Central West Toronto Community - Needs Assessment and Gap Analysis Report

Table of Contents

Foreword 2

Executive Summary 3

Introduction 6

Approach and Methodology 7

Populations 10

Population health and the factors impacting health and wellness 17

Health/health-related services and programs - gaps and needs 20

Health care utilization, quality and access gaps and 22 variations

What we Heard from the Community and Stakeholders 25

Conclusion and Next Steps 36

Appendices A, B, C, D 39

Prepared by: Prepared for:

Santis Health Toronto Central LHIN 655 Bay Street, Suite 401 425 Bloor Street East Toronto ON M5G 2K4 Toronto ON M4W 3R4 SantisHealth.ca Torontocentrallhin.on.ca

Foreword from the Toronto Central LHIN

Toronto Central Local Health Integration Network (LHIN) identified Oakwood-Vaughan and the surrounding neighbourhoods as an area where access to basic health care services, including primary care are inadequate, resulting in poor health outcomes for this community. This work aligns with the our strategic priority of taking a population health approach and working with communities and providers to implement targeted solutions that bridge gaps in access and appropriateness of care.

As part of this strategy, the Toronto Central LHIN commissioned a Needs Assessment and Gap Analysis to better understand the health needs and service gaps in the Oakwood-Vaughan community. At the time of the engagement, several considerations were at play in the periphery. A City of Toronto building at 524 Oakwood Avenue, the focal point of the community, became available to lease. Further to this, the Toronto Western Hospital Family Health Team (FHT) also expressed interest in opening a satellite office in the area.

In the time since, Nia Centre for the Arts has proposed a plan to the City that would have them utilizing the available space at 524 Oakwood. Additionally, the Toronto Western Hospital FHT has secured a location at Oakwood and Robina Avenues that would provide primary care services to the Oakwood-Vaughan community. These changes resulted in a shift in focus to one that is more in line with the original objective of the assessment - to help guide efforts to further strengthen and support health services in the community as a whole.

Toronto Central LHIN understands the important role community partnerships play in the sustainability of efforts to improve access to primary care and community health services in a community. We are committed to working collaboratively with community based partners to take this needs assessment and begin planning for how best to meet the health needs of the Oakwood-Vaughan community. In the months to come, the Toronto Central LHIN will be actively convening health service providers to bring forward community solutions to strengthen and enhance access to care for the community.

Executive Summary

Central West Toronto neighbourhoods are home to increasingly diverse populations, including vibrant and well-established cultural communities, a growing number of young families and youths, newcomers, and seniors who live alone and are at high risk of isolation and declining health. Central West Toronto reflects the income polarization that has been well-studied in Toronto and, like many areas in the city, is experiencing a scarcity of affordable housing.

Santis Heath used a mixed methods approach combining quantitative and qualitative analysis to gain an up-to- date and comprehensive understanding of the neighbourhoods, the populations who live in Oakwood- Vaughan, their current health status and wellbeing, and health care needs, gaps and inequities. This included undertaking 26 separate community and stakeholder engagement activities, involving nearly 400 individuals in Central West Toronto.

Neighbourhoods of focus Through data analysis and discussions with residents, providers, community groups and health professionals, it became clear that, while people residing in the neighbourhoods surrounding Oakwood-Vaughan will benefit from increased primary and community health care, most clients will come from Oakwood-Vaughan and areas adjacent to it – Caledonia-Fairbanks, and parts of Corso Italia-Davenport, Wychwood and Humewood- Cedarvale.

Central West Toronto Health Link Community and Demographic Facts • Central West Toronto Health Link’s Population is 115,932 • 2/3 of the Central West Toronto Health Link’s population speaks a non-official language at home • There is a high percentage of immigrants – older immigrants groups (Portuguese, Spanish, Italian, Caribbean) in some communities and growing newcomer populations in Oakwood-Vaughan, Caledonia- Fairbanks, and Keelesdale-Eglinton in the north west corner of the area • A high proportion of people from visible minorities live in the area, particularly Oakwood-Vaughan, Caledonia-Fairbanks and Humewood-Cedarvale • There are low education levels compared to the rest of the Toronto Central LHIN and significant unemployment and underemployment • Children and youth make up over a quarter of the area’s population. Many Central West Toronto neighbourhoods are above the City of Toronto rate for the proportion of children and youth • There are a high number of lone-parent families, particularly in Oakwood-Vaughan • A number of neighbourhoods have a relatively high number of seniors who are isolated and/or living alone (of the neighbourhoods included in this report, the highest number of seniors living alone are in Oakwood- Vaughan and Wychwood)

Key health issues affecting the neighbourhoods Of the neighbourhoods of focus, there are high rates of the most common chronic diseases (diabetes, high blood pressure) among different age groups in Oakwood-Vaughan and Caledonia-Fairbanks. A higher percentage of residents of Oakwood-Vaughan, Corso Italia-Davenport and Wychwood have physician visits for mental health needs compared with the City or Toronto Central LHIN overall.

