Broken Pencil: Amidst overdose crisis, survival is an art

DECLAN KEOGH  

Amidst overdose crisis, survival is an art

WRITTEN BY DECLAN KEOGH • PHOTOGRAPHY BY DECLAN KEOGH AND JEFF BIERK

A few years ago, Les William Harper did what most people have done at one time or another: he sought his mother’s opinion.

The 46-year-old Cree harm reduction worker and artist, who works at a safe-injection site in Toronto, wanted to know how she thought the overdose crisis would end and what he could do to help it along.

Elder Pauline Shirt is a survivor of Canada’s residential schools for Indigenous children. She was forced to spend years away from her family, suffering abuse under a system many, including the Truth and Reconciliation Commission of Canada, call genocide.

“That was her world she was living in,” Harper says. “She never knew if it was ever going to end.”

But it did end, eventually, and she was finally able to leave and carry on with her life. She ended up in Toronto where, in 1976, she and her then-husband Vernon Harper opened Kapapamahchakwew, or the Wandering Spirit Survival School, the first Indigenous day school in Canada.

Shirt told her son to be steadfast in his commitment to the work, and to his heritage. Canada tried to erase her culture but, she said, Indigenous teachings and practices were precisely the things that kept her alive.

“It just showed that it’s not going to stay like this. If we keep on fighting and doing what we need to do, we will find that answer,” Harper says.

Today, his mother’s advice — to honour and practice cultural traditions — grounds Harper’s work as a harm reduction worker in drug user communities, as well as in his artistic practice, painting murals. Harper works with community members to paint murals around Toronto, 10 so far. He says it’s important to bring people in to create art together, whether they’re from community centres, housing co-ops, or safe injection sites. He says it allows each individual to express themselves in a shared social context.

“I’ve always believed in art,” he says. “I want to take everyone else for the ride too.”

Crisis wears on

As Canada remains in the deadly grip of an unprecedented overdose crisis, some are turning to art to raise awareness, cope with grief and trauma, or to bring power to the community. The slow drip of solutions from health and government officials have already forced those on the front line to take things into their own hands. In Toronto, illegal safe-consumption sites started popping up in 2017, eventually forcing the provincial government to fund and sanction many across Ontario.

Despite incremental progress, people are still dying at an increasing rate. There were 4,460 opioid-related overdose deaths last year, up from 3,017 in 2016 — nearly a 33 percent increase — according to the Public Health Agency of Canada. The statistics paint a grim picture: more than 11,500 Canadians died of an apparent opioid-related overdose between January 2016 and December 2018. Fentanyl or a fentanyl analogue were involved in nearly three-quarters of the deaths.

Harm reduction workers have been saying something has to give.

The two worlds, harm reduction and art, have long overlapped. But as the crisis wears on, art is emerging as its own form of harm reduction — from an individual level to a broader political response. For Harper, the connection is personal. He’s been working in harm reduction for over a decade and has a deep connection with the community.

“There are people that I’ve grown up with that come into these sites,” Harper says. “I have relatives that come into these sites.”

‘I work in my community;
my community is me’

Les Harper touches up Two Worlds, a community mural project at The Bickford Centre in Toronto. The centre of the piece is an outline of a syringe, swaddled in purple. This colour represents the deadly opioid fentanyl. Photo by Declan Keogh.

Les Harper touches up Two Worlds, a community mural project honouring Indigenous women’s role in the overdose crisis. The centre of the piece is an outline of a syringe, swaddled in purple. This colour represents the deadly opioid fentanyl. Photo by Declan Keogh.

Wandering Spirit, which continues to operate in Toronto’s east end, is where Harper’s artistic interest blossomed. Woodland Art, originally brought to Canadian consciousness by esteemed Ojibwe artist Norval Morrisseau, remains his favourite.

Harper has adapted the Woodland style for his mural projects, an approach to painting characterized by rich, vibrant colours portraying symbolism and spirituality drawn from Anishnaabe and other Indigenous traditions.

It’s a natural fit. Woodland Style juxtaposes immemorial customs with a contemporary form; Harper, steeped in Indigenous teachings, uses them to guide his work amidst the concrete and steel of Toronto. Like his mom, he fights for life where there is death.

“My work, my passions and my personal life all connect together,” he says. “I work in my community; my community is me.”

A mural project at the Bickford Centre, in Toronto’s Koreatown, holds special significance to Harper. Two Worlds is a 20-foot-long homage to both the overdose crisis and murdered and missing Indigenous women and girls. The idea came to him during a fasting ceremony, where he prayed for guidance on how to get his message to the world.

It’s the only mural in Ontario that looks at the overdose crisis from an Indigenous perspective.

The piece depicts two faceless women in traditional pink dresses, framed by richly coloured flowers, strawberries, and a bird on a bright yellow background. In the centre is a syringe wrapped in purple. He chose purple to represent fentanyl and its role in the overdose crisis. The women represent strength and resilience.

“[Women are] why our culture is still here,” Harper says.

Harper, one of only a handful of Indigenous harm reduction workers on the front line of the overdose crisis, hopes his art will help foster dialogue between those inside and outside his community.

“People will walk by that mural and they’ll see that syringe and that Indigenous artwork and they’ll be a part of that now,” he says.

Nearly one million Canadians reported using illegal drugs in 2017, according to Statistics Canada — not including then-restricted marijuana. Yet, drug users are often imagined as a monolith. Harper hopes community art can disrupt commonly held stereotypes.

“When people first see people or think of people that are using drugs, they see them as one person,” he says. “They see them as a drug user, not as a person that’s an artist or … writer.”

“My work, my passions and my personal life all connect together,” says Les Harper, left. The harm reduction worker collaborates with community members like Bradley Nolan, pictured, on public art projects. Nolan says art helps distract them from thinking too much about loved ones who have died as a result of opioid overdose. Photo by Declan Keogh

Bradley Nolan, an Ojibwe service user originally from Garden River First Nation, helped Harper paint Two Worlds. Like Harper, 31-year-old Nolan has lost a lot to fentanyl: their brother, partner, and best friend.

