How ETHP’s Oakridge Health and Harm Reduction Hub became a safe space for people who use substances

Carmel Barker (left) is a client at ETHP’s Oakridge Health and Harm Reduction Hub, where she sees Dr. Leonard Bienenstock, addictions physician and founder at Comprehensive Treatment Clinic.

Carmel Barker was on a stroll with a friend one late afternoon last February when a sign pulled them from their usual route through the southwest Scarborough neighbourhood of Oakridge.

Plastered outside the entrance of the Hub at Warden Woods Community Centre (WWCC), the sign read, in large black letters, Oakridge Health and Harm Reduction Hub.

“We have addictions,” Carmel says. “So the fact that there was this space right in our neighbourhood that was going to help us access addictions resources — that’s what appealed to us.”

Carmel, who lives a short walk from WWCC, would go on to visit the Oakridge Health and Harm Reduction Hub almost every day for the next month.

Launched in February 2020 as a pilot initiative by East Toronto Health Partners (ETHP), the Ontario Health Team (OHT) serving East Toronto, with support from Michael Garron Hospital (MGH), the multi-service centre is designed to be a safe space and one-stop shop for health care for people who use substances.

It offers a range of services, including harm reduction, counselling, peer support and case management, from an inter-professional team representing nine health care and social services organizations in East Toronto: Agincourt Community Services Association (ACSA), Comprehensive Treatment Clinic (CTC), Cota Health (Cota), MGH, Providence Healthcare (Unity Health Toronto), St. Michael’s Homes, South Riverdale Community Health Centre (SRCHC), the Toronto Central Local Health Integration Network (TC LHIN) and WWCC.

In addition to their clinical duties, staff at the Hub help clients navigate community and social services such as resources for housing, food security and transportation.

It was set up with the goal of increasing access to substance use services in the Oakridge neighbourhood with a long-term goal of reducing the need for emergency services related to overdoses.

This addresses data from emergency medical services and MGH’s Emergency Department (ED) that identifies a high number of crisis situations related to substance use among residents of the Oakridge and Warden Woods areas.

“The space is made up of a number of organizations within the community,” says Leah Dunbar, project manager of the Toronto mobile crisis intervention team (MCIT) program who was project manager of the Hub at the time of its launch.

“This means our clients don’t have to navigate multiple providers or leave their neighbourhood to access the services they need. We’re eliminating these barriers and coming to them.”

Prior to the pandemic, the Hub became “a place to hang out” for Carmel.

In addition to appointments with Dr. Leonard Bienenstock, addictions physician and founder at CTC, Carmel says she enjoyed spending time in the Hub’s common area which offered a place for clients to relax, engage with staff or chat with others.

Carmel says she participated in peer groups and informational sessions at the Hub, including one that provided clients with naloxone training.

“The staff made me feel really comfortable,” she says. “They don’t judge you in any way. I really appreciated that.”

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Dr. Bienenstock says he jumped at the opportunity to join the Hub because it takes a holistic approach to treating clients with lived experiences of substance use and mental illness — one that considers elements such as stress management, physical fitness and basic health education, which he says many people take for granted.

“I think it’s important that we bring these services into the communities where our clients are,” says Dr. Bienenstock, who continues to meet with Carmel virtually via the Hub during the pandemic.

“This is a place where they’re already comfortable and can easily access. There’s a very low barrier in terms of travel and transportation, which can be difficult for those who face socioeconomic challenges.”

By providing complementary and comprehensive health care and social services in one accessible space, the Hub also allows for warm handoffs: the transfer of a client’s care that involves one member of a health care team referring the patient to another member.

This helps to build trust between the client and health care team, decreasing loss to follow-up and ensuring patients are able to receive the care they need.

“Patients are often reluctant about or intimidated by counselling, trauma therapy or other services, but they tend to listen to a doctor when they recommend them,” says Dr. Bienenstock.

“Before the pandemic, the Hub allowed all of us to be in the same space, so introducing a patient to an addictions counsellor or case manager with a warm introduction and endorsement resulted in very high uptakes.”

Although services at the Hub have been scaled back since March 2020 because of COVID-19, the space remains vital in the Oakridge and Warden Woods communities.

During the Hub’s pilot run from February to April, the Hub responded to 242 service requests for harm reduction supplies and facilitated 23 individual one-on-one service encounters and 20 group session encounters.

This success led the Hub to be extend its run into 2021, thanks to support from Cota and SRCHC.

“Cota has been pleased to play a role in the development and implementation of the Oakridge Health and Harm Reduction Hub. We view it as a very good example of how service organizations can collaborate to deliver innovative and valued support to people in need within our community,” says Paul Bruce, CEO at Cota.

“We are thankful to Cota’s Board of Directors and to our colleagues at SRCHC for contributing resources that have allowed us to maintain operations at the Hub on an interim basis. We remain hopeful that we will be successful in securing the required government support and funding that will enable it to be sustained on an ongoing basis.”

“The Hub acts as a satellite service, which plays a critical role in delivering resources and services to our most vulnerable, hard-to-reach clients,” adds Jason Altenberg, CEO at SRCHC. “Models like this are essential to our goal of saving lives and ending the stigma and discrimination faced by people who use drugs.”

“At the Hub, more informal services are provided. It’s a place where people who use drugs can access safer-use supplies, naloxone, information and training,” Altenberg continues. “Many people think of first responders as emergency medical service workers. However, first responders in the opiate crisis are largely other people who use drugs. Satellite sites are usually homes or places in communities, relying on organic networks, provided by people who use drugs.”

Carmel says she continues to visit the Hub as often as she can for her virtual appointments with Dr. Bienenstock.

She also receives bus tokens from staff, which enables her to travel to the pharmacy to pick up prescriptions.

She says, with the help of the Hub’s inter-professional team, she’s been able to meet her health goals.

“It means a lot,” Carmel says. “There used to be days where it was difficult for me to even leave the house, but knowing that they were just down the street was a big, big help. I’m not using anymore and I feel better every day.”

ETHP is working to ensure the Hub can continue its full suite of in-person services as soon as it is safe to do so again.

Leah says when the Hub opened last year, the participating organizations worked to build trust in the community, which involved staff visiting local residential buildings with hot meals and flyers.

She says it’s important to continue nurturing the relationships that have been developed with clients and community residents in the area, many of whom have reported positive and welcoming experiences at the Hub.

“It’s the partnership of East Toronto organizations that really makes this work,” Leah says. “I don’t think one group could do this on their own. The Hub gives us the opportunity to co-locate our services so we’re really able to lean on our respective strengths and learn from each other to provide better care for our communities.”

“I hope they don’t leave,” Carmel adds. “There are a lot of people like me who, at times, don’t have the mental capacity to navigate the health care system or seek out different services on our own. So knowing that the Hub is there — that there are people who can and are willing to help us— is huge. They’ve helped point me, and others, in the right direction.”