!

Written by: Rhiannon Thomas, COUNTERfit Program Coordinator

Did you get excited reading that? If you did, you are among the many harm reduction advocates and people who use drugs who have been calling for years to decriminalize all drugs. Cannabis was finally legalized in Canada on July 1, 2018, and the story of marijuana legalization can tell us not only what is possible when there is political will, but also a lot about what legalization does to change attitudes about different substances.

For people who have been using cannabis (or other illegal substances) for many years, legalizing weed seems like a no-brainer. Although any substance can be harmful, marijuana has widely been used safely for hundreds of years or maybe even longer. When you think of the “reefer madness” movies of the past and all the supposed dangers of marijuana, it seems ridiculous when you now consider that the biggest danger to consuming cannabis might be not being able to reach the chips.

But for people who use substances that continue to be criminalized (and for those in criminalized communities who have been serving their communities for years by supplying weed without access to legal market status), looking at public attitudes towards marijuana says a lot about how drugs are seen. As a kid in the “Just say no” era, we learned that all drugs are evil and lead to after-school PCP and jumping off roofs. Acid, weed, coke, heroin – these were all equally dangerous (or so Nancy, Tipper and crew would have us believe). Anyone who does these drugs, or looks at scientific facts about them, would know that wasn’t true. You can’t really overdose on acid (though I wouldn’t recommend taking more than a hit or two unless you have lots of experience and a guide). You smoke too much weed and most likely you’ll just fall asleep. Coke and heroin, though – different story. Too many days up doing coke and your nervous system will be a jangled mess, or too big of a hit and you can stop your heart. Too much dope and your breathing slows until your heart stops.

This kind of information would have been useful to a lot of young people experimenting with drugs. The problem wasn’t the drugs, it was the lies told about them, falsehoods based on moral judgement, and systemic attempts to control and incarcerate Black, brown, Indigenous and poor people, as well as anyone who powerfully criticized patriarchal capitalist power.

And then what happened when weed became legal? Not much except that, within three years, it’s legally widely available, in every form, colour and flavour you could ever want. More importantly, every dose you could want. And the stigma around marijuana use seems to have continued to dissolve.

One major downside is that those people who made a living from selling weed have either lost business or are now even more heavily criminalized. This situation could be remedied by expunging all marijuana possession and trafficking charges from people’s records, and offering small business support and loans so that people who have experience and expertise (and probably a client base) could have options to open shops or delivery services without as much risk of policing. Similarly, we could seriously improve the health and economic status of thousands of people in this country if we followed a similar path for stimulants and opioids. There are already many types of opioids and stimulants that are legally regulated for quality and dosing, we just have to make them available with or without a prescription as we did for cannabis.

“But what about the children?” say the usual suspects. Well, there are legal sanctions in place to prevent access to marijuana, alcohol and tobacco for minors. We know that young folks can still access, and this has happened for substances that are both illegal and legal. The legality of the substance has nothing to do with young people accessing it. You know what does make a difference to the health and safety of young people? Knowing what they’re taking, what the dose is and getting access to factual information. And more importantly, just like weed, the stigma around using these substances will diminish so that talking about using drugs gets easier. And that benefits the rest of us, too.

Virtual Acute Primary Care

Written by: Serena Menezes, Family Physician

The past eight months at SRCHC have been both challenging and highly rewarding. I have had the privilege of working with and learning from skilled colleagues to help deliver care to Toronto’s most vulnerable.

I am relatively new to practice, having graduated from my residency program in 2019. Thus, more than half of my career as a primary care provider has been within the context of the Covid-19 pandemic, and I have been impressed by our clinical team’s dedication to providing comprehensive care during these challenging times. Although this pandemic has been difficult, an opportunity emerged to provide virtual primary care in an unprecedented way.