“[Art] gets me out of the frame of mind of thinking about loved ones who have passed away from opiates,” says Nolan. They get a good feeling when they see the mural, because they know they contributed to something that stands out in the community.

“Somebody can make a piece of art and it can mean the world to them,” Nolan says. “A powerful piece of art makes people think.”

Honouring the lives of loved ones while they’re still living is an important part of Indigenous culture, Harper says, which is why the mural at the Bickford Centre is so meaningful to him.

“No matter what is happening in Indigenous culture and our lives, we’re still going on forward,” he says.

Grief and the canvas

On Jan. 7, 2019, Kira Hamilton cried throughout the night for no apparent

reason. “I didn’t have anything to cry about but I just knew something was wrong,” she says.

The next day, Hamilton, 38, went in to work at Sistering, an agency supporting at-risk women, where she does harm reduction and housing support.

I had a rough night, she thought. But I’m at work with my people. But people were staring at her, and no one said a word to her as she made her way to her office. What the hell is going on here, she asked herself.

Then she received the call. “You need to sit down,” the coworker said. “Crystal died. They found her last night. I’m so sorry.”

Crystal Papineau was found dead in a clothing donation bin. The 35-year-old’s death became front page news for months, as advocates demanded better housing and support for street-involved people — even sparking a public consultation in Toronto on the safety of donation bins.

Papineau was Hamilton’s closest client at work. “Every day … when she went off to use, or I would go home from work, she’d say ‘I love you.’” Hamilton recalls. “And, I said, ‘I love you back.’ Because she needed to hear that from somebody.”

“When you work that closely with somebody, they kind of become your family,” she says. “I cried, but I knew she wasn’t in pain anymore.”

Hamilton echoes what many in the harm reduction community describe: an impossibly complex relationship with their clients. One where the duty of care intermingles with human nature, emotion and camaraderie.

Eight more of Hamilton’s clients have died this year, many of them as a result of overdoses. When Broken Pencil reached out to Hamilton for this article, she was attending a funeral for a client. As a multi-disciplinary artist who studied fine arts at Georgian College, she feels somehow duty bound to use her paintbrush to eulogize Papineau. She envisions a darkly baroque and realistic image of a skeleton floating through the air, thick and textured like red velvet. In the skeleton’s stomach is a bright red balloon, representing “the person she was when she was alive, [and which] will keep her alive in my mind,” she says.

But when she sits down in front of her easel, Hamilton can’t bring herself to do what she had done hundreds of times: press the bristles into the paint, and gently apply it to the canvas.

Hamilton says she feels stuck, badly wanting use art to cope with the trauma of her work but, ultimately, being unable to do so. She likens it to the feeling she gets at work: spending every day trying to keep her clients alive, while faced with stagnating political action, funding cuts, and increasingly dangerous drug supplies.

Hamilton talks with a lot of her clients about art; what they’re working on, and her paintings that hang in her office. She’s planning to start an art group at work for some of her clients.

“It’s healing without realizing it, because when you’re putting the paint on the can- vas, you’re not thinking about the stuff that we have to deal with.”

Truth to power

Jimmy, pictured, often appears in the photography of Jeff Bierk. The Toronto artist has become a default documentarian for communities directly hit by the terrifying surge in overdose deaths. Photo courtesy of Jeff Bierk

The first time Jeff Bierk tried to get sober was after his mom died while he was in his early 20s. Shortly after, his partner at the time was in and out of the hospital.

“I felt new to the world because I was clean,” says Bierk, a Toronto-based photographer. “I had no idea who I was, I had not processed or even dealt with all the grief of both my parents dying at a young age.”

He needed a way to grieve without using drugs again. So Bierk, now 38, started to take pictures of hospital curtains between 2009 and 2010. The photos were mounted as an exhibit called Curtain at a gallery in Brantford earlier this year.

A decade after he took them, he says he’s happy to show the photos with the privilege of reflection. “I was able to re-contextualize it with all the time in between. All these ways I’ve been able to heal outside of an art practice,” Bierk says. “At the root of it was talking about my experience with death and addiction.”

Bierk is best known for his honest photos of people he knows. Many of these friends come from far-flung places but wound up in Toronto. Many struggle with housing or health; many are drug users. The images candidly depict life on the streets, a world many never experience. It’s easy for people to project assumptions onto the photos. When people see a picture of Jimmy, one of Bierk’s best friends who frequently appears in his work, they see a tough man, covered in blown-out DIY tattoos. They see salt-and-pepper hair and deep lines on his face that come with years of alcohol consumption and cold winters. It’s easy to simply read Jimmy as a drug addict or a homeless person. An undesirable.

Bierk sees beauty; he sees his friend.

“Jimmy is an example of how to be. He’s the example to me of all these beautiful things that I don’t see in a lot of other people,” Bierk says. “It’s just this freedom.”

Bierk emphasizes that the people who appear in his images are his friends and his collaborators, disavowing the term “subject.” Bierk is seen in the self-portrait Me and Jimmy in an intimate, stylized embrace with his most frequent collaborator. Photo courtesy of Jeff Bierk.

Bierk has worked hard to get away from the traditional way photographers interact with their subjects. Jimmy is not Bierk’s subject; they are collaborators, and they split any profits. Often, Jimmy will come to an exhibit of Bierk’s work and visitors will get to meet and talk with him.

The shows “offer the potential for people to see Jimmy in the fullness of who he is … the art is a conduit for this kind of connection,” Bierk says.

In late February, Bierk took part in an open panel discussion on addiction and homelessness as part of Curtain’s run in Brantford, a city that’s been hit hard by the overdose crisis.

Between July 2017 and June 2018, Brantford and the surrounding area had one of the highest rates of overdose deaths in Ontario. Mayor Kevin Davis and other local politicians listened from the crowd as Bierk used his time on the panel to call for the city to open a safe injection site. “I remember that feeling where I was like, ‘Oh, fuck. I actually have to speak the truth to the power in this situation,’” he says.

