Issue10 | September 22, 2021
Monthly Bulletin of the Alliance's Learning Health System
National Safer Supply Community of Practice
New Research: SMART Goals for Older Adults
The Economic Impact of Green Infrastructure
Learning Events & Opportunities
Get Involved: Research & Sharing
New Tools &
Resources
How are we doing? Tell us at the bottom of this email.
Growing Together in Scope and Impact
Introducing the National Safer Supply Community of Practice
Over the last few years, primary healthcare providers in Canada have begun responding to the public health crisis of opioid poisonings by prescribing opioids to people who live with opioid use disorder. These providers and their teams were already providing harm reduction tools, supervised spaces, and overdose prevention and management response and education. However, they realized that this is insufficient as long as the content and potency of substances from the illegal drug supply are unknown and unregulated.

Since early 2020, the crisis has grown exponentially, making the need for a safer opioid supply even more urgent. This “shadow pandemic” has been fueled by COVID-related disruptions such as job loss, homelessness, social disconnection, and supply-chain interruption, as well as an increasingly toxic street supply. As the crisis deepens, safer supply programs are growing and spreading across the country, and they are increasingly recognized as an important component of the response to the crisis.

Safer supply prescribing practice is informed by the evidence supporting injectable Opioid Agonist Treatment (iOAT). Over the past year, guidance for safer supply prescribing has emerged from Ontario, BC, and Quebec, and many research and evaluation studies are underway, building an evidence base for safer supply. However, as program models and best practices are developed in response to continuous changes in the highly unpredictable and contaminated drug supply, clinical and social care providers who work in safer supply are building the path by walking it. In the fall of 2020, a community of practice was formed in Ontario. It has since swelled to nearly 300 members who stay connected through weekly meetings, working groups, special events, a discussion forum, and an online resource library.

In recognition of the need to scale up safer supply programs, Health Canada has awarded $1 million to London InterCommunity Health Centre to scale up the community of practice to the national level, in partnership with the Alliance for Healthy Communities and the Canadian Association of People who Use Drugs. The newly launched National Safer Supply Community of Practice (NSS-CoP) facilitates member meetings (drop-in sessions, working groups), a members' discussion forum, and public ‘hot topic’ meetings and events. They will soon be launching a website that will become a knowledge and resource hub for safer supply practice and advocacy. 

To learn more about the NSS-CoP, consider attending our inaugural speaker series talks (listed below) or email SaferSupplyON@gmail.com. By participating, you are committing to the principles of harm reduction, anti-oppression, and person-centred care. 
Simpler, SMARTer Goals:
Helping older adults improve their health and wellbeing

There are at least a dozen modifiable lifestyle factors – such as physical inactivity, social isolation, and alcohol overuse – that increase the risk of major illness such as heart disease or dementia. Studies have demonstrated that combining lifestyle modifications can reduce multiple risk factors at once. However, some participants – especially those who face barriers – find it hard to stick with multiple lifestyle changes after the study ends. What if, instead, study participants were supported to make just one lifestyle change at a time?

Mary Hynes is a PhD student at the University of Toronto Institute of Medical Sciences. Her research interests include policy, community development, resiliency, and the health of older adults. An older adult herself, Hynes suspects it would be easier – and ultimately more effective – for this population to make risk-reducing lifestyle changes one at a time, based on what matters most to them.

The SMART Goals Study

To test this idea, she plans to work with older adult peer groups, helping them to set SMART goals and choose one behaviour modification that makes sense for them. A SMART goal is one that is Specific, Measurable, Achievable, Relevant, and Time-bound; research in numerous areas has shown that setting SMART goals increases one’s chance of success. After an initial goal-setting meeting, each group will meet monthly to share their progress and provide mutual peer support. Every month, each participant will decide whether to continue working towards their SMART goal, modify it, or choose a new one. After six months, Hynes expects that participants will be ready to continue SMART goal setting on their own. Because the COVID pandemic makes in-person meetings problematic, Hynes will meet virtually with participant groups. This means the groups can be formed across communities from a broad area.

  • Recruitment for the SMART goals study is expected to begin in early 2022.

Older Adult Self-Efficacy Survey

As a first step, Hynes is conducting a survey that will help better understand how older adults in Ontario use the Internet for health information and for communication, and how they want to learn new information. She’s surveying older adults from across Ontario. As a long-time community health centre client, Hynes is particularly keen to hear from clients of CHCs and other Alliance member agencies, and to recruit participants from this group. She hopes to work with a cohort of participants who reflect the ethno-cultural, racial, sexual, and gender diversity of the Alliance’s client base. The results of the survey will be written up as a standalone report. That report will be submitted for publication and shared with Alliance members and partner organizations, who may find it helpful as they conduct their own research or develop programs for older adults.