For our clients who have access to a phone and/or internet, virtual care has reduced some of the common barriers to accessing care such as time needed to take off from work for appointments, and mobility issues that often keep patients from having regular follow-up appointments. And thinking about what primary health care could look like post-pandemic, virtual care could continue to play a valuable role. By providing access, especially to our clients who struggle with mobility, have challenges with transport, or need to prioritize their work over appointments, this kind of care remains important.

When we emerge from the pandemic, there might be a temptation to go back to the previous way of offering care. In-person clinical assessments are still essential in certain situations, but we can try to draw from our recent experience and incorporate, when appropriate, these new, virtual tools to help us deliver care.

Supporting Individuals and Families in Coping with Covid-19

Written by: Bernadette Lettner, Registered Nurse

Since November, 2020, the Covid Resource Team (CRT) has been working to support people who test positive for Covid-19. Comprised of nurses, health promoters, social workers, case managers, counsellors, project coordinators, drivers and the infectious disease team at Michael Garron Hospital, the CRT links hospital-based testing to community agencies and supports. Through these links, we can connect with and support people by offering practical resources to manage the unequal burden of Covid-19 infection in Toronto.

The integrated web of people and resources that hold up, and hold together, communities is very apparent when doing this work. Relationships and resources are strained by the physical separation that happens when people must remain at home in isolation or quarantine, but the many places we turn to for help, comfort and care are also revealed.

Through regular phone calls, the CRT provides symptom management, personal protective equipment and grocery deliveries, financial support, counselling, settlement services and a wide array of other services. To be able to do this work, the CRT has developed relationships with many community organizations, including East End Community Health Centre, The Neighbourhood Organization, Health Access Thorncliffe Park, Scarborough Centre for Healthy Communities, and the East Effort Fund. Between November 2, 2020 and March 31, 2021, over 2,695 people were helped and new referrals are accepted daily.

We have seen first-hand that high vaccination rates have an impact. Many long term care, shelter, and group home residents in east Toronto have received at least a first dose of vaccine and have avoided the outbreak conditions seen in so many areas of the city. Other areas have seen the emergence of pop-up vaccine clinics, specifically designed to bring vaccination to areas with the highest rates of community transmission. Every single vaccination makes an impact – perhaps the biggest impact we can make right now.

Throughout the vaccine rollout, we will continue to support people who contract Covid-19, and ensure that we move towards health together. We started with a small team and a big vision, and it has been incredible to see how the CRT has grown and evolved. The connection and mutual support that has developed as a result of listening and responding to community needs will remain strong, and the ripples of these care-filled connections will carry us through this wave and beyond.

COVID-19 and the Mental Health Pandemic

Written by: Stephen Fenn, Social Worker

Since the beginning of the pandemic, almost all of us have been focusing on our physical health and keeping ourselves safe. This should be our focus as we navigate these difficult times of surges, variants and vaccine rollout. However, most of us have also experienced another pandemic, one of mental health.

Mental health practitioners around the world have been sounding the alarm over the increase in mental health challenges many have faced throughout this turbulent time. While we may still be able to access support for our physical health during the pandemic, mental health support, which was difficult to find pre-pandemic, has become even more challenging to secure.

The burden of mental health has also disproportionately affected those most vulnerable as communities living with unaffordable housing found this even harder as they lost income. People with chronic conditions, more vulnerable to becoming sick, were faced with increased difficulty accessing community supports or treatment, and increased isolation due the higher risk associated with leaving home. And for those who face discrimination and unequal access to society, hostility and insensitivity increased. The support mechanisms we used before, such as seeing family and friends, became impossible due to the associated risks.

The challenges of this pandemic will continue. Although a focus has been on bringing ourselves back to “normal,” we also need to account for the mental health challenges and trauma many have experienced. Many of us don’t know how to seek support and how to take this first step. But support is available and, although we have faced the last year alone, we don’t have to do this moving forward. SRCHC and many other agencies have mental health supports available. While our goal this past year has been on protecting our physical health, a focus on mental health is just as important and worthy.

According to the World Health Organization, “There is no health without mental health.”