“I spoke about my experience in a really vulnerable way,” he says, telling the crowd he was lucky and privileged — he got out of jail and was able to do a detox program where many don’t have that opportunity.

Not long after the talk, a Brantford friend messaged him with news: Brantford was going ahead with a study on opening a safe-consumption site in the city.

“It’s not that [the announcement] directly happened because of me or the art, but the art and my experience was this conduit to potentially shift the consciousness of people in the audience,” Bierk says.

Councillor Joshua Wall, whose constituency includes downtown Brantford, also attended the talk. He says the talk was one of many factors that lead the health unit to explore a safe-consumption site.

“It absolutely impacted me,” he says. “Art has the ability to inspire and elicit such strong emotions.”

“It’s unbelievably important to speak with people who have been there, who have been through turmoil and who can speak firsthand on how they’ve overcome,” Wall says. “There are so many people involved with [drug use] who haven’t been through it. There’s merit in listening to somebody who’s actually been there.”

Still, Bierk says he remains skeptical about art’s potential to foster societal change. He notes that the art world can be inaccessible. But, towards the end of our long conversation, he seems more open to the idea that the work he’s doing is creating dialogue and making people happy — even if it begins as a something for him and his friends.

‘This is the Indian that saved us’

Les Harper’s favourite colour is pink — It always has been. He says it stems from the old saying that when the evening sky is pink, the next day will be better.

He moves with an ingrained, deeply held optimism in the face of an acute crisis. Just as his mother and her generation survived, so too will he and his.

“People go through so many hardships,” he says. “Hopefully tomorrow will come and it’ll be a beautiful day.”

Harper often quotes John Trudell, a Native American activist, author and poet from Omaha, Neb., who discussed the “Drunken Indian” stereotype.

“Without them [the Drunken Indian], we wouldn’t be here today,” Trudell said in a previous interview. He said that, after centuries of forced assimilation, genocide, and oppression, there were generations that simply had to survive, by any means necessary.

“This is the Indian that saved us, because this is the Indian that said, ‘I can’t be who I am and I’m not going to be who you tell me to be, so I’ll just be nothing” he said. “I’ll be something else. I’ll just do my time and get through it. I’ll erase the pain and get through it. But I will not become you.”

Harper applies this framing to the over- dose crisis and the drug war. “We, as Indigenous people in our activism, have a great debt that we owe to the Drunken Indian because they survived,” Harper says. “We thought that one day we would be annihilated … And we weren’t.”

Harper sees parallels in the drug user community, where people remain vibrant and resilient despite terrible odds. “In this crisis that’s going on, people right now are still being the wonderful, beautiful people that they are.”

Many people in Harper’s community have died.

There is deep heartache.

But, each night, he sees pink — even in the middle of a storm.

Government Announcement: New Toronto East Ontario Health Team to Provide Better Connected Care for Patients

Ontario Health Teams Part of Province’s Plan to End Hallway Health Care

NEWS

December 3, 2019

TORONTO — Ontario is delivering on its commitment to end hallway health care and build a connected and sustainable health care system centred around the needs of patients. The province is introducing Ontario Health Teams, a new model of care that brings together health care providers to work as one team.

Today, Christine Elliott, Deputy Premier and Minister of Health, was at Thorncliffe Park Community Hub to announce the Toronto East Ontario Health Team as one of the first 24 teams in the province to implement a new model of organizing and delivering health care that better connects patients and providers in their communities to improve patient outcomes. Through an Ontario Health Team, patients will experience easier transitions from one provider to another, including, for example, between hospitals and home care providers, with one patient story, one patient record and one care plan.

“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 throughout their health care journey,” said Elliott. “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 and building a connected and sustainable public health care system centred around the needs of patients.”

The Toronto East Ontario Health Team, known as East Toronto Health Partners, will create a local health care system that provides coordinated care for patients, reduces wait times and leads to better heath outcomes for the population. The team will provide a comprehensive basket of health and social services tailored to meet changing local needs, including primary to acute care, birth to end-of-life care, food security, supportive housing, home-based health care, community support services, settlement and employment.

“With our new Toronto East Ontario Health Team, patients will benefit from better integrated health care, with a seamless experience when moving between different health care services, providers and settings,” said Elliott. “I would like to thank all the health care providers and organizations that helped plan the Toronto East Ontario Health Team; there is lots of work to be done, but with their dedication and hard work, we will continue to improve health care in our communities and ensure Ontarians get the care they deserve.”

As it continues its work to integrate care, the East Toronto Health Partners will put in place 24/7 navigation and care coordination services for patients and families. Patients will receive these services through their integrated primary care teams and the broader Ontario Health Team partners. This work will be implemented in phases and over time will provide care for everyone within the East Toronto Health Partners population, with an initial focus on helping seniors and caregivers, particularly those dealing with chronic disease, people with mental health and substance use challenges, and priority neighbourhoods, to meet the local needs of diverse communities.

“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, CEO, WoodGreen Community Services, on behalf of East Toronto Health Partners (ETHP). “It takes the creativity, flexibility and commitment of everyone involved to transform the delivery of local care to our communities. Today marks an important milestone in our journey to provide more seamless and accessible care experiences to our patients and to end hallway medicine.”

The Toronto East Ontario Health Team has already begun putting integrated care into action through their community-based approach to ‘winter surge,’ a heightened demand for health and community care services that occurs during the cold winter months. There are 25 initiatives being provided from November 2019 to March 2020 by a number of health and community care partners together with the East Toronto Family Practice Network, a network of self-organized physicians and an anchor partner of ETHP, to help people in East Toronto stay well.

Ontario has a comprehensive plan to end hallway health care, which includes making investments and advancing new initiatives across four pillars:

  1. Prevention and health promotion: keeping patients as healthy as possible in their communities and out of hospitals.
  2. Providing the right care in the right place: when patients need care, ensure that they receive it in the most appropriate setting, not always the hospital.
  3. Integration and improved patient flow: better integrate care providers to ensure patients spend less time waiting in hospitals when they are ready to be discharged. Ontario Health Teams will play a critical role in connecting care providers and, in doing so, helping to end hallway health care.
  4. Building capacity: build new hospital and long-term care beds while increasing community-based services across Ontario.