Teen pregnancy and birth rates are higher than the Toronto Central LHIN average in all but one of the seven neighbourhoods in the Central West Toronto Health Link. The percentage of low weight babies is also higher in Corso Italia-Davenport, Oakwood-Vaughan and Caledonia Fairbanks than the rest of the Toronto Central LHIN. Males and females age 15 to 19 in Oakwood-Vaughan, Caledonia-Fairbanks and Corso Italia-Davenport have significantly higher rates of chlamydia and gonorrhea than the City of Toronto as a whole.

Health/health-related services and programs in the Central West Toronto Health Link Access to primary care is one of the most pressing and apparent gaps in the Central West area of Toronto. There are fewer primary care providers in these neighbourhoods than the Toronto Central LHIN and less local access to comprehensive, team-based primary care models, e.g., there are no Family Health Teams in the Central West Toronto Health Link. Caledonia-Fairbanks has no primary care providers within the neighbourhood.

There are a high number of primary care physicians in the neighbourhoods of focus who are at or nearing retirement age and there is no systematic plan to transition their patients to other primary care providers. Of the eight physicians in Oakwood-Vaughan, four practice in a walk-in clinic at 2045 Dufferin Avenue, one is part of the Humber River Family Health Team, and two are family physicians with psychologist/psychotherapy practices. Five of the physicians are over the age of 60. There are only four physicians in the west part of Wychwood and all are over the age of 60. In spite of this reality, the opening of the new Family Health Team in the area will help to address resident access to primary care, including physician services.

Emergency Department (ED) visits – People in Central West Toronto Health Link visit the ED more often than the rest of the Toronto Central LHIN overall (the area has a higher than average rate of ED visits per 1,000 population). Of the total ED visits, 48% for Humewood-Cedarvale are low triage, and 45.9% for Wychwood and 40.9% for Oakwood-Vaughan are low triage, indicating that residents are turning to EDs for minor or non- urgent health issues that could be resolved earlier by a primary care provider. The number of older adults aged 75 and over with one or more ED visit per year is also higher in some Central West Toronto Health Link neighbourhoods compared to the Toronto Central LHIN rate.

Three of the seven buildings in the Central West Toronto area with the most calls to EMS are in Oakwood- Vaughan and Caledonia-Fairbanks. A greater proportion of Oakwood-Vaughan, Caledonia-Fairbanks and Wychwood residents have high to very high needs compared to other neighbourhoods in the Central West Toronto Health Link.

Community and stakeholder engagement themes Local residents are experiencing a range of challenges accessing needed health care and health-related services. They generally relate to the lack of key services in or near certain neighbourhoods, long waits and wait lists, language and cultural barriers, low awareness and knowledge about services, difficulty getting to services (e.g., immobile, limited transportation), and limited and inflexible hours of service.

Most people consulted for this report across the seven neighbourhoods say they have a primary care provider; however, primary care services are often difficult to access. The most common concern we heard is that primary care hours are restricted and people have to wait too long for appointments and in the waiting room. As a consequence, it is common for people to go to an ED or walk-in clinic for urgent and time-sensitive issues, even if they have a regular primary care provider. Another challenge, particularly expressed by residents in Oakwood-Vaughan and Caledonia-Fairbanks, is that there are few primary care practices in their neighbourhoods. The ability and willingness to travel for primary care and other health care services vary depending on a person’s age, abilities and culture.

