Issue 20 | November 28, 2022
Monthly Bulletin of the Alliance's Learning Health System
Country Food and Wellbeing
Clinical Engagement at SP Conference
Social Prescribing at FMF
Guidance for Virtual Care
Fall Prevention
at Compass CHC
Learning Events & Programs
Get Involved: Research & Sharing
New Tools &
Country Food: A Key Ingredient for Wellbeing
by Crystal Tunnillie
My name is Crystal Tunnillie, and I am studying social work at Carleton University, with a double minor in Indigenous studies and women and gender studies. As an Inuk, Country food is important to me because it brings Inuit together, and it makes us feel connected to one another and to our culture. Country food nourishes our bodies and souls. As part of my student placement with the Alliance, I’m sharing some of my knowledge of Country food with you. I hope that this knowledge will help you understand the importance of Country food to Inuit and our culture.
Inuit communities have traditionally had to rely on one another to get through the harsh winters and realities of living in the Arctic. One of the ways they get through this together is by hunting and harvesting animals together, working as a collective to feed their community. Throughout the year, groups of hunters go out and hunt for whales, seals, and caribou; to fish; and to pick berries. What they harvest this way is known as country food. Country food is full of good fats and nutrition that give us energy and vitamins to keep us healthy.
There are different roles that individuals play in this process. Preparation is a key part of this process. When you go out on the land, you have to make sure you have the right equipment and that it is working properly, bring more than enough supplies just in case of emergency, and always tell someone where you are planning to go and a rough idea of when you are planning to return. There are guides who know the way to the hunting grounds. Usually, this is the most experienced hunter. The women and other members of the community help harvest and distribute the catch. Traditionally, women would be given the furs of the animals to make clothing for their families and community members. A young hunter's first catch is cause for celebration, and the community makes sure to honour that. 
Inuit are taught from a young age to have respect for the land and animals. Hunting is a great time for elders and knowledge-holders of the community to pass on this knowledge in a hands-on way. Inuit have lived alongside these animals since time immemorial, learning and studying their movements and behaviours. One way that Inuit respect the animals is to not hunt the first herd, because those are the older members of the species, who know where the feeding and breeding grounds are. Inuit respect this and leave them so they can teach the younger animals where to go. 

Country food is a way to bring families and community members together. Families will often invite other families over to eat together. Community feasts are also very popular, as they bring people together. Also because of strong community values, it is expected that whatever is brought back from hunting or fishing is shared with the whole community, especially people who are unable to hunt for themselves. 

When we consider Inuit Qaujimajatuqanit Principles (what Inuit have known to be true since time and immemorial), we see that country food supports several principles including:

  • ᐃᓅᖃᑎᒌᑦᓯᐊᕐᓂᖅ - Inuuqatigiitsiarniq: Respecting others, relationships and caring for people

  • ᐱᔨᑦᓯᕐᓂᖅ - Pijitsirniq: Serving and providing for family and/or community

  • ᐱᓕᒻᒪᒃᓴᕐᓂᖅ - Pilimmaksarniq: Development of skills through observation, mentoring, practice, and effort

  • ᐃᑲᔪᖅᑎᒌᓐᓂᖅ - Ikajuqtigiinniq: Working together for a common cause

  • ᐊᕙᑎᑦᑎᓐᓂᒃ ᑲᒪᑦᓯᐊᕐᓂᖅ - Avatittinnik Kamatsiarniq: Respect and care for the land, animals and the environment.

Though Inuit would never use the term “social prescribing” to describe this, we can see how culturally safe & appropriate food can have a big impact on an individual’s physical health, mental health, and wellbeing. Getting together with our community to share and eat country food brings Inuit joy. It is in our nature to look after one another.

Inuit in the south can’t hunt for the kinds of animals they are used to, so their families or friends will send them country food through cargo. There are Inuit organizations that recognize how important it is for Inuit to have country food in their diet. Organizations like Tungasuvvingat Inuit distribute country food as part of their food security programs, and they provide country food at events and programs.

Individuals and organizations that want to learn more about country food and food security for Inuit must understand that preparing and accessing country food isn’t the same as it is with typical foods found in the south of Canada. Country food often has to be kept frozen, as Inuit like to eat our food such as Muktuk (whale), Tuktu (caribou), and arctic char frozen and raw. Having respect for the animals also means hunting according to their life cycles. For instance, we don’t hunt female caribou when they are carrying young. Due to the decrease in caribou numbers, there is a moratorium on hunting in parts of the Arctic and a tag system to manage hunting, which may cause delays in food availability. 