 

 Quick Facts

  •  An Ontario Health Team will be responsible for delivering care for their patients, understanding their health care history, directly connecting them to the different types of care they need, and providing 24/7 help in navigating the health care system.
  • Ontarians can be confident that they can continue to contact their health care providers as they always have to access the health care they need.
  • The first wave of Ontario Health Teams is being approved after an extensive readiness assessment process, which involved significant time, collaboration, research and effort from partners across the health care sector.
  • The government will continue working with its partners to review their applications to become an Ontario Health Team.

 

Additional Resources

 

 For public inquiries call ServiceOntario, INFOline at 1-866-532-3161 (Toll-free in Ontario only)

Toronto Star: Kevin Dickman died a broken man, homeless and alone in a city grappling with a housing crisis

Kevin Dickman died a broken man, homeless and alone in a city grappling with a housing crisis

By Laurie Monsebraaten Social Justice Reporter

 

Sat., Nov. 9, 2019

Paula Tookey always knew she would end up at Kevin Dickman’s funeral. She also knew his death would be as heartbreaking as his life. Dickman’s body was pulled from the Don River on Oct. 5, a month after he lost his housing — again. He was 62.

He struggled with mental illness and homelessness for most of his adult life.

“You hated being homeless — being dirty, tired and cold. Being alone,” Tookey said, addressing Dickman’s pine casket in the chapel of the Rosar-Morrison Funeral Home on Sherbourne St. on a grey afternoon last month.

“You often broke into schools and garages to sleep. You were in and out of emergency rooms, and in and out of jails for years. Decades,” said Tookey, who befriended Dickman in the early 1990s when she was working at the now-closed StreetCity transitional housing project.

“I loved you Kevin. We loved you,” she continued as several dozen homeless support workers sat solemnly in the wooden pews, some weeping openly. “But I couldn’t promise that it would get better. For people like you, it rarely does.”

Dickman is among scores of homeless people who have died in Toronto this year, including more than 30 who used the city’s shelter system, which has been running at or near-capacity since the summer.

On Thursday evening, the Ontario Coalition Against Poverty (OCAP) held a vigil outside the city’s Peter St. emergency shelter referral centre where Dickman lined up nightly — often in vain — for access to a bed. Capacity has doubled in four years to over 7,000 permanent beds and about 600 temporary and respite spots. And still people are turned away.

The coalition is demanding the city open 2,000 new shelter beds to prevent more deaths this winter amid Toronto’s worsening affordable housing and homelessness crisis.

The city, which released its winter shelter plan earlier this week, plans to add almost 500 new permanent and temporary beds. But activists say this comes nowhere close to meeting the need.

Despite Dickman’s age, troubles with mental illness and substance abuse, those who knew him say he seemed like a little boy.

“I always called him ‘smile boy’ and we would laugh and laugh,” said Chaudhry Ahmed, harm reduction project co-ordinator at StreetHealth, a downtown agency that supports the homeless.

“He was always asking about our kids,” added Myra Hewson, another StreetHealth worker. “He loved babies.”

But Dickman was also the boy who got “stuck in time and hurt,” whose childhood was stolen by sexual abuse, said Tookey, who runs the safe injection site at South Riverdale Community Health Centre and was Dickman’s caseworker at StreetHealth a decade ago.

Tookey, 53, knew him the longest — almost 30 years — and said she “often thought of him like a brother.”

“He struggled with loneliness in the worst kind of way … he felt the world was against him,” she said in an interview.

“There were times he would come into my office sobbing like a little boy, pouring out his broken heart. He had so many losses that he couldn’t understand.”

Dickman was born in Belleville and adopted into a Brampton family. He had happy memories of his early childhood, including a trip to England with his family that was “definitely a highlight,” Tookey recalled Dickman telling her.

But when he was about 10, his father died unexpectedly in hospital during a routine medical procedure. Dickman was devastated.

Kevin Dickman wrote a poem about his struggles with addiction. He struggled with mental illness and homelessness for most of his adult life.

In an attempt to ease his sorrow, his mother contacted a local mentorship agency who paired Dickman with a police officer. But the man was a pedophile, a horror revealed by one of the other boys the officer was also molesting. As far as Tookey knows, the abuser was never prosecuted.

As Dickman grew up, that trauma translated into angry outbursts, petty crime and substance abuse that eventually caused his family to sever ties.

Years later, Dickman was heartbroken when he learned his mother had died and nobody told him, Tookey said.

No one from his family attended his funeral.

A capacity assessment by the Centre for Addiction and Mental Health that formed part of his trial for auto theft and drunk driving in 2003, also referred to the childhood sexual abuse and his subsequent mental health challenges.

“Kevin was diagnosed with mental illness — schizophrenia — but the trauma he endured was never acknowledged,” Tookey said.

His anti-psychotic medication didn’t appear to manage his symptoms — the voices in his head, the explosions of anger and erratic behaviour — and like so many homeless people, Dickman turned to alcohol and prescription and street drugs to ease the pain.

His trajectory appeared to change when the judge at his 2003 trial — who took Dickman’s medical history to heart — sentenced him to a mental health treatment centre in Brockville, where Tookey says he was surrounded with kindness and humanity.

For perhaps the first time in his life, he got treatment. He participated in programming. And he started to get better, Tookey said.

When he was released a year later, just before his 50th birthday, Tookey helped Dickman get an apartment with support. And he thrived.

“Kevin got a job as a peer worker, he got a cat, he felt hopeful,” she said. “He began to feel his life had a purpose. He loved to feel useful.”

But after several years, his support worker got another job. Dickman never connected with her replacement and eventually, he ended up on the streets again.

His last home was The Edwin, a transitional housing program for older men on Queen St. E. But that fell apart over the summer.

Toronto Employment and Social Services funded about 2,100 funeral, burial and cremation services last year for people who lived on welfare and others who died with no money to cover the cost. Of those, just over 200 were “Coroner’s Warrants,” which often include the homeless, like Dickman.