Other access issues mentioned • Care coordination and the lack of common entry/triage points for health and community services • A general lack of culturally sensitive or culturally competent services • Challenges in getting timely access to specialists

In the absence of a succession plan, access will get worse as local physicians retire. Patients and primary care physicians are worried about what will happen once the family physicians retire, but most do not have a transition plan in place. 4

In order for services to meet the needs of and to be used by the diverse residents of Central West Toronto, they need to be designed together with the people for whom they are intended. It will be necessary to invest the effort and time to build positive relationships and, over time, trust with community members. There are many community members who would be willing to assist the hub to build relationships within the community, if they are given a meaningful role throughout the process.

Social determinants of health are crucial. The most commonly mentioned factors are: isolation, poverty, food security, lack of recreation, and low literacy about health and wellness. One of the greatest potential advantages of a community hub is to provide a platform for social participation. Community members also identified that there is a dearth of current, relevant and visible information and education about health and wellbeing, geared to different populations.

Mental health and addictions was the most commonly mentioned and often challenging concern for all groups consulted. Across all the resident, provider and stakeholder groups, there is a view that people receive mental health services when they are in crisis, but it is difficult to know where to turn to get help early. The pervasive stigma – particularly in certain ethnocultural groups – holds people back from seeking help and getting proper support.

Many people point out that there is a difference between the perception of neighbourhood safety and the reality. Some people who are new to the neighbourhood may have outdated perceptions from a decade ago when there was a wave of high-profile shooting incidents in Oakwood-Vaughan.

Consistently those consulted identified an absence of children’s programs, particularly in Oakwood-Vaughan and Caledonia-Fairbanks. There are Early Years Programs in other areas of Central West Toronto, however, they are not geared to or used by teenage/young mothers.

Those consulted emphasized the absence of programs, recreation options and positive spaces for youth in Oakwood-Vaughan and Caledonia-Fairbanks and how this affects the health and wellbeing of youths living in the area. Many youths and adults would be eager to contribute to the development of local youth programs.

Seniors emphasized the importance of accessible services – available during flexible hours, physically accessible, available in different languages and comfortable for seniors. The relatively healthy and active seniors we consulted said that access to primary care and preventative and social/recreation programming are most important to them. The more complex and isolated seniors interviewed also want to be as independent as possible. These individuals cited a lack of mobility and poverty as the greatest barriers to social participation and receiving services. Cognitive challenges such as Alzheimer’s are also a significant factor for some isolated and medically complex seniors in the area.

The women we consulted identified some distinct health and wellness concerns, most notably access to reproductive and sexual health services, parenting support, and gender-related mental health issues, such as post-partum depression and the impact of violence against women and children.

Each of the five retirement-age physicians whom were consulted are concerned about what will happen to their patients after they retire. Many of their patients are medically and socially complex. They would value administrative support to transition their practices and connect their patients with other primary care providers. The Family Health Team and community health centre physicians and other health professionals whom were interviewed highlighted opportunities for the hub to partner with other providers to deliver mobile and outreach services to homes/community sites and to act as a resource that links people with community services and helps with navigation.

Considerations for Addressing Local Needs Given the magnitude of the health and wellness gaps in these neighbourhoods, it is not feasible to tackle all needs at once and with the same intensity. There will be a need to carefully prioritize and sequence populations of focus, programs and services.

Through consultations, there is a general agreement that the populations of early focus for program planning/development are: children and young parents, youth, isolated and homebound seniors, high-needs patients whose physicians are retiring, and different groups requiring mental health and addictions coordination and support.

A number of features were identified so frequently that it is important to restate them. • Engagement and creating a community solution is key • Services need to be accessible in every way • Learn from and leverage culture-based programs in the area • Services should help promote anonymity and address the stigma associated with mental health, substance use and sexual health • Language support is crucial • Need for high-quality, customized information and education about health and wellbeing and the value of comprehensive primary care and integrated service delivery

Introduction

The Toronto Central Local Health Integration Network (LHIN) is committed to bring and integrate primary care and community health services closer to residents in underserved communities. In 2014, the Toronto Central LHIN identified Oakwood-Vaughan and the surrounding neighbourhoods as having a high concentration of vulnerable populations where residents face multiple barriers to health care, including geographic isolation, lack of transportation, rapid growth, poverty and other cultural barriers. In addition the area is under-served by primary care providers. With this in mind, Toronto Central LHIN identified Oakwood-Vaughan as a priority neighbourhood (along with the United Way and City of Toronto) and began to work toward improving health outcomes for its residents.