Special thank you to Billy Akavak, Food Security Manager at Tungasuvingat Inuit and Trudy Metcalfe- Coe, an Inuit chef from Nunatsiavut for providing the information for this article. 
Enjoying time on the land
Berry picking
Seal hunting
Images courtesy of Crystal Tunnillie.
Improving Clinical Engagement in Social Prescribing
Social Prescribing Conference Report
by Sasha Strong

The Alliance for Healthier Communities’ first Social Prescribing Conference took place on October 12. It featured an interview in the form of a fireside chat with three family physicians who are champions for social prescribing: Dr. Gary Bloch, Dr. Dominik Nowak, and Dr. Jennifer Lawson. Their conversation highlighted several key approaches around engaging other clinicians in Social Prescribing, which are outlined below.

Building up a set of resources. 

As Dr. Bloch says, “Social Prescribing is about having a social need and an intervention to deal with it.” When physicians have a general understanding of the programs and supports that exist within the community they practice in, it may improve their ability to make social prescriptions without the support of a social prescribing navigator.
Making the referral easy.

When clinicians are provided with multiple referral pathways, it improves their effectiveness and allows an easier process of connecting their patients with social programs. Dr. Nowak suggests that when healthcare systems are overwhelmed, an effective referral system may help physicians adopt Social Prescribing into their practice.
Asking questions beyond the scope of a traditional medical approach. 

A purely medical approach may lead to overlooked health risks and underlying causes of health issues. 
Dr. Nowak recalls an instance where he was able to link his patient’s worsening diabetes with a shift in the patient’s lifestyle: long caregiving hours for a sick family member. Rather than increasing his patient’s medical prescriptions, Nowak opted for a referral to community support programs. As a result, the patient's condition improved. Nowak notes: “I would have missed it had I not asked one or two extra questions…these are things that sometimes people don’t share if you take a purely medical approach”.
Exploring social factors that create or sustain adverse health outcomes may enable other clinicians to identify root causes and mobilize social support in their clinical practice.  
Normalizing Social Prescribing as a part of standard medical practice.

The physicians also suggest that reframing the expectations of clinical practice to include Social Prescribing may help to normalize the practice and engage more clinicians. In Dr. Bloch’s reflection on current healthcare infrastructure, he notes, “Physicians can become very tied into the structures that create and perpetuate inequities”. He suggests that policy-level change may facilitate the uptake of Social Prescribing in clinical care. 
Since adopting Social Prescribing in their own practices, the physicians reflected on the reciprocity of Social Prescribing. In practice, Social Prescribing extends beyond the patient by reducing the burden on the healthcare system and helping clinicians improve their capacity to help their patients. Dr. Nowak notes, “At the end of the day, Social Prescribing helps me be a better doctor.” 
Sasha Strong is a fourth-year student at Western University, studying Health Sciences with a focus on health promotion. Her passions in healthcare include Black maternal health and health equity. She is currently completing a student placement at the Alliance, supporting the Social Prescribing program. 
Image courtesy of Sasha Strong.
Advancing Social Prescribing in Family Medicine
Taking Centre Stage at the Family Medicine Forum
Supporting Clinicians with Practical Tools

Earlier this month, the Alliance’s Social Prescribing Lead, Natasha Beaudin, participated in a panel with intersectoral Social Prescribing at this year's Family Medicine Forum (FMF), a national conference hosted by the College of Family Physicians of Canada. The presentation, Addressing the Social Determinants in Primary Care through Social Prescribing was selected for both the in-person session on November 12 and the virtual session on November 17. 

At both sessions, Natasha was joined on the panel by Sonia Hsiung, Director of the Canadian Institute for Social Prescribing (CISP), and Dr. Dominik Nowak, a family physician and clinical champion for social prescribing from Toronto. The panel was rounded out at the in-person session by Dr. Gary Bloch from Toronto and Dr. Karin Kausky, from Whistler, BC, and at the virtual session by Dr. Lara Kent from Centretown CHC in Ottawa and Dr. Grace Park from Fraser Health Authority, BC.