  • If your organization works with older adults, please share the Information Page and the link to the Survey with them. The survey is anonymous, but those who take it will have the option to provide contact information – on a separate form – to enter a draw and/or receive a summary of the study report when it is completed.

Need More Information?

For more information about the survey or the SMART goals study, please email Mary.Hynes@mail.UToronto.ca. Due to funding limitations, the survey and goal-setting groups will be conducted only in English.
Making the (Business) Case:
Measuring the Economic Value of Nature-Based Infrastructure
Our members’ commitment to health equity means we need to participate meaningfully in climate-change mitigation and adaptation. Nature-based solutions, such as green infrastructure, can play an important role in this, and these present opportunities for local advocacy and action by our members and community partners.

The Greenbelt Foundation and a multi-sectoral network of partners have developed a new tool that can help identify the specific improvements to health outcomes that will result from a green infrastructure project and then value these improvements in fiscal terms by considering avoided health care costs and loss of productivity.
Describing the benefits of green infrastructure project in financial terms may seem counterintuitive, but it can help communicate their value to policy-makers and funders, who are often concerned with the bottom line.

Thomas Bowers, Senior Manager of Research and Policy at the Greenbelt Foundation, notes that the evidence connecting greenspace investments to health outcomes is strongest in three areas:
  1. Physical health improvements associated with higher levels of physical activity.
  2. Mental health improvements associated with spending time in nature.
  3. Health improvements associated with reduced exposure to air pollution and extreme heat.

Bowers shared two examples with EPIC of how this framework has already helped advance green infrastructure in Ontario communities.
Improving the Tree Canopy in Brampton

In 2016, Brampton experienced 38 very hot days, and this number is expected to rise to 62 by 2080. Very hot days are considered to be over 30 C in Southern Ontario, but heat can affect health at around 26 C. In 2019, the Peel Climate Change Partnership (PCCP) identified some high-priority neighbourhoods that were vulnerable to health impacts from such hot days. They then worked with the Greenbelt Foundation and a team from Ryerson University to assess how increasing the urban tree canopy could reduce the heat vulnerability of these vulnerable communities.

The group found that that an 80% increase in tree canopy could almost half the number of very hot days in Brampton and prevent 34 very hot days by 2080. This would result in health system savings of between $2.5 million and $3.2 million. The PCCP was recently awarded nearly $3/4 million in federal grant funding to start implementing the tree planting strategy.
A New Park for Downtown Peterborough

A new, 1.1-acre park is being constructed in Peterborough, on a site that used to be a parking lot. When completed, the park will provide an urban greenspace alongside a variety of amenities for residents and visitors in downtown Peterborough. The budget for the project is over $6.3 million. Using the valuation, it was determined that the resulting health-system savings will amount to $4.2 million annually. The health return on investment will thus pay back the development cost in 1.5 years.
What's Next?

As with all pilot projects, the valuations aren’t perfect. The datasets and models used for this project are being improved by teams from Ryerson and Waterloo Universities. However, they area already able to capture a lot of valuable information to support advocacy for green infrastructure projects. This information may be particularly helpful in times of fiscal restraint, or when working with governments who are motivated by economic concerns. This makes these tools a significant step in the right direction.

If you are interested in using the EcoHealth conceptual framework, please contact Tom Bowers at the Greenbelt Foundation.
Upcoming Learning Events & Programs
September

September 29 - Lunch 'n' Learn Webinar: Health Promotion in Community Primary Health Care. Join us for an exploration of what health promotion looks like in practice and how it contributes to making our model of primary healthcare unique and effective.
  • What is health promotion, how does it contribute to primary health care?
  • What role has health promotion played in our sector’s response to the COVID-19 pandemic?
  • How can health promotion help your organization improve community and population health?
12:00-1:30 pm. Register here or contact us for more information.

October

October 5 - TOPHC Risk Communications Workshop. This workshop will focus on risk communication and community engagement (RCCE) as an essential public health function in health emergency preparedness and response planning. Presented by the Public Health Ontario's Ontario Public Health Convention (TOPHC) $59.60, 10 am - 12 pm. Registration & information here.

October 5 - TOPHC Indigenous Cultural Safety Workshop. Topics covered will include the nuances between cultural safety and interrelated terms, such as cultural competency, and will showcase examples of real-life contexts for both employees in health care settings and patients. Presented by TOPHC and the Indigenous Primary Health Care Council. $59.60. 10 am - 12 pm. Registration & information here.

October 5-7 - The Fourth International Housing First Conference: Knowledge Mobilization of Evidence-Based Housing First Practice. Share and learn about evidence-based practices and adaptations of the Pathways Housing First model. Registration i$50, less for people with lived experience of mental health challenges, substance use, or homelessness. Bilingual, virtual. Learn more here or register here. (Information and registration also available in French).