Data clearly demonstrate that access to basic health care services, including primary care, and poor health outcomes are challenges in this area. Central West Toronto neighbourhoods are home to increasingly diverse populations, including vibrant and well-established cultural communities, a growing number of young families and youths, newcomers who are building their lives in Canada, and seniors, many of whom live alone and are at high risk of isolation and declining health. Central West Toronto reflects the income polarization in Toronto described in various reports including the Three Cities Report. In every neighbourhood in the area, there are a large number of low-income individuals and families living alongside high-income groups and gentrification is contributing to a scarcity of affordable housing.

The Toronto Western Hospital Family Health Team (FHT) also took notice of the needs and gaps in this area and began exploring the potential of creating a satellite near Oakwood-Vaughan in order to increase primary care in this underserved community. A satellite location has now been secured at St. Clair and Robina Avenues.

Needs Assessment and Gap Analysis

The purpose of this work is to understand the health and wellness needs and gaps for populations who are 6 underserved in Central West Toronto and to identify strategic opportunities and approaches that could be considered to address these gaps. Specific objectives: • Identify the services that are needed in Central West Toronto neighbourhoods from the perspectives of those living in/requiring services in the area and those who deliver and/or have a stake in health and community services in these communities.

• Identify the “hot spots”: urgent service gaps, underserved/high-needs populations and neighbourhoods, gaps that could be meaningfully reduced in the short to medium term.

• Elucidate what is required to improve local residents’ access to services, health outcomes and experiences to inform local planning.

• Inform how to meet identified local health care needs.

Project Governance

A Steering Community Hub Committee was created to ensure that the organizations with the most direct involvement and stake in primary health and community care in Central West Toronto are s collaborating on key decisions for the Needs Assessment and Gap Analysis. The Toronto Central LHIN is accountable for guiding and approving the report and will determine any next steps that follow.

A community council was created to enable a broader group of key health and community stakeholders to be informed about, and provide input on the gap analysis (see Appendix A for the terms of reference and membership for the Community Hub Steering Committee and Council).

Reconnect Mental Health Services provided project leadership for this phase of work, including overseeing consultant services and chairing and supporting the Community Hub Steering Committee and Council.

The Steering Committee would like to thank the patients/clients of the health care system, local residents and community groups who provided their personal experiences, insights and ideas about health needs. We would also like to recognize the health care providers, health professionals, community-based groups, and partner organizations who contributed their perspectives, information and invaluable assistance with engagement activities.

Approach and Methodology

For the needs assessment and gap analysis, we used a mixed methods approach combining quantitative and qualitative analysis to gain the most current and comprehensive understanding of the neighbourhoods, the populations who live there, their health status and wellbeing, and the health care needs, gaps and inequities.

Quantitative analysis We drew from various primary and secondary data sources (most of which was previously synthesized and analyzed by the Toronto Central LHIN, and additional sources such as Emergency Management Services, TC CCAC), plans, reports, and grey literature.

Qualitative analysis This assessment relied heavily on qualitative analysis undertaken between the summer and fall of 2015 to gain a deeper and more nuanced understanding of the people who live in Central West Toronto neighbourhoods and their needs and challenges, and of people’s perceptions and priorities about their health and wellbeing and health care. Using a variety of engagement approaches, tailored to each stakeholder and community

7 group, we identified critical information that is not captured in the data and challenged our assumptions. In addition to engagement activities, we reviewed existing environmental scans and needs assessments that had been undertaken in the communities included in this report.

The starting point in planning local health services is understanding the population(s) of interest, and their health and wellbeing, needs and the factors affecting their health.

New services and approaches can only be truly responsive and sustainable if the local residents/ patients/clients/caregivers are integrally involved in developing and delivering the solutions. Top-down solutions, no matter how evidence-based and well-intended, can fail if they are not accepted, trusted and supported by the people for whom they are designed – recipients, front-line professionals and community partners.

The following outlines the community and stakeholder engagement approach that was undertaken to support the needs and gap analysis.

Identifying the populations To identify the populations of focus, we reviewed key data and qualitative information about the demographics, health status, determinants of health, and health care outcomes in the Central West Toronto Health Link, and consulted with key informants from agencies and groups in the area.

Assumptions A main assumption was that any new services, programs or initiatives will primarily serve Oakwood-Vaughan1 residents, recognizing that people in neighbourhoods could also benefit. For example, residents in nearby Caledonia-Fairbanks (there are no primary care physicians in the neighbourhood), and underserved parts of the Corso Italia-Davenport and Wychwood neighbourhoods and Humewood-Cedarvale (which is in the North West Toronto Health Link area).