Both sessions described how physicians can use and benefit from Social Prescribing to address social needs in a variety of clinical settings, whether as a solo practitioner, or as part of an interprofessional team such as a CHC or a FHT. The discussion was based on practical and experiential questions about what Social Prescribing looks like in the panelists’ practices, what advice they’d share with a new Social Prescriber, and what Social Prescriptions they’ve found most powerful. Hundreds of family doctors joined the conversations. Members of the FMF committee have since asked for this panel discussion be made a recurrent yearly part of core family medicine education at FMF.

Dr. Nowak also presented Social Prescribing as one of the Big Ideas at a “soap box” session, and FMF attendees voted it as one of the Top Two Big Ideas for shaping the future of family practice.

To further advance social prescribing in clinical practice, the Alliance and CISP have partnered with the Centre for Effective Practice to publish a new Social Prescribing Toolkit: A Resource for Health Professionals. This step-by-step guide and resource collection was produced by the Alliance and CISP in partnership with the Centre for Effective Practice. It was co-designed with clinicians to support primary health care providers and teams implementing Social Prescribing in their practices. The toolkit includes conversation prompts to help you advocate for social prescribing with colleagues and peers. 

Join our Social Prescribing Communities of Practice!

  • Canadian Social Prescribing Community of Practice meets quarterly, 12:30 p.m. EST on the second Tuesday of the month. Next meeting: Tuesday, January 10.

  • The Ontario Social Prescribing Community of Practice meets bimonthly, 1:00 pm, every third Thursday of the month. Next meeting: Thursday December 15.

Ontario Health’s New Virtual Care Guidance
Co-Designed by Patients & Clinicians 
Over the past year, Ontario Health has been developing virtual care guidance for primary care clinicians to help create clarity and support primary care clinicians to make decisions about how they plan and deliver virtual care to patients. The newly released guidance, Clinically Appropriate Use of Virtual Care for Primary Care (also available in French as Utilisation cliniquement appropriée des soins virtuels – Orientations pour les soins primaires) is Phase One of Ontario Health’s virtual care guidance materials for primary care.

This phase of the guidance will help ensure that the choice of modality for virtual care is deliberate, made by patients and clinicians together, and informed by evidence. It addresses questions about how to determine whether a virtual visit is appropriate for a particular appointment, and, if so, what modality is most suitable.

Normally, Ontario Health’s quality standards are built on robust scientific evidence. However, evidence about clinical appropriateness in virtual care is still emerging, and a great deal of it is anecdotal. Regulatory bodies are urging their members to exercise “clinical judgement.” Ontario Health recognized that guidance on this topic would need to draw heavily on the judgement of experts, so they convened a panel of 16 primary-care clinicians and 5 patient partners with clinical and lived-experience expertise, respectively. EPIC News spoke to two of the members about their work as panelists: Dr. Alykhan Abdulla, a family physician, and Jeanette Smith, a patient partner.

An essential role for patients in research is to ensure the wording of surveys and knowledge products is clear and accessible, and that it means the same thing to patients as it does to clinicians. Dr. Abdulla shares an example: A screening tool may include a question such as, “Do you feel light-headed?” To a clinician, it might seem to be unambiguously about dizziness, but to a patient from another culture, “light-headed” may mean “silly” or “stupid.” Ms. Smith and her fellow patients on Ontario Health’s expert panel flagged long words and complex sentences, and helped to rewrite them in plain English. She saw how the patients’ feedback sometimes sparked debate amongst clinicians, but these debates were always resolved with a change all could agree on. Seeing that process unfold gave her confidence that patients’ feedback was being taken to heart.

Another role of patient advisors is to identify opportunities to flag inequities and power imbalances. Ms. Smith shares that an earlier version of the guidance asked clinicians to ensure the patient was in a private, distraction-free setting for their virtual care appointment, yet there was no corresponding requirement for the clinician. As she notes, “Sometimes, there is no way of knowing where our doctor is during a call. It could be the supermarket!”

One of the great benefits of co-design, Dr. Abdulla says, is that it allows people with different values and experiences to understand each other. He speaks of having his eyes opened to barriers he has never experienced, such as not having access to a cell phone or living with a disability that makes medical appointments less accessible. He was surprised to discover that in spite of the barriers they experience, many patients want to receive more care virtually, finding it more convenient and accessible than travelling to an appointment. From the patient perspective, Ms. Smith speaks of her surprise learning about barriers faced by clinicians who want to expand virtual care but are hindered by issues like clinic infrastructure and workflow processes.