A traditional funeral service costs almost $5,000 and is paid for by the province through the Ontario Works Act. In 2018, the province reimbursed the city $8.4 million for funeral and burial costs.

In cases where the deceased does not have a plot, burials are usually in cemeteries outside the city where space is more readily available and less costly.

A number on a small metal plaque in the ground is usually the only marker. Names are kept in the cemetery’s record system.

Services for the homeless are particularly heart-rending, said Father Larry Whissell, a Catholic priest who presides over many of them with a mix of outrage and levity.

After Tookey’s eulogy, Whissell began his homily for Dickman by leaning over the pulpit and shaking his head.

“Don’t you know the 11th commandment is don’t upstage the priest?” he teased.

But his words quickly turned to the tragedy of Dickman’s death.

“We, in Canada, live in one of the richest countries on earth. There is no excuse for anyone not having a roof over their head. There is no excuse for anyone going hungry who needs to eat,” he said.

“And yet here we sit, mourning the death of someone who died homeless. And undoubtedly hungry,”

Whissell talked about Dickman’s contributions, his work with StreetHealth as a peer researcher, his training as a harm reduction worker for crack users and media interviews he gave to help others understand the challenges of homelessness.

“He’s flying with the angels. And if he’s doing it properly, he’s probably making some trouble with the angels,” Whissell said to a few knowing smiles.

After the funeral service, five outreach workers accompanied Dickman’s casket on the hour-long drive up the Don Valley Parkway and across Highway 401 to Duffin Meadows Cemetery in Pickering.

At the gravesite, a windswept hilltop lined by a new housing subdivision, Whissell tucked a cigarette into the arrangement of yellow roses and daisies that adorned his casket.

“I think he would have liked that,” he quipped.

“The social safety net is supposed to catch people like Kevin,” Tookey said this week as she sifted through letters, notes and drawings Dickman gave her over the years.

“But only if you behave nicely. Otherwise, people don’t want to deal with you — and you default to the criminal justice system.”

For Tookey, and many of the outreach workers at his funeral, Dickman was a teacher.

“He taught us through his suffering — and being insufferable,” she said sadly, recalling his “very challenging” behaviour when he was mentally unwell.

“He helped us to become better people. He continuously gave us opportunities to practise patience.”

“I am who I am today, thanks to Kevin. He was a huge part of my life, whether I wanted it or not. And I am very grateful for what he offered.”

At StreetHealth, outreach worker Jessica Slotnick recalled Dickman’s distress in the last weeks of his life, after leaving The Edwin, his home for about four years.

When he left, he took his cat, Nutella, and bought a GO Train ticket to Brampton to visit a friend, she said. But when he let Nutella out of the carrier to stretch after the journey, the cat ran away. Dickman was gutted.

As always, Dickman returned to StreetHealth for support. He didn’t have a phone, so he would go to the red-brick house at Dundas St. E. and Sherbourne St. to call the city’s shelter referral service to reserve a bed for the night.

“Often we were put on hold or told to call back in two hours,” she said.

But by then StreetHealth would be closed and Dickman would be forced to walk almost three kilometres to the Peter St. referral centre and wait there. Sometimes he would wait until midnight to get a bed. Sometimes he’d sleep rough, she added.

It’s not clear how Dickman ended up in the Don River. Tookey thinks he became so disheartened that he just gave up.

“I remember how much he suffered physically, emotionally and spiritually from being homeless when he was in his 30s and 40s,” she told the OCAP vigil on Thursday night.

“I can’t imagine how Kevin felt when he found himself back there again, without a place to go, having nothing and no one,” she said.

“I know for a fact that if Kevin had a place to go, a place to be, he would not be dead.”

Kevin Dickman was part of a short documentary film shot in late 2004 about finding homes for the homeless. The film aired on CBC’s Moving On in January, 2005.

Laurie Monsebraaten is a Toronto-based reporter covering social justice. Follow her on Twitter: @lmonseb

East Toronto Health Partners (ETHP) submit full application to become an Ontario Health Team for East Toronto

October 9, 2019

Hon. Christine Elliott
Ontario Deputy Premier and Minister of Health
Hon. Merrilee Fullerton
Ontario Minister of Long-Term Care
College Park, 5th Fl.,
777 Bay St, Toronto
ON M7A 2J3

RE: Ontario Health Team Submission from the East Toronto Health Partners

Dear Ministers Elliott and Fullerton;

In partnership with those who receive care and those who provide care in East Toronto, the East Toronto Health Partners (ETHP) are pleased to submit our full application to become one of Ontario’s first Health Teams. In your call for applications, you invited us to be bold in our thinking, and we have taken this to heart. We also recognize that with the changes envisioned
for health care in Ontario, there are both opportunities and inherent risks. We want you to know that we are fully committed to building a bolder, brighter future for the delivery of health and social care for our local communities, and we look forward to the support of your Ministry to help us transform our systems of care.

Our vision is to work with our community to co-design ‘A System without Discharges’: A seamless continuum of care focused on population health, with programs tailored to our 21 local neighbourhoods and communities. We have grounded our vision in the Quadruple Aim, with goals to improve quality of care and the experience of our patients and caregivers, enhance health and wellness for clinicians and other front-line providers, improve overall population health, and increase the value of investments in health and social care.

About Our Population
Collectively, we serve the approximately 300,000 children, adults and seniors who live in the multiple communities that comprise East Toronto. Our boundaries span from the Don River to the West, to Warden in the East, and from South of Eglinton Ave to Lake Ontario; and include priority neighbourhoods such as Thorncliffe Park and Flemingdon Park. We also serve Ontarians across the Greater Toronto Area and beyond for a total attributed population of 375,000. When our Ontario Health Team reaches maturity, we will have a full population health and integrated care model that supports our entire population; however, in Year 1 we will focus on integrating care for the following three populations:

1. Seniors with chronic care needs and caregivers: East Toronto has a significant population of seniors (53,712) and heavy burden of chronic illnesses including Chronic Obstructive Pulmonary Disease (3,937 people) and Congestive Heart Failure (2,734 people). Seniors with chronic care needs experience high levels of hospital admissions, and long lengths of stay, contributing to hallway medicine pressures. We selected this population because of the risk factors within the East Toronto seniors’ population with chronic care needs, including high rates of caregiver distress (up to 47% in some of our communities). The redesign of care for this population will build on what we’ve heard from patients, families, caregivers, and health care providers about the current challenges they face with fragmented services and poor transitions of care.

