Year 1 Population Focus
In our progress report to the Ministry, we outlined our focus in Year 1 on improving health care outcomes and experiences for two priority populations:
- People experiencing homelessness
- Adults 18+ years (16+ if applicable) with mental health symptoms who would benefit from counselling or psychotherapy in addition to or instead of medication
YEAR 1 WORKING GROUPS
Mental Health and Addictions Working Group
Progress to date:
- The MHA working group has conducted an environmental scan to identify innovative models to deliver mental health care for people with mild to moderate mental health symptoms in Downtown East Toronto (DET).
- To analyze the needs of the DET Year 1 population, the team conducted a preliminary assessment of the existing counselling and psychotherapy services and accessibility of these services to our DET patients and providers by collecting survey responses from family physicians, MHA service providers and clients.
- The team’s ongoing efforts are focused on designing the pilot of the Model of Stepped Care between partner organizations on which to build a DET framework with emphasis on level of need in an undifferentiated MHA population.
DET OHT Stepped Care Model
People Experiencing Homelessness Working Group
The DET OHT People Experiencing Homelessness (PEH) Working Group provides a forum for the exchange of ideas, information, and advice on the challenges and opportunities for improved care delivery for people experiencing homelessness. The voices of people with lived and living experiences will guide the work of the PEH working group.
The PEH working group objectives are divided into four implementation teams, each with a core focus on the provision of a coordinated continuum of care to people precariously housed or experiencing homelessness:
|Outreach-High Density Housing||Bring comprehensive support to people living in high-density housing with a focus on COVID-19 testing and flu vaccination in the fall while addressing the issue of ‘hallway medicine’ through creating pathways to comprehensive care (primary care/clinical supports) and service integration||· COVID-19 testing sites: coordinated staffing, information/education about the vaccine, provided wrap-around supports at three downtown locations: St. James Town, Regent Park, City Park Co-OP|
· Vaccination sites: promoted existing sites and provided education about commonly asked questions related to the vaccine; supported the development of two new pop-up vaccination sites (Wellesley Community Center; 40 Oaks)
|Sheltering Sites and Drop-ins||Ensure people in shelters, hotels, and drop-ins have access to primary care, case management, and harm reduction·||· Recruited three Lived Experience Partners to include the voices of those who have experienced institutional marginalization to support the design of the equity framework.|
· Finalized the list of Drop-in and Sheltering sites in DET and Validate what services are in each site (both pre- and post-COVID-19).
· Developed equity definition and framework to guide the decision of which sites to prioritize for additional support.
|Improved Transition and Navigation||Bridge the gap in care that patients encounter between hospital and community partners by embedding Peer Workers in acute services||· Recruited and trained three outreach workers located at the St. Michael’s Hospital emergency department to assist clients in accessing their care pathways.|
· Finalized the plan of piloting the Verto digital solution to track client’s pathways.
|Crisis Support for People who use the substance||Design a model for comprehensive, 24-hour crisis services for people who use substances||Completed environmental scan and preliminary research to draft a crisis support center business case.|
Digital Working Group
The Downtown East Toronto Digital Working Group (DET-DWG) has been established to provide a forum for exchange of ideas, information and advice on the challenges and opportunities for digital health in the DET OHT. It also provides a platform for developing collective priorities for investment and activities related to digital health; data (governance, standards, policies); information exchange, and information technology architecture and infrastructure, as part of the DET OHT strategy and priorities.
For Year 1 (21/22), DET-DWG has prioritized the following areas of work:
- Developed a Digital Strategy and Framework for DET OHT
- Pilot a digital solution to enable connected care for our priority population, people experiencing homelessness
- Advocacy of Regional/ Provincial Digital Solutions
- Support the establishment of a Privacy Working Group
- Support the submission of Ontario Health’s Harmonized Information Management Plan (HIMP) for DET OHT
Privacy Working Group
DET OHT is collaborating with West Toronto OHT to establish a joint Privacy Working Group. The Cross-OHT Privacy Working Group will focus on the following areas of work for Year 1 (21/22):
- Developing a Data Sharing Agreement, which will also support the implementation of a pilot for a digitally integrated care pathway for people experiencing homelessness in DET OHT;
- Support the development of DET OHT’s Harmonized Information Management Plan;
- Identify the OHT’s needs within a Privacy and Security Framework;
- Align with Ontario Health Teams’ Privacy Committee’s Community of Practice
The Ministry of Health announced the approval of the Downtown East Toronto team as the Downtown East Toronto Ontario Health Team (DET OHT) on November 18, 2020.