Dr. Abdulla is a passionate advocate for the role of patient advisors. He believes the inclusion of lived-experience expertise is central to developing high-quality research and care. “We live in a society where patients and physicians are in an increasingly dyadic relationship. The physician has a lot of information about science, and the patient has significant knowledge about their challenges, difficulties and goals.” As people become more informed and empowered, he says, they can make more decisions for themselves. “The old paternalism in the system is gone.”

Ms. Smith agrees, noting patients can make significant contributions to research and that their lived-experience and insights are increasingly valued. “We’re not just being patted on the back,” she says, “Researchers and clinicians are really listening.”
Ontario Health’s Clinically Appropriate Use of Virtual Care for Primary Care guidance document is now available for download from their website
Finding Balance at Compass CHC
Continuous Innovation in Fall Prevention Programming
November is Falls Prevention Month. In the last issue of EPIC News, we introduced our readers to the Loop and Loop Jr. Falls Prevention Communities of practice and some resources you could consider using to advance falls prevention work in your centre. This month, we are sharing the story of a falls prevention program at the Compass Community Health Centre (CCHC). We spoke to Gail Simpson, a physiotherapist (PT) with the CCHC Rehabilitation Team about their falls prevention program.

It began nine years ago with two programs: Sit and Fit, a bi-weekly, drop-in seated exercise program, run by a certified fitness instructor, and Finding your Balance, a 12-week registered educational and balance exercise program. Gail and several occupational therapist (OT) colleagues, most recently Maija Mckibbon, have facilitated Finding Your Balance, with a focus on helping older adults improve their strength, balance and awareness of falls prevention. Over the years, they have developed an interdisciplinary component, with many educational presentations from Compass dietitians, pharmacists, and nurses. The exercise component has also progressed, with optional additional standing balance challenges including dual task training, basic Tai Chi moves, stepping patterns, and yoga poses.

Over time, the safety of the program has been improved. A medical screening by the CCHC diabetes team is now included, which involves blood sugar and blood pressure checks, medication reconciliation, and more. Conversations with a vestibular therapist led to the addition of a dizziness screen. Outcomes are measured pre- and post-program through a Timed Up-and-Go (TUG) test, a four-stage balance test, and a falls risk self-assessment. 

The pandemic led to many more changes as in-person programming was put on hold. To ensure classes could continue safely without in-person support, Maija Mckibbon (OT) and Gail (PT) brought back the original Sit and Fit approach and created a virtual group. The online Sit and Fit classes are still offered, now on a drop-in basis (after initial phone-based health screening) and led by the same fitness instructor with 12-15 participants joining every week. To make the online classes as accessible as possible, participants receive an instructional video, as well as optional technical coaching from Maija over phone. Device-lending is also available through the CCHC’s health promotion program.

Over the past year, as restrictions have lifted, an in-person version of Finding Your Balance has resumed, enabling people at risk of falling to get much-needed standing balance exercise, screening, and social connection. The class has been shortened from twelve weeks to eight, allowing for greater turnaround as there is a lengthy waitlist. Another PT, Miriam Miedema, has joined the team to offer a two-tier exercise section, where participants do foundational or advanced balance exercises based on their initial outcome measures. The initial testing, conducted the first day in addition to the medical screening, determines which stream of exercise each participant will join. Facilitators assign homework each week so that participants can continue to work on their strengthening and balance at home.

As a result of shortening the class, the choice of educational components is now flexible. At the start of each course, participants choose from a range of options. Medication management is always a popular topic, as is managing the fear of falling and how to safely get up after a fall. Selecting and using mobility devices is sometimes chosen, depending on the needs of participants. Additionally, the team, spearheaded by Maija, have released a fall prevention toolkit as part of their Seniors Wellness suite of tools. The toolkit is given as a hard copy and instructions are given how to access this online.

At the end of the Finding Your Balance class, clients receive a certificate and advice on how to continue practicing their exercises. Most participants demonstrate significant improvement on the objective measures, with some being eligible to progress from the foundational to the advanced balance tier. Many have sent letters and testimonials describing how the program has helped them stay safely active. They also enjoy the opportunity for social connection – another protective factor against falls – and many stay in contact with their classmates after the course ends.

