Issue14| February 9, 2022
Monthly Bulletin of the Alliance's Learning Health System
Measuring the Benefits of Safer Opioid Supply
Advancing Vaccine Equity
Compassion and a Healthy End of Life
Learning Events & Programs
Get Involved: Research & Sharing
New Tools &
Measuring the Impact of Safer Supply
Preliminary Report from LIHC Demonstrates Benefits
Imagine you’re a person who uses drugs, who is experiencing homelessness, who has irregular employment and whose relationships with family and friends are strained – in short, a person in an unstable environment who is at high risk of overdose.  

Imagine also that you live in London, Ontario and are a client of the London Intercommunity Health Centre (LIHC), which has a Safer Opioid Supply (SOS) program. They have just accepted you as a client. Now, instead of needing to rely on street drugs, you get your opioids prescribed to you by LIHC’s interdisciplinary team. You don’t need to wonder how strong the drugs are, what they might be contaminated with, or when you can next find them.

Prescribed opioids lower your overdose risk immensely – and provide stability. With that in place, now you have time and energy for other things. Perhaps you can take care of other health issues or strengthen your relationships with friends and family.

You don’t have to think, ‘Okay, I have to go sell this, to go do that, or go do this to get that’. You know it’s gonna be there [your prescription] at 8 o’clock when the pharmacy opens.


Indeed, these are some of the findings of LIHC’s SOS Program preliminary evaluation report, released last week. LIHC began the SOS program in 2016. They offered it initially to people who physicians believed were at high risk of imminent death due to unmanaged health conditions such as infective endocarditis and untreated HIV, and to those who were having difficulty engaging with the health system because their drug use could not be accommodated within a traditional healthcare model. Importantly, the SOS program is embedded in a community health centre where clients can access low-barrier, comprehensive primary health care. Every SOS client becomes a family practice patient and thus can receive wrap-around harm reduction services and primary care as part of the SOS program model.

As the program slowly expanded, LIHC decided that the SOS program would focus on harm reduction as the guiding philosophy of care, and that the program would be firmly rooted in the voices of people who use drugs and developed with their guidance.

Health Canada funding as of March 2020 allowed the SOS program to be scaled up. In a spirit of ongoing learning and quality improvement, LIHC began an evaluation to look at what was working well and what could be improved.

The story the report tells is one of benefits and frustrations for individual clients, and of challenges at both the program and systemic levels. Demand for SOS is high and the drug poisoning crisis continues to escalate. LIHC’s learnings and recommendations can usefully inform our actions as we scale up SOS programs.

The report and a summary webinar recording are available online at the National Safer Supply Community of Practice website. This report and infographic about how the COVID-19 pandemic has exacerbated the ongoing opioid overdose crisis, leading to drastic increases in substance-related illness and death, shows that accessible SOS and harm reduction are are more essential than ever.
Vax for the Future: Equity, Community, and Trust
Understanding key enablers of vaccine uptake in priority populations
On January 26, the Alliance brought together primary care providers, health system leaders, policy influencers, and others for Vax to the Future: Equity, Community and Trust

This virtual event examined how community-based primary healthcare organizations are responding to the deep-rooted social and health inequities which present barriers to some people in accessing necessary health information and services, including COVID-19 vaccinations.
Panelists described their innovative practices, discussed barriers and facilitators, and shared lessons they learned as they worked to increase vaccine confidence and uptake. Participants were provided with strategies for the current pandemic as well as for future immunization campaigns and health care services.

The following key enablers were identified for effectively promoting promoting vaccine uptake in priority populations:

  • Establish and build on trusted relationships within the community, and leverage existing community relationship strengths (e.g. hiring from the community, volunteer networks, etc.).

  • Be creative, collaborative and nimble when addressing vaccination barriers as the pandemic has evolved. Having linguistic and culturally appropriate staff dedicated to community outreach, collaboration across health/social systems partners, and targeting supports to specific populations were all recommended interventions.

  • Sustain investments, resources and support for grassroots needs-based approaches. Ensure responses are consistent and make testing, or additional information, widely available.

Alliance members have longstanding relationships of trust with their communities. By building on this foundation, they were able to forge new partnerships, develop ambassador networks, and implement new community programs without starting from scratch. The lessons learned from this work in communities across Ontario must endure beyond the pandemic. Robust investments in community-led strategies can help sustain and expand relationships of trust between the health system and marginalized populations. This can help reduce the inequities that leader to poor health outcomes.