2. Youth Mental Health and Wellness: As rates for mental health issues in youth are rising across Toronto and Ontario, some neighbourhoods in our region such as Taylor Massey have three times higher Emergency Department (ED) use for youth mental health than the Toronto average. East Toronto has approximately 7,977 youth living with mental health conditions. Our initial work with youth in East Toronto has identified several opportunities for us to co-design improved access to care and better support youth mental health and well-being.

3. Substance Use and Health: East Toronto providers serve significant numbers of people with issues of substance use. The Canadian Institute for Health Information identified 7,288 people in our attributed population with diagnosed Drug/Alcohol Dependency; often these individuals are disconnected from basic primary care, have significant issues related to the social determinants of health, and have high rates of emergency room use and hospital admission. We have identified opportunities with patients and providers to coordinate harm reduction, treatment, and crisis supports to improve health for this population.

Our work with our priority populations will be grounded in a neighbourhood approach; starting with the five “Neighbourhood Improvement Areas” as defined by the City of Toronto. This neighbourhood-based approach is intended to help us address some of the priority equity considerations facing our population; a high proportion of newcomers and immigrants, patients who are uninsured, individuals and families with lower incomes, and engagement of Indigenous and Francophone populations. Of our total attributed population of 375,000, the 178 family practice physicians who have joined the new East Toronto Family Practice Network (EasT-FPN) care for approximately 200,000 patients. In addition, the priority populations for Year 1 aggregate to roughly 69,000 people.

Through our members and the scope of services we provide, ETHP will provide actively coordinated care for roughly 20% of the total Year 1 population: a total of 13,800 individuals. In addition, the 200,000 residents who access primary care through family physicians who are part of EasT-FPN will have access to integrated care through our SCOPE program, interprofessional care teams, fall/winter community surge investments and other existing programs in East Toronto.

About Our Team and How We Will Work Together
The ETHP are building on a 25-year history of collaboration to improve the health of our local population through collaborations such as Partners for Health and the Solutions Network. In late 2017, the CEOs of five organizations that represent the continuum of healthcare came together to form the foundation for an integrated care network (ETHP). Over the past two years, the ETHP has been working with patients, families, community representatives and a range of partner organizations towards this goal.

In October 2019, the ETHP welcomed our newest Anchor Partner, the East Toronto Family Practice Network (EasT-FPN) which was created to be the representative voice of the over 260 family physicians in East Toronto. EasT-FPN has established an Interim Board of Directors, Interim Executive and a Memorandum of Understanding for engaging with family physicians. Over the next few weeks, EasT-FPN is hosting a series of engagement sessions for family physicians to learn about the work of the ETHP and encourage physicians to participate in the design and development of our Ontario Health Team. To date, 178 family physicians have joined the EasT-FPN, who care for approximately 200,000 patients as part of the ETHP.

The ETHP is governed through an Anchor Partner model, with each member of our anchor organizations representing a different care sector. Our starting point for governance has been a ‘network of networks’ model which has enabled a small group of trusted partners, which represent the full continuum of care, to facilitate change and improve care through a streamlined decision-making process. The current members of the East Toronto Health Partners are:

  • Patients, Families and Caregivers** East Toronto Family Practice Network – EasT-FPN
  • Michael Garron Hospital (Toronto East Health Network)
  • Providence Healthcare (Unity Health Toronto)
  • South Riverdale Community Health Centre (on behalf of East Toronto CHCs)
  • VHA Home HealthCare (liaison to home care providers)
  • WoodGreen Community Services (representing home and community care, community mental health, addictions and developmental services, community support services and housing)

The organizational members above will be formal signatories to the Joint Venture agreement and to the eventual accountability agreement with the Ministry of Health. Our Joint Venture agreement, which will be signed by the Anchor Partners in October 2019, outlines our shared principles, how we will work together, and how our partnership will evolve over time.
In addition, the ETHP network of providers includes two other levels of partnership:

  • Engaged Partners, actively involved in the planning and delivery of specific initiatives; and,
  • Supporting Partners, who remain informed and involved, but may not be active in planning or delivery.

A letter of support from our partners is included in the supplemental information of our application. Together, all of our partners deliver the full range of services needed to support our Year 1 populations.

**Over the last 6 months, the ETHP has hosted a number of community engagement sessions to involve patients, caregivers and providers in helping us co-design the future of care for our priority populations. To help guide our ongoing work, a Patient and Caregiver Engagement Planning Team consisting of advisors from existing Patient and Family Advisory Committees from several East Toronto organizations was established to advise on different approaches to patient, family, caregiver and community engagement for the ETHP. Our Patient and Caregiver Engagement Planning Team is assisting us with next steps in this work, including a process to identify ongoing membership at the Governance level to ensure patient and caregiver involvement in strategy, priority setting and decision making.

We will continue to work with all our communities as we redesign the future of care in East Toronto. To support this work, the ETHP has developed a Community Engagement Framework; a best practice guideline for current and future engagement activities within the OHT planning context. Patients, community members and providers were engaged in a joint working group with representation from the East and Downtown East OHTs to develop this framework.

How We Will Transform Care
The ETHP see significant opportunities to improve care for our population and health system performance as we create an integrated health system. Our shared vision is centred on creating ‘a system without discharges’; one connected system of health care and support for all residents in East Toronto. Our most important improvement opportunities are fully aligned to this shared vision:

1) Create a one-team approach with patients, caregivers and providers: This includes engaging with care recipients to design care transformations that meet their needs, supporting all our staff to work to their full scope, and building stronger networks between providers who deliver similar and complementary services. For our Year 1 focus, we will expand our existing integrated, interprofessional team-based care models and simplify access to community support services. For our youth and adults with mental health needs, our focus will be on building skills, relationships and trust, to support them with their goals.