For Falls Prevention Month, CCHC held a falls prevention promotion session at their Seniors Kitchen, which included two short presentations about their programming, a self-assessment of falls risk, how to get up from a fall and resources about different community programs. 
Image courtesy of Compass Community Health Centre.
Learning Events & Programs


November 30, 7:45-8:45 am | Breakfast Webinar: Highlights and Implications of the Ontario Science Table's Brief on Primary Care. On October 3, 2022, the Ontario COVID-19 Science Advisory Table (OST) released its final brief, a 3-part exploration of how primary care responded to and was affected by the pandemic, and implications for ongoing health system planning and policy. In this webinar, you'll hear from a panel of primary health care experts who contributed to that brief. They'll discuss some of the most significant findings and implications of that report. More info here. Register here.


December 4-7. Institute for Healthcare improvement Forum 2022. This year's Forum will take place in Orlando, Florida. Registration is open now for in-person and online attendance.

December 6, 11:00am – 12:00pm | Webinar on Investing in the Future of Ontario’s Greenbelt: A blueprint for advancing conservation finance in Southern Ontario. The Greenbelt has long been a source of economic growth and prosperity and a source of health and well-being for local communities. New development pressures jeopardizing the ability of its ecosystems to continue supporting health and wellbeing. Join the Smart Prosperity Institute as they launch a new blueprint tool to attract necessary investments using a conservation finance approach. More details here. Register here. Questions? Email

December 7, 1:00-2:15 pm | Compassionate Ottawa's Conversations with Leaders presents Caregiving in Canada. This live virtual event will feature a conversation between Kelli Stajduhar, professor in the School of Nursing and Institute on Aging & Lifelong Health at the University of Victoria, and Janet Dunbrack, former Executive Director of the Canadian Hospice Palliative Care Association and an active volunteer with Compassionate Ottawa. They will talk about what is happening (or not) in Canada regarding caregiving and what role Compassionate Ottawa, and others, might play in tackling this ongoing and worrying crisis. There will be time for questions and comments following the discussion. Register Here.

December 8, 12:00-1:00 pm | Climate Conscious Inhaler Prescribing. Metered dose inhalers produce significant carbon emissions. Ironically, these contribute to changes to the climate that can exacerbate respiratory conditions. Simple practice changes can help disrupt this cycle and lessen the health sector's contributions to climate change.  This webinar will explore the carbon footprint of healthcare systems and how inhalers contribute to it and imagine practice change that results in an immediate reduction in emissions. Register here.

December 13, 12:00-1:00 pm | Lunch ‘n’ Learn: Introduction to the OHRS Benchmarking Report. On November 8, 2022, the Alliance released the CHC Benchmarking Report. This lunch & learn will provide an opportunity to review the report and its contents and answer any questions members may have as it relates to the functionality and the data included in the report. More information here. Register here.


Last Thursday of every month, January - April 2023, 1:00 -2 :30 pm | Monthly Webinar Series on Mobilizing to Promote Health and Well-Being for Older Adults. These webinars are hosted by Core Canada. Register here for all upcoming sessions.
Research & Sharing Opportunities
Research Partners Needed

Primary care clinicians needed: Help guide comparative research about the care and outcomes in different PC models for people living with dementia. A research team from Arizona State University and Dalla Lana school of Public Health want to understand what enables effective communication and diagnoses with primary care clients who have mild cognitive impairment (MCI) or early-stage Alzheimer disease or related dementia (ADRD). They're comparing different models in Ontario, Arizona, and New York State. Interested? Consider joining the project's steering committee. For more information, please email Allie Peckham email Allie Peckham at Arizona State University.

Clinical Trials and Participatory Research

Research opportunity for Alliance member organizations: Goal-oriented care in Community Health Centres. A research team at the Lunenfeld-Tanenbaum Research Institute is recruiting primary health care teams (6-8 clinicians and interprofessional providers) from four CHCs to participate in this study. If you are familiar with goal-oriented care and have either used this approach or are willing to try it, you can help them understand how it’s implemented in a real-world setting. They’ll use what they learn to make the model more accessible and feasible. Participants will be asked to reflect on their experiences with goal-oriented care in interviews. Check out the infosheet or email Carolyn Steele Gray for more information.  