October 6 - Arts for Mental Health Conference. Mass Culture and the Mississauga Arts Council are hosting a one-day virtual conference on October 6, where health care providers and arts sector leaders will explore the business case for a pilot program to deliver and expand arts programs to people living with mental health issues. Online, free. Register here.

October 7 - Inaugural guest presentation from the National Safer Supply Community of Practice: Uprooting Medical Violence: How to build an Anti-Oppressive Practice in Safer Supply Programs Dr. Nanky Rai, an experienced safer-supply prescriber, will share insights drawn from her formal training in public health, her practice as a family physician, and her experience working with diverse marginalized communities. Thursday, October 7, 12-1:30 pm. Register here.

October 15 - Trillium Primary Health Care Research Day: This year's Martin Bass Lecture by Dr. Gina Agarwal is about Community Paramedicine, Primary Care, and the Pandemic. The panel discussion with Dr. Bridget Ryan, Dr. Tara Kiran, and Dr. Rachel Ashcroft explores Equity and Access to virtual Care during the Pandemic. Save-the-date flyer here. Abstract submission open until October 1. Registration opening soon.

October 19-21 - Conference on Transforming Care: Supporting Older Adults Post-COVID in Ontario.Topics include virtual care, collaborations with community support services, and aging at home. Online, free. Learn more and register here

October 27-28 - AFHTO 2021 Conference: Post-Pandemic Primary Care: Respond, Recover, Rebuild. Explore themes related to health equity, the opioid crisis, artificial intelligence in primary care, and building resilience within healthcare teams. Early bird registration fees of $55 for a single day or $80 for the full conference available until October 20. Discounts available for students and patients for whom registration fees would be a barrier to participation. Register here.

Ongoing

Interactive Online Medical Education from ECHO at UHN: Check out their latest offerings here. Participants can earn CPD credits and present their client cases for peer support.

Improving early palliative care in primary healthcare teams. The CAPACITI program (Project ECHO) provides three 6-week training modules for primary care teams Apply by August 19 for first session (begins November 10; more scheduled through 2021, 2022, and early 2023. Visit the CAPACITI website to learn more and sign up your team

Build your team’s capacity for evidence-informed decision-making. The National Collaborating Centre for Methods and Tools is offering free online modules, and an in-depth knowledge broker mentoring program. Learn more here.

Doing research and need help designing your end-of-grant KT plan? Consider registering for this self-paced online course from the KT program at St. Michael’s hospital. Enroll whenever it is convenient and get access to the materials for two months. Email Meghan Storey for more information.
Research & Sharing Opportunities
Networking and Collaborative Learning

SPIDER Learning Collaborative: De-prescribing dangerous medications. Can data-driven QI activities help de-prescribe potentially harmful medications, such as Benzodiazepines, for medically complex senior clients? Help answer this question and improve health outcomes for your clients by participating in a 12-month learning collaborative, starting this fall. EMR queries will be provided to help participating Alliance members identify clients who would benefit. Contact Jennifer Rayner for more information.

September 23 - Kickoff of Adverse Childhood Experiences (ACEs) and Resilience Community of Practice: Register now to join the kick-off meeting of the ACES and Resilience CoP on September at 12:00. This CoP is for anyone who wants to:
  • Understand the impact of adverse and positive childhood experiences on health and wellbeing
  • Improve outcomes for clients who have experienced ACEs
  • Build resilience by creating positive childhood experiences (PCEs)
  • Team up with like-minded peers in to develop best practices for ACEs and PCEs.
  • Build your capacity for local, inter-sectoral work for a more resilient community.
  • Support peers who are new to ACEs- and PCEs-informed practice.
This kick-off is your chance to meet like-minded peers, get a first look at the CoP, and let us know your goals and what kinds of support would best help you achieve them. For more information, please contact Kate Vsetula or Wendy Vuyk.

Calls for Abstracts & Papers

Deadline October 1 - Submit your abstract: Virtual Trillium 2021. Posters and oral presentations wanted for the virtual Trillium Primary Health Care Research Day happening on October 15. Find the abstract submission guidelines and instructions here.

Deadline October 15 - Call for abstracts now open for ICIC22 in 2022: Abstract submissions are now open for the 22nd International Conference on Integrated Care in May 2022. Hybrid virtual/in-person from Odense, Denmark, May 23-25, 2022.

Feedback Wanted

Ontario Health wants to know what you think of the quality standards (QS) placemats. They’re looking for clinicians willing to review and use any of the QS Placemats for approximately 2 weeks, and then complete a short survey to provide feedback on the how useful you found them. If you are interested in participating or have any questions, please email Jorge Ginieniewicz.  