Another assumption was that while any new services, programs or initiatives be open to everyone living in and around Oakwood-Vaughan, it will be specifically designed for those who are underserved, have unmet needs and experience barriers accessing health and social services.

Based on these assumptions, we segmented the population based on data and other information about sub- population size, unique health and social characteristics, needs and gaps. Through the process of engagement and analysis, we further segmented these populations, identified additional sub-populations and refined our understanding of who would benefit most from services based in Oakwood-Vaughan. The following are the population groupings identified.

1 In this report we are using Oakwood-Vaughan neighourhood. Oakwood Village is another name used for this neighbourhood. 8

Understanding needs, priorities and informing service delivery approaches We looked at needs through various lenses. First and foremost, we sought direct input from residents in the target neighbourhoods and populations of focus. We also dialogued with community groups and leaders, primary care and other professionals, workers and agencies who work directly with residents.

The neighbourhoods in Central West Toronto and Oakwood-Vaughan, in particular, are highly diverse and dispersed. There are no predominant networks or hubs within or across the neighbourhoods that draw different groups together – whether it’s youth, seniors, newcomers, or ethno-cultural groups who have been in Canada for generations.

Because there had not been a visible or broad community development and health planning effort for some time, if ever, in Oakwood-Vaughan and Caledonia-Fairbanks, it will take time and a concerted strategy to make a connection with local residents and, over time, to achieve their buy-in and eventually trust and involvement in community development.

For these reasons, our strategy was to partner with a variety of community groups and agencies as well as formal and informal leaders to undertake community engagement activities with local residents and patients. We worked with agencies and community groups to develop targeted strategies to engage residents in different neighbourhoods, to jointly undertake various engagement activities, and, in some cases, community groups led engagement activities for us, which was very effective given their existing relationships with residents and clients. In addition, agencies and professionals provided their knowledge and perspectives about the needs, gaps and potential role of an Oakwood-Vaughan-based community hub.

Tailored approaches were used to reach those who are “hard to reach” and face barriers to public participation. These approaches included having language interpretation so that we could have discussions with non-English-speaking residents, having trusted intermediaries engage/co-facilitate sessions with their communities, and organizing culture-based activities.

Discussions and interviews were recorded in written form. The notes were summarized by theme, highlighting the information repeated with the greatest frequency and/or intensity.

Populations

Geographic area in Central West Toronto Our starting point for planning was the seven neighbourhoods that comprise Central West area of Toronto between Bloor and Eglinton and Christie and Keele. (see Figure 1.)

Figure 1.

Population Overview in Central West Toronto Central West Toronto has a large immigrant and ethnoculturally diverse population – a mix of an older immigrant population from southern Europe (largely Portuguese, Italian, Spanish), a sizable Caribbean community, and a growing proportion of newcomers from South Asian and Southeast Asian countries in some neighbourhoods. The population is also relatively young compared to the rest of the Toronto Central LHIN and includes a considerable proportion of youth who have difficulty accessing health and community services and have unmet needs. There are also a relatively high number of seniors with complex health and social needs who are isolated and/or living alone.

The social determinants of health, including limited affordable housing, low income, and unemployment/ underemployment affect the health and wellbeing of many area residents. Any strategy to improve the health status of the local populations and help build communities must encompass the social determinants of health.

Various indicators point to challenges accessing primary and community care throughout Central West Toronto. For example, this area has the second lowest proportion of primary care physicians of any Health Link in the Toronto Central LHIN. Most neighbourhoods do not have local access (not located in their neighbourhood, not within walking distance or a 15 minute car or public transit ride) to a comprehensive primary health care practice (Family Health Team, Community Health Centre). Immigrant, non-English- speaking and racialized populations report that they do not receive culturally appropriate and language- specific primary care and community services.

Two Central West Toronto neighbourhoods are designated Neighbourhood Improvement Areas by the City of Toronto – Weston-Pelham Park and Keelesdale-Eglinton West. However, other neighbourhoods in this Health Link area (e.g., pockets within Oakwood-Vaughan and Caledonia-Fairbanks) have similarly poor health and social outcomes but less local access to primary care and some other vital community-based services.