Do you have older adult clients who are experiencing loneliness? A research team at Baycrest is studying the use of a virtual, at-home program aimed at promoting brain health. Participants will engage in either mindfulness meditation or brain training for 8 weeks and complete online sessions and surveys to assess the impact of the interventions. Compensation will be provided. To be eligible, participants must be over 60 years of age, living in Ontario, and have access to a mobile device or computer with an internet connection. Full details and contact information here. Register here

Need help with client engagement and communication? Get access to the Canadian Primary Care Information Network (CPIN), tailored messages for your vaccine-hesitant clients, and up to three additional communications and survey campaigns on topics of your choice. Family physicians at the University of Ottawa and Monfort Hospital are studying how automated patient engagement systems like CPIN can improve communications with clients about COVID-19 vaccines. Get more information here or email the study team. 

Interviews and Focus Groups

Seeking racialized women over 40 with osteoarthritis for a study. University Health Network and the Arthritis Society are looking for women, 40+, with probable or confirmed osteoarthritis (OA) to participate in a study about how to improve OA care. Participants must speak and understand English, have lived in Canada for 10 years or more, and belong to one or more of the following ethno-cultural groups: African, Caribbean, Chinese, Filipino, Indian, or Pakistani. Participants will share their opinions in a single phone interview of approximately 20 minutes. If interested, email Angelina (Angel) Abbaticchio at

Social workers in primary health care: Your insights are needed. Researchers at the U of T are inviting you to help inform recommendations on how best to organize social work practice in interprofessional primary care settings. In this phase of a mixed-methods study, social workers from primary health care teams across Ontario will participate in semi-structured, 60-minute group conversations about their daily practice during the pandemic. All data collected will be kept confidential, and you will not be identified in study results. Dr. Rachelle Ashcroft, an Associate Professor of Social Work at the University of Toronto, is leading this study. For more information or to get involved, email Simon Lam, Research Coordinator. 

Canada-Wide Case Study on Health Equity and Virtual Primary Care.  Dr. Jay Shaw is leading a project with the Canadian Network for Digital Health Evaluation that aims to gain insights into how primary care organizations across Canada have successfully incorporated health equity into virtual primary care design, implementation, and delivery. The Primary Care Research Network (PCRN) is inviting primary care organizations across Canada to participate in a 30-to-40-minute phone interview about how equity considerations were incorporated when they implemented virtual primary care. If you'd like more information or are interested in participating, email the research coordinator, Simone Shahid, at WCH.

Primary Care Providers: Is at least 60% of your practice made up of clients who experience marginalization in some way? Do you have high (70%+) cancer screening rates for these clients? Consider sharing your insights and approach through a 1/2-to-1-hour interview with researchers from Women's College Hospital. Learnings will be used to develop targeted cancer-screening interventions. Remuneration will be provided. For info, see this flyer and email Arlinda Ruco at WCH.

How have newcomers to Canada experienced health and social care from community organizations since the beginning of the pandemic? RÉAC! Responsive services for newcomers in the context of the COVID–19 pandemic is a study led by researchers in Quebec and Ontario who are exploring this question. They are looking for newcomers (arrived 2016 or later) who are refugees, asylum seekers, or without status to participate in discussion groups. Participants will be compensated. For more information, see this feature from our July issue and the project website for more information.


Does your organization provide health care or other supports to refugees and asylum seekers? Researchers at the University of Calgary are looking for people working in clinical, public health, or settlement organizations to answer some questions via an online survey. They want to understand who provides care to refugees and asylum seekers in Canada, how this care is coordinated and delivered, how it differs among jurisdictions, and how COVID-19 has impacted it. Participate by completing this short survey. In lieu of an honorarium, the research team will donate $10 to support refugee student scholarships. See flyer (English or French) for more information.