To learn more, check out the slide deck and recording of the Vax to the Future Event. Note that while it featured predominately English-speaking presenters; a recording with French-language interpretation is available here.

You may also want to to check out this poster and audio narrative. Sonia Hsiung, Project Lead at the Alliance for Healthier Communities, presented key lessons from community-led vaccination activities within the Alliance membership at the Immunizing Children With Confidence virtual pop-event hosted by Children's Healthcare Canada, on January 27.

For more resources on vaccine promotion, check out the Alliance’s Resource Library and this infographic from the Indigenous Primary Healthcare Council (IPHCC) about an Indigenous-led project that engaged youth as vaccine ambassadors in their communities.
The Vax To The Future virtual event and the vaccine outreach efforts highlighted were supported by funding from the Public Health Agency of Canada (PHAC)’s Immunization Partnership Fund (IPF) as part of Alliance for Healthier Communities’ Community Vaccination Promotion – Ontario (CVP-ON) project.
HELP for Better Wellbeing at the End of Life
Supporting a Community to Respond With Compassion
What do health and wellbeing look like at the end of life, or during a life-changing transition such as the onset of chronic physical or mental illness, frailty, old age, or bereavement? How does a healthy community support people through such transitions, and what happens when we start to see the end of life as a normal part of life?

The Compassionate Cities movement is a worldwide, volunteer-driven movement empowering communities to embrace illness, disability, end of life, and grieving, and to support community members who are experiencing these things. Within this movement, Compassionate Ottawa is working with researchers at Carleton University to develop a Canadian version of the Healthy End of Life Project (HELP) developed by researchers at LaTrobe University in Australia. EPIC News spoke with Pam Grassau, Assistant Professor of the School of Social Work at Carleton University in Ottawa, and one of the HELP Ottawa project leads. She shared an overview of the project’s goals and its journey towards them.

The HELP Ottawa research project began in September 2019. The project has four phases:

  • Phase 1 was completed in December 2019. During this phase, pilot HELP projects were established at 4 sites: Centretown Community Health Centre (CHC), South-East Ottawa CHC, Orleans United Church, and Christ Church Bells Corners. These four organizations represent a mix of urban and suburban communities and have a total of nearly 300,000 people in their catchment areas.

  • Phase 2 was completed in September 2020. During this phase, baseline data was collected and analyzed to advance an understanding of the needs, assets, and goals of each site and its community.

  • Phase 3 began in September 2020 and will be completed in August of 2022. During this phase, the researchers will create asset maps for each community and they will develop, implement, and iteratively improve on programs that are tailored to each community’s assets and needs. These include resources, events, workshops, and peer support groups.

  • Phase 4 is running concurrently with Phase 3. During this phase, the researchers will continuously evaluate the programs, measure impacts, and compare what works well in each of the four sites. Conducting Phases 3 and 4 at the same time means that what is learned through the ongoing evaluation activities will inform ongoing program improvements. Another essential part of this phase is sharing what has been learned through publications, conference and community presentations.

Sustainability is essential to HELP Ottawa’s mission and is a key element of community-based participatory action research. Although HELP Ottawa was established with a grant from the Mach-Gaensslen Foundation of Canada, its goal is to build capacity and systems so the work can continue long after the grant and research activities have ended. Each site has an advisory council which is co-designing a workplan with the research leads, and these workplans will guide the sites as they develop, implement, monitor, and evaluate future initiatives. This co-design process ensures that each initiative in the workplan is aligned each site’s existing mission, vision, and strategic plan; site-specific HELP goals; and HELP Ottawa’s overarching objectives.

This slide deck provides a detailed overview of the project, including examples of the initiatives that have been put into practice so far as well as more information about the ongoing evaluation and knowledge-sharing elements of the project. Currently, the HELP team is collecting and analyzing mid-point data to understand how it has impacted individual, site, and community capacity for compassionate support. Watch EPIC News for updates to come!
Licensed for use through Creative Commons (PDM 1.0).
Learning Events & Programs

February 22, 12:00-1:30 pm - Webinar: Equitable and age-friendly communities. This webinar is presented by the National Collaborating Centre for Determinants of Health. Free. More information here. Register here.

February 25, 9:30am – 3:30pm – RHO 2022 Symposium: LGBT2SQ Health in Focus. This online event features panels on topics related to 2SLGBTQ+ health: Relationships with food and disrupted eating behaviours; equity and respect in health for LGBTT2SQ seniors; transition-related surgeries – post-operative complications in primary health care. $10. Physicians can earn up to 4.5 Mainpro+ CME credits. Panel descriptions and panelist bios here. Register here.