2) Coordinated Care tailored to Local Neighbourhoods; scaling up our early successes: This includes evaluating and expanding our existing integrated care initiatives and shifting more care from hospital to community. We will co-design tailored solutions for our 21 neighbourhoods to address their distinctive needs, ranging from designated improvement areas to higher income communities. For our Year 1 focus, we are targeting improvements to three Neighbourhood Improvement Areas; Thorncliffe Park, Taylor-Massey and Oakridge. We will also expand our Home 2Day program to support a broader range of patients with cardiac and respiratory conditions, increase our community investments during the flu season, and expand our interprofessional care team models to other neighbourhoods in partnership with our primary care partners.

3) Support the Success of our New Primary Care Network – The ETHP is very excited to welcome our newest Anchor Partner, the East Toronto Family Practice Network (EasT-FPN). Full engagement of primary care at every level of the ETHP is critical to the success of an integrated model of care in East Toronto. Together, the ETHP will develop multiple ways to engage and connect with local family physicians so they can continue to be an integral part of the design and evolution of integrated care. The ETHP are also working on a financial plan as part of our shared commitment to develop and sustain our partnership.

4) Streamline Access and Navigation, enabled by Digital and Virtual Care: This includes providing easier access to information and access to services, reducing the burden of chronic disease, and improving coordination of care to support patients and their caregivers. For our Year 1 focus, we will: finalize our asset maps of services that support our Year 1 populations; create digital navigation tools for local services such as Youth mental health and wellness programs; and, establish patient navigators to support seniors with chronic disease and caregivers with health system navigation, service planning, care plan accountability, and one touchpoint for hospital to community transitions. For individuals who access the Emergency Department related to substance use we will coordinate access to community services based on similar models implemented at peer hospitals.

5) Improve population health and health equity: This includes reducing gaps in care and improving coordination of services for vulnerable, marginalized and under-served populations. For our Year 1 focus, we are targeting improvements for seniors living in Toronto Community Housing buildings, youth with mental health concerns, and adults with substance use issues.
Our overall vision for care redesign is centred on creating integrated, community-based health and social care teams across our 21 neighbourhoods that will support 24/7 access, and link to acute care, specialty care and other regional services as depicted in the graphic below.

Unlike our current siloed health care system, through our neighbourhood-based model of integrated care, people will experience one local system that provides simple access to health services and social supports, navigation and care coordination, inter-professional/ interorganizational teams, and streamlined communication of health and social care providers. This model focuses on simplifying the system for patients and frontline staff, maximizing current system investments and enhancing efficiency and effectiveness. Key enablers of this model of care are:

  • A simplified model for care transitions, with established care pathways that support patients to move easily from hospital to home;
  • Integrated, neighbourhood-based care teams, that align interprofessional teams from home care and community support services with primary care;
  • Care Coordinator/Navigators aligned to neighbourhoods / specific geographies using existing staffing resources from organizations that currently provide these services;
  • Access to regional supports including, but not limited to; acute care, specialty care, 24/7 call centre support services for patients and caregivers, virtual care and remote monitoring; and,
  • Digital communications and integrated information systems to support care teams, patients and caregivers with real-time access to patient health information and care plans that address the full social determinants of health.

Digital Health

The ETHP Digital Health Team has created a vision and a strategy for advancing virtual care, access to health information, information sharing, and quality improvement. Our overarching goals for the ETHP Digital Strategy are:

1. Achieving Digital Connectivity – to allow for the exchange of information and open communication that is fundamental to an integrated system of care

2.Digital-First Customer Service – to prioritize solutions that support health equity, positive experiences and flexible virtual care options

3. Fostering an Intelligent Learning System – to optimize our use of population health and care data, advance predictive capabilities, provide centralized supports and enable innovation

Specific solutions included in our Digital Strategy include expanding the use of the MyChart application across our partners, testing a patient-oriented portal, leveraging existing app-based technology to facilitate 24/7 access to support for patients and caregivers, expanding use of virtual visits, and enabling secure messaging between providers (and eventually patients and caregivers). The ETHP are in the process of developing a data-sharing agreement as well as common policies for privacy, security, cyber-security and data governance.

The Province’s policy shift to the Ontario Health Team model has provided a substantial opportunity for East Toronto to spread and scale the work we have already started, as well as creating new platforms for change and innovation across all our provider partners. In our application we have identified specific actions the provincial government can take to help us accelerate our efforts (including addressing policy barriers, providing resources and funding support in specific areas, and supporting provincial digital solutions), which we would be pleased to discuss further. We are excited to submit our full application and are confident that we are ready to be one of the province’s first Ontario Health Teams.

Sincerely,

Anne Babcock
President and CEO, WoodGreen Community Services
On behalf of the East Toronto Health Partners

Copy/
Dr. Rueben Devlin, Special Advisor and Chair of the Premier’s Council on Improving Healthcare and Ending Hallway Medicine
Helen Angus, Deputy Minister, Ministry of Health
Marie-Lison Fougère, Deputy Minister, Long-Term Care
East Toronto Health Partners

The Full Application for ETHP to become an OHT can be read here.

Board appoints co-CEOs to lead SRCHC during transition

SRCHC’s two directors Jason Altenberg, Director of Programs and Services, and Shannon Wiens, Director of Organizational Health Systems were jointly appointed as interim Co-Chief Executive Officers effective September 6.

Lynne Raskin retired from her position as Chief Executive Officer at South Riverdale Community Health Centre effective September 5, 2019.

Ms. Raskin’s leadership established a resilient organization, well positioned to continue advancing SRCHC’s vision of empowered, healthy and thriving communities where everyone belongs. In the interim, the Leadership Team will continue the organization’s good work and rely on internal management resources to maintain the vision, mission and values of the organization.

The Board of Directors has a plan in place around the search for a new CEO to lead the organization with a view to ensuring a smooth transition during this change of leadership. The Board has engaged the services of a reputable executive search firm in the process to appoint a suitable and qualified successor who will meet the needs of the organization. This process could take four to six months.