Collaborative Learning

Partnering on Appropriate Virtual Care (Healthcare Excellence Canada). Participants in this learning collaborative will develop a framework for shared decision-making and will receive up to $20,000 in seed funding! It runs from January through November 2023 and involves a range of learning and design activities. More information and eligibility requirements here

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.
Tools and Resources

Social Prescribing Toolkit: A Resource for Clinical Providers. This step-by-step guide and resource collection was co-produced by the Alliance for Healthier Communities and the Canadian Social Prescribing Institute in partnership with the Centre for Effective Practice. It was co-designed with clinicians to support primary health care providers and teams implementing Social Prescribing in their practices. It also has conversation prompts to help you advocate for social prescribing with their colleagues and peers. Please share widely with your networks!

Toolkit for Action: Integrating Health Equity & Community in Ontario Health Teams. The Alliance prepared this toolkit to help our members advance health equity and community as drivers of OHT design and delivery. It is based on an evidence synthesis conducted in the Spring of 2022 and the work of Alliance member organizations. Here's what's inside:

Clinically Appropriate Use of Virtual Care – Guidance for Primary Care / Utilisation cliniquement appropriée des soins virtuels – Orientations pour les soins primaires (Ontario Health). This guidance document is Phase One of Ontario Health’s virtual care guidance materials for primary care. It will help you and your clients make good decisions together about virtual care, based on client needs and capabilities as well as clinical safety and effectiveness.

Indoor Air Quality Checklist to help reduce transmission of COVID-19 in community spaces. This plain-language, step-by-step checklist by Amy Katz and Dr. Jeffrey Siegel and provides detailed information about HVAC systems, portable air filters, identifying spaces in your building that are high-risk for COVID-19 transmission, and much more.
  • Have questions about air quality? FREE virtual office hours are available with Amy & Jeffrey. Learn more here.

Reduce overdose risk with safer washroom design. The Safer Bathroom Toolkit was developed by researchers at the Canadian Institute for Substance Use Research, Vancouver Coastal Health, the University of British Columbia, and the British Columbia Centre on Substance Use. It can help you and your community partners make washrooms safer for people who use drugs and reduce overdose risk. Learn more in this article from The Conversation.

Support from Ontario Health for your 2023/24 Quality Improvement Plans (QIPs). QIPs will once again be mandatory this year, On November 16, Ontario Health unveiled their priority organizational QIP indicators for the coming fiscal year, as well as changes to the QIP Narrative and Progress Report. This year's priority indicators for interprofessional primary health care are:
  • Percentage of non-palliative patients newly dispensed an opioid.
  • Patient experience: Do patients feel involved in decisions about their care?
Ontario Health plans to launch the updated QIP Navigator shortly, along with information about resources and support, on their web page as well as on Quorum. Please e-mail if you have any questions.

Common QIP indicators for community-based primary health care. Although QIPs are mandatory, but organizations do not have to adhere to the stated priority indicators. The Alliance continues to recommend that our members consider including the five common QIP indicators that were developed by and for our sector:
  • Completion of sociodemographic data collection.
  • Cervical cancer screening rate stratified by income and racial/ethnic group.
  • Client feeling comfortable and welcome at CHC Client involvement in decisions about their care and treatment. 
  • Client perception of timely access to care. 

Webinars and Podcasts: In Case You Missed It (or Want to Revisit It)

POPLAR EDIIA Webinar Series | Part 3: Measuring EDIIA. This webinar was held on September 21. Dr. Nicole Kaniki from the University of Toronto returned as a follow-up to the first POPLAR EDIIA webinar, Embedding Equity in Leadership and Teams. This session expanded on the first one and addressed the question of how we can measure the effectiveness of our EDIIA efforts.

Plan to Stay Open: Health System Stability and Recovery This webinar was hosted by the Alliance for Healthier Communities on behalf of the Primary Care Collaborative on Monday, October 3, 2022. Guests from Ontario Health presented the Ministry of Health's strategic plan to support stabilization of the health care system in Ontario for the fall of 2022. They shared five key strategic directions: 
  • Preserving our Hospital Capacity
  • Providing the Right Care in the Right Place
  • Further Reducing Surgical Waitlists
  • Easing Pressure on our Emergency Departments
  • Further Expanding Ontario's Health Workforce

Finding Meaning in a Universe of Data : Exploring Opportunities for Learning Machines to Advance Health Care Planning and Delivery In this interactive session held on October 7, Dr. Jaky Kueper described what the existing datasets tell us about people who received ongoing primary care from a Community Health Centre in 2009-2019, in terms of their sociodemographic and clinical characteristics and their interactions with the health system. 