February 28, 12:00pm - MyPractice Primary Care Report: Cancer Screening. Join Ontario Health to learn about the MyPractice: Primary Care Report. This 1-credit-per-hour Group Learning program has been certified by the College of Family Physicians of Canada and the Ontario Chapter for up to 1.0 Mainpro+Ⓡ credits. Full description here.


March 1-3 – National Newcomer Navigation Network (N4) conference | The Past is Practice: intersectoral lessons learned from the dual pandemics of COVID-19 and systemic racism. This event will provide attendees the tools to close the equity gaps faced by marginalized communities and contribute towards their mission to optimize the wellbeing and success of our newcomers.  Supported by a grant from Immigration, Refugees, and Citizenship Canada (IRCC). Register here for free.


Governing for Health Equity Training. This five-part, online course was created by the Alliance to help boards go beyond diversity and inclusion, and build organizations that are better equipped to advance health equity at every level in the organization, the community, and the health system. Self-paced. Discounts for Alliance members and health equity builders. Register here.

BETTER Prevention Practitioner Training Institute: Prevention Practitioners are interprofessional primary care team members who support clients in taking actions to reduce their risk of cancer and chronic disease. Training for BETTER Prevention Practitioners is available to Alliance members on a cost-recovery basis. See the prospectus and website for more details, or email Carolina Fernandes.
website to learn more and sign up your team.
Research & Sharing Opportunities
Open Calls for Abstracts

Deadline March 1Public Health 2022 (June 14-16). This virtual conference is hosted by the Canadian Public Health Association. Attendees come together to learn, exchange knowledge, and advocate for policies to improve health and wellbeing. The call for submissions is open now until March 1. See the 36 conference keywords here.

Networking and Collaborative Learning
CAPACITI, a program designed to support primary care teams to provide early palliative care is now accepting registrations for Cohort 2, beginning in April 2022. Presented in partnership with Pallium Canada's Project ECHO. Register by March 15. Curious? Attend the informational webinar on February 24.

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

Study Participants & Stories Wanted

Seeking people who have been impacted by long COVID. Researchers from the Bruyère Research Institute (Ottawa) and St. Michael’s Hospital (Toronto) are studying the effects of long COVID, how it impacts health equity, and what policymakers can do to prevent and manage it. People who have long COVID, think they might have it, are a caregiver to someone who has it, or are part of a community that has been impacted are invited to join their Advisory Committee. Participants will be compensated. See the recruitment flyer here for more information about the study and how to participate.

Has your organization been involved in new, cross-sectoral initiatives for newcomers in the context of COVID-19? Tell us about them! Researchers from the University of Toronto, University of Montreal, Access Alliance, and Crossroads Clinic are collecting information about cross-sectoral work that emerged in Ontario during the pandemic to continue serving vulnerable newcomers. Submit your examples here. Find more information about this CIHR-funded project here.

Tailored messages about COVID-19 vaccines for your hesitant clients: The Canadian Primary Care Information Network (CPIN) is looking for physicians and NPs to participate in a study that will use the CPIN platform to communicate with clients who feel hesitant about the COVID-19 vaccines. Participating providers will receive CPIN services free for one year and will be compensated for their time. For more information, see the research flyer (English and French) or email the study team.

Share your experiences working with uninsured migrants. Researchers want to hear from health care providers who have experience providing health care services to uninsured migrants. What they learn will inform policy recommendations and will be shared through community events. Confidential interviews will be conducted over Zoom. Email Melissa Anderson to participate or learn more.

Clients who are planning a pregnancy are invited to participate in a randomized controlled trial of a new initiative that may help them improve their health and health-seeking behaviour. The Healthy Life Trajectory Initiative (HeLTi) Canada study is part of a global project evaluating the effectiveness of technology-based care provided by specially-trained public health nurses. Visit HeLTI Canada's website to learn more, or follow @HeLTICanada on social media.
New Tools and Resources
Fellowships and Awards

Health science mentorship for high school students from marginalized groups: The Centre for Wise Practices in Indigenous Health is currently accepting applications for its Summer Student Research Opportunities program for people who identify as Black, Indigenous, racialized, gender diverse, or as persons with a disability. Participants receive first-hand health research experience and access to seminars, panel discussions and networking events. Apply here by March 1.