News Release: Films for people with chronic disease to ‘Choose Health’ in East Toronto, September 19, 2019

NEWS RELEASE

September 19, 2019

Films for people with chronic disease to ‘Choose Health’ in East Toronto

TORONTO (September 19, 2019) – Last night, South Riverdale Community Health Centre (SRCHC) and the Toronto International Film Festival (TIFF) launched a community film screening program to bring short films into communities across Toronto. As part of a community building experience to address social isolation, the two partner organizations leveraged their strengths to train people living with chronic health conditions to facilitate post-screening discussions. This community film screening program is an expansion of work previously done with arts and cultural institutions within SRCHC’s city-wide service, Choose Health. Choose Health is a Government of Ontario, Ministry of Health mandated service offering 14 peer-facilitated programs that help people learn how to take care of themselves while living with long-term health conditions such as diabetes, heart diseases, cancer and other chronic health conditions.

People watching a movie in a group setting.
Participants enrapt with the film “Roy Thomson”at the inaugural peer facilitated community film screening program of South Riverdale CHC and TIFF.

“We are excited to begin this partnership with TIFF and bring celebrated Canadian short films and guided conversations to our clients who will benefit from social interaction, community engagement, and wellness opportunities like these. We have found that a social activity like visiting the museum or watching a film together that is led by someone with similar lived-experience and relatable health conditions improves access and connections for our clients,” said Jason Altenberg, interim co-CEO and Director of Programs, SRCHC.

By partnering with arts and cultural institutions across Toronto and co-creating peer-led programs with people who live with chronic conditions, SRCHC and Choose Health are inviting clients to engage in their health and well-being through social interaction and belonging.

“TIFF’s Mental Health Outreach program is one of several community initiatives dedicated to increasing access to film. Year-round, we partner with hospitals and community health programs across the Greater Toronto Area to co-create film experiences that reflect the needs, interests, and experiences of each group. Watching and discussing film in a supportive group setting can be a transformative experience, promoting well being by creating space for self-expression, social connection, and skills development. We are thrilled to partner with SRCHC and Choose Health to empower a passionate group of film lovers to bring these films and experiences to their communities,” said Elysse Leonard, Senior Coordinator of Youth & Community Initiatives, TIFF.

This partnership with TIFF is built upon the success of the community health centre’s partnership with the Art Gallery of Ontario that began in January 2016. In both partnerships, SRCHC and Choose Health have brought in expertise, an understanding of the importance of the social determinants of health and people who live with chronic health conditions trained to deliver the services. TIFF, much like the AGO, provided an empowering training program that encouraged peer facilitators to approach film through the lens of their individual strengths, interests, and experiences, as well as those of their audience, and also allowed time for co-design with trained peer facilitators.

“I’m passionate about film because it can entertain, enlighten and change hearts and minds. It’s a window into society. It communicates feelings and thoughts, ideas and culture, in an inclusive and powerful way. As a TIFF Peer Ambassador, I look forward to introducing film to clients so that they can engage in activities and meaningful discussion about what they see,” said Carolyn B., SRCHC Peer Ambassador.

Hosted at SRCHC’s Danforth and Greenwood location, the program featured short films that explore themes of “storytelling” as a vehicle for family reminiscence (Roy Thomson, directed by Sofia Bohdanowicz), navigating one’s cultural identity (Show & Tell, directed by Reem Morsi), and combating colonial views of history (Flood, directed by Amanda Strong).  The 14 people who attended the screening were past participants from one of seven community based peer programs offered through Choose Health.

The idea of referring patients to supports offered in the community to improve their health and well-being has been described as social prescribing and has gained broad support in the UK’s National Health Services. In Ontario, the Alliance for Healthier Communities’ social prescribing pilot has brought similar attention to the power of community supports in helping a patient live a healthier life. SRCHC’s partnership with arts and cultural institutions, such as TIFF and the AGO, are about leveraging community supports to engage people in their health and well-being. The peer-facilitated model and access to co-designed programs provided by these cultural institutions is a unique service offered by SRCHC and its partners like TIFF and the AGO.

SRCHC and TIFF will host two more film screenings in the coming months. To learn more, please visit: www.selfmanagementtc.ca

– 30 –

 

About SRCHC:  South Riverdale Community Health Centre is a non-profit, multi-service organizaton that provides primary healthcare, social and community outreach services with an emphasis on health promotion and disease prevention primarily to people of East Toronto. Our mission is to improve the lives of people that face barriers to physical, mental, spiritual and social well-being. We do so by meaningfully engaging our clients and communities, ensuring equitable access to primary health care, and delivering quality care through a range of evidence informed programs, services and approaches. We value health equity and inclusion and respect in our work and in the delivery of our services.

 

About Choose Health: Choose Health is one of South Riverdale Community Health Centre’s city wide services. Our service mandate is to enhance patient self-management and provider health literacy using evidence-based training and programs. Choose Health works in partnership with 33 arts, health, and social service sector organizations that are located in neighbourhood improvement areas and engages 1300 people annually in Toronto.

 

About TIFF: TIFF is a not-for-profit cultural organization with a mission to transform the way people see the world through film. TIFF is dedicated to presenting the best of international and Canadian cinema and creating transformational experiences for film lovers and creators of all ages and backgrounds. As Canada’s premiere home of cinema, TIFF offers screenings, lectures, discussions, festivals, workshops, events, professional development and opportunities to meet, hear and learn from filmmakers from Canada and around the world.

SRCHC Launches New Community Food Centre in East York

Woman and man chefs in a kitchen
Special guest chefs prepare a meal in new kitchen at Harmony CFC.

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.

Harm Reduction Program in East Toronto Enhanced by the Addition of Supervised Consumption Services

Harm Reduction Program
Woman hands supplies to a man in the office.

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.

MATCH Midwives provide equitable, quality midwifery care

A woman holding a baby.
A friend of the family holds this baby who was delivered by MATCH midwives.

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.

Chronic Disease and Homelessness

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.