Social Prescribing featured on Community Matters! Check out October's Social Prescribing episode of the national Community Matters podcast from Canadian Association of Community Health Centres (CACHC). It featured the Alliance’s Natasha Beaudin, Josephine Pham, and presenters from the Social Prescribing conference.

POPLAR EDIIA Webinar Series | Part 4: EDIIA and Data - Building Capacity This webinar was held on October 19. It featured Dr. Andrew Pinto, founder of the Upstream Lab and co-lead of POPLAR’s Clinical Research Committee. He took us through key considerations relevant to building capacity in primary care for both applying EDIIA and the conduct of data science, outlining four key recommendations for research teams.

Is Your Healthcare Pension Aligned with Climate Safety? Understanding how your pension dollars are invested is part of understanding how you can take action to support ecological health equity. In this webinar, held November 8, climate and finance experts from Shift: Action for Pension Wealth and Planet Health shared:
  • The risks the climate crisis poses to pension funds and retirement savings
  • An overview of HOOPP’s approach to the climate crisis, including its investments in fossil fuels
  • What you can do to engage with HOOPP on the climate crisis.

Health Care Reform: It's not just about healthcare. This Lunch 'n' Learn Webinar was held on November 16, 2022. It features Russ Ford, a health system researcher with a long history of leadership in Ontario's Community Health Services. He presented preliminary findings from his PhD research into health system reform, observations about the OHT initiative, and his insights into what reforms he thinks are really needed - especially the need for OHTs to make meaningful commitments to advancing health equity, and the role CHCs can play in making that happen.

Training and Learning Resources

Get Mainpro+® credits for reading quality standards: Attention, family physicians! Do you need additional CME credits for end-of-year? Through Ontario Health’s no-cost Understanding Quality Standards in Primary Care Program, you can earn Mainpro+® credits for the quality standards you read. Just read a quality standard, complete a simple self-reflection exercise and submit for your credits! This one-credit-per-hour Self-Learning program has been certified by the College of Family Physicians of Canada and the Ontario Chapter for up to 54.5 credits. Learn more here

The Loop and Loop Jr. Community of Practice knowledge hubs support fall prevention in older adults and children. Both websites are available in English and French and offer networking, knowledge-sharing, information-gathering support for people working in fall prevention across Canada.

Newly Published

Afrocentric approaches to disrupting anti-Black racism in health care and promoting Black health in Canada. Leben Gebremikael and colleagues from TAIBU Community Health Centre wrote this article which was published in the October 31 issue of the Canadian Medical Association Journal. It explores how Afrocentric community health care can disrupt systemic anti-Black racism and related health inequities, informed by the experience of TAIBU staff, clients, and community.

Using Trusted Relationships and Community-Led Approaches to Promote COVID-19 Vaccine Confidence and Uptake across Ontario. This article, published in the October edition of Longwoods Healthcare Quarterly, was written by the Alliance's Sara Bhatti, Josephine Pham, and Jennifer Rayner. It describes initiatives used by Alliance members to promote vaccine confidence and uptake, along with challenges and key enablers. Lessons learned can be used to engage in other health-promoting activities.

Giving Care: An approach to a better caregiving landscape in Canada is the Canadian Centre for Caregiving Excellence’s first policy whitepaper. The report aims to ignite a public conversation on the state of caregiving and offer potential policy solutions to address the many challenges and systemic issues experienced by Canada’s 8+ million caregivers and care providers across the country.

Effective Modalities of Virtual Care to Deliver Mental Health and Addictions Services in Canada. This new report from the Ontario Science Table explores the effectiveness of virtual mental health care, how it can be tailored to ensure it is effective for different groups and communities, and what do health care professionals need in order to deliver mental health care? This paper includes findings specific to mental health care in primary care settings, where 71% of mental health care visits are now conducted virtually. 

Looking for more?

Consider subscribing to these newsletters to receive regular updates from Alliance system partners
Got a moment?
Tell us what you think of EPIC News.
Do you consider the content relevant?
Do you consider the presentation (writing, layout, visual elements) to be engaging?
Thank you!
Your responses will help us make EPIC better.
Please send comments, suggestions, or story ideas to

Haven't subscribed yet? Email to get on the list!

Have an innovation, study, or project you'd like to share with other EPIC readers?
Reach out to us at