Guidance & Tools to Support Quality Improvement

Support for your collaborative quality improvement plans: The Alliance hosted a special Lunch 'n' Learn webinar on January 18 to help primary care teams better understand Collaborative Quality Improvement Plans (cQIP) and start planning theirs for 2022/23. Check out the recording and slide deck here along with links to the guidance document and technical specifications, a cQIPs community of practice, and other helpful resources from Ontario Health. More Ontario Health resources for quality improvement in primary care are available here.

  • Now available: Primary Care Data Reports for OHTs
  • Coming soon: more cancer prevention indicators, mental health emergency department visits, addiction-related emergency department visits

Hearing the Voices of Queer Black Men: Sex With Me: Conversation with Black Gay Men about Sexual Health is a video project from the Gay Men's Sexual Health Alliance. If consists of three short videos, each featuring a Gay Black man sharing his lived experience accessing healthcare and health information.

Resources for advancing Black health in Ontario: The Black Health Alliance's Knowledge Hub includes reports on Black health and wellbeing and Black experiences with the health system, developed in partnership with Black community members and leaders in our sector. Statistics gathered on this page are a reminder of the health inequities experienced by Black people in Ontario and the urgency of addressing them.

Equity, Governance, Access, and Protection (EGAP) is data governance framework developed by the Black Health Equity Working Group to address Black communities' concerns about how race-based data was being collected and used during the pandemic. As we prepare to move beyond the crisis phase of the pandemic and focus as a sector on meaningfully collecting and using sociodemographic data, the EGAP framework remains a vital resource. Download it here in English or French. If you're interested in connecting with the Black Health Equity Working Group, you can reach out to them by email here.

Recently Published Research

Article - Exploring the perspectives of healthcare providers that care for non-insured individuals utilizing emergency departments in Toronto. Non-insured individuals have different healthcare needs from the general Canadian population and face unique barriers when accessing emergency department (ED) care. This qualitative study aims to better understand the system of emergency care for non-insured individuals from the perspective of healthcare providers.

Report - Health of Canadians in a Changing Climate: Advancing our Knowledge for Action. The chapters in this report discuss relevant findings from the scientific literature on priority health risks related to climate change and on adaptation options for protecting health. It includes quantitative projections of future health risks from climate change; analysis of the interplay between climate change and important determinants of health, which can affect adaptive capacity and health equity to influence vulnerability to health impacts; and a separate chapter on climate change impacts on Indigenous Peoples’ health as well as information on on these impacts throughout the full report. All chapters include illustrative case studies of actions being undertaken by health authorities to reduce risks to Canadians from climate change.

Preprint Article - Systematically omitting indoor air quality: sub-standard guidance for shelters, group homes and long-term care during the COVID-19 pandemic.  This article examines the guidance provided by Public Health Ontario (PHO) about air quality for congregate settings, comparing them to the guidelines for schools, camps, and doctor's offices. The researchers conclude that PHO has provided sub-standard COVID-19 guidance to long-term care and congregate settings, putting workers and residents at greater risk of illness and death, and exacerbating health inequities in Ontario. For more about indoor air quality, see this webinar and related resources from July 2021. Watch EPIC News for

Opinion - The Quintuple Aim for Health Care Improvement: A New Imperative to Advance Health Equity. This "Viewpoint" article was published in the CMAJ Newsletter. It argues that quality improvement is meaningless - and potentially harmful - if there's no focus on disparity reduction. This supplement provides examples of equity-focused quality improvement initiatives.

Report - Evaluation of the Safer Supply at London Intercommunity Health Centre (see article above). This report provides clear evidence that safer supply prescriptions, provided in a comprehensive primary healthcare setting, can save lives and help people who use drugs have better health outcomes. See the summary report, full preliminary report, and webinar presentation here.

Report - Patterns of medication and healthcare use among people who died of an opioid-related toxicity during the COVID-19 pandemic in Ontario. This report, prepared for the Ontario Drug Policy Research Network, describes the characteristics and health journeys of people who died of an accidental opioid-related toxicity in Ontario prior to the pandemic and during the first two waves of the pandemic. See the key findings presented as an infographic here.

Article - Conceptualizing success factors for patient engagement in patient medical homes: a cross-sectional survey. This paper from the Alliance and research partners was based on surveys of primary care leaders across Ontario, including Alliance members. It explores the relationships between structures (including organizational culture, and policies), processes (engagement, knowledge-sharing, and knowledge-use), and outcomes. It finds that processes directly impact outcomes, while structures indirectly affect outcomes by directly impacting processes.
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