Study Participants Wanted

Can collecting demographic and social needs data improve Canadian health care? A team from Upstream Labs and Unity Health are looking for community members aged 18+ to share their thoughts about health centres routinely collecting this data. Eligible participants will complete two surveys and an interview in a single online session lasting 60-90 minutes. Contact sparkproject@unityhealth.to or call 467-778-1707 to learn more. Recruitment poster here.

What are the experiences, beliefs, and impacts of gender-based violence on migrant and refugee women in Canada? What are their experiences with service providers? This CIHR-funded study out of Saint Mary’s University, Halifax, is exploring these questions through qualitative interviews. Compensation will be provided. See recruitment poster in English and French. Contact Mia Sisic for more information or to refer a potential participant.

Pregnancy-planning clients wanted for a study on delivering preconception care. HeLTI Canada are exploring whether technology-based care provided by specially-trained public health nurses can help people improve their health and health behaviours through preconception, pregnancy, and early childhood. Clients and clinicians can learn more at www.helticanada.ca.

If you are a primary care pharmacist, researchers want to hear from you! A study from the University of Toronto is examining primary care team pharmacist contributions to patient mental health care and pharmacists' experiences with collaboration during the COVID-19 pandemic. The 15- to 20-minute online survey includes a mix of multiple choice and open response questions.
New Tools and Resources
Funding and Awards

Ted Freedman Award for Innovation in Health Education (Longwoods): Open to all healthcare organizations that inspire, advocate, and enable education in health, health services, and healthcare management. If your organization has an education or knowledge-sharing program, consider applying. Deadline to apply is Friday, October 22.

Published Studies

Better Virtual Care for Adults with Intellectual and Developmental Disabilities. This scoping review by Jennifer Rayner and research partners explores what is known about virtual health care for adults with IDD and the impact on this population of shifting to virtual care..

New Black-led research paper on increasing COVID-19 Vaccination. A research team of Black women clinicians, researchers, and health leaders from the University of Toronto, Women's College Hospital, Black Creek CHC and TAIBU CHC have just published an article in CMAJ summarizing key barriers to and enablers of vaccine confidence in Black communities.

How do social connections impact our wellbeing as individuals? The GenWell Project and the Social Bubble Project conducted a Canadian Social Connection Survey (CSCS) with over 3,500 participants of people in Canada. The results indicate a need to address social isolation and chronic loneliness to help recover from the COVID-19 pandemic.

Does Toronto Public Health emphasize indoor air quality in its public COVID-19 advice to congregate settings?  This review by MAP Urban Health Solutions finds the 2021 Toronto Public Health Congregate Living Settings Toolkit lacking in this area.. Read the full report here., For more information about the report, email Amy Katz at Unity Health.

Clinical Guidance & Tools

The Cold Standard: Using Antibiotics Wisely in the Era of COVID-19 and Virtual Care. This toolkit from Choosing Wisely Canada provides practical recommendations about when a patient with a respiratory infection should be assessed in-person and when they should be prescribed antibiotics.

Support for Self-Management of Diabetes: Kingston CHC has funded the development of a tool that puts a copy of an individual’s self-management plan in their own hands. If you are interested in knowing more and having access to the finished tool, please contact Brian Stutt at The Knowledge Pool.

New Person-Centred Virtual Cancer Care Clinical Guidance is now available. Informed by the principles of person-centered care, recommendations were created to guide clinicians, including primary care teams, in caring for cancer patients and their care partners. Please read and share this guidance with any relevant stakeholders. Any questions can be directed to Naomi Peek.

Community & Population Health Data

Vital Signs are community wellbeing reports produced for the public by Community Foundations of Canada, using intersectoral datasets on 70 quality-of-life indicators. Here are two recent examples:

Updates to the Ontario Community Health Profiles: New information now available on cancer screening in numerous communities at the LHIN, sub-region, and neighbourhood levels for 2018-2020. This can help with planning at the organization and OHT levels.

COVID-19 Datasets: An interactive table showing the availability of linkable COVID-19 related datasets (lab testing, vaccination, and surveillance) at HDRN Canada’s member organizations is now live. The table also shows a list of field areas that may be contained in data sets related to COVID-19, and indicates the availability of those field areas in each province/territory. Learn more

The impact of COVID-19 on Canada’s healthcare systems. CIHI has released new data highlighting the impact of COVID-19 on Canada’s health care systems (March –Dec 2020). This update includes new data on hospital services, emergency department services and physician services.

Reading

Linkages September Newsletter: If you work with older adults, you may want to check out Linkages, the monthly newsletter of the Centre for Aging and Health. This month’s issue features a spotlight on dementia. As always, it includes a reading list, blog post, and lists of events and opportunities.
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