Neighbourhoods of focus Through the data analysis and discussions with residents, providers, community groups and health professionals, it became clear that, while people residing in the neighbourhoods surrounding Oakwood- Vaughan are expected to benefit from health services and programs, residents from Caledonia-Fairbanks, and parts of Corso Italia-Davenport, Wychwood and Humewood-Cedarvale would also benefit.

The Davenport-Perth Neighbourhood and Community Health Centre (DPNCHC) is a key provider of comprehensive primary care and community services for Corso Italia-Davenport; however, given the needs and current outcomes of the population living there (e.g., rates chronic disease, teen pregnancy and mental health and sexual health needs) it is assumed that some people living in this neighbourhood will benefit from services and supports in the Oakwood-Vaughan area of Central West Toronto.

Each neighbourhood in Central West Toronto is distinct – and residents see them as distinct. One example of many is that the youth with whom we spoke in the west side of Central West Toronto (Weston-Pelham Park and Keelesdale-Eglinton West) say they are not interested in travelling to Oakwood-Vaughan for primary care or other basic health and community services that they expect to be available within their neighbourhoods. Moreover, the east-west TTC routes between Weston-Pelham and Oakwood-Vaughan are not convenient. People from all age groups expressed that travelling across several neighbourhoods especially if the TTC route is not direct would be a barrier. In these situations, it may be more effective for services to partner with agencies in other parts of Central West Toronto to provide collaborative programs at various sites throughout the area.

The engagement and analysis covers the entire Central West Toronto area, with a particular focus on Oakwood-Vaughan, Caledonia-Fairbanks, the north part of Corso Italia-Davenport, the northwest part of Wychwood, and Humewood-Cedarvale (see Figure 2.)

Figure 2.

Central West Health Link Community and Demographic Facts

• Low percentage of individuals that include English as their mother tongue • High percentage of immigrants • Low education levels compared to the rest of the Toronto Central LHIN • Significant unemployment and underemployment • Children and youths make up over a quarter of the population. Many Central West Toronto neighbourhoods are above the City of Toronto rate for proportion of children and youths • A high proportion of lone-parent families, particularly in Oakwood-Vaughan. • Neighbourhoods with a relatively high number of seniors who are isolated and/or living alone

Central West Toronto Health Link Population: 115,932 (2011 Census)

Table 1. Population projections for Central West Toronto Health Link Growth 2011- Growth 2016 2011-2021 0-14 9.9% 11.4% 15-44 -6.4% -7.8% 45-64 2.1% 0.1% 65-74 17.9% 34.5% 75-84 5.5% 9.7% 85+ 21.1% 26.5%

While Central West Toronto’s entire population is projected to grow over the next six years, the largest growth will be among seniors aged 65 to 74 and over 85, followed by children under 14. The working age adult population will not grow and, in fact, the 15 to 44 age group will decline (see table 1).

Language and Ethnocultural Facts (2011 Census) Two-thirds of the Central West Toronto Health Link’s population speaks a non-official language at home.

Figure 3.

Top 10 Non-Official Home

50.0%Languages (Single Response) 38.4% 40.0% 30.0% 20.0% 13.3%13.0% 13.8% 4.5% 4.4% 10.0% 3.9% 3.1% 3.0% 1.5% 1.1% 0.0%

The Aboriginal population is relatively small in this part of Toronto, ranging from 0.1% in Oakwood-Vaughan to 1.2% in Wychwood. Aboriginal health agencies that are largely located in the downtown core serve Aboriginal people across Toronto. As well, Anishnawbe Health Toronto operates an Aboriginal Mental Health and Addictions Program out of 22 Vaughan Road and the Native Men’s Residence (Na-Me-Res) provides shelter and housing services at 14 Vaughan Road.

Immigration (2011 Census) The highest proportion of newcomers to the Central West Toronto Health Link resides in Caledonia-Fairbanks at 9%, Keelesdale-Eglinton West at 9% and Oakwood-Vaughan at 8% (arrived 2006-2011), which is similar to the City of Toronto overall at 8%. Oakwood-Vaughan has the highest proportion of non-permanent residents at 3%, on par with City of Toronto.

A number of the neighbourhoods have a high proportion of older European immigrants. The main immigrant populations in Wychwood are English, Scottish and Irish whereas in Oakwood-Vaughan, Caledonia-Fairbanks and Corso Italia-Davenport, the three main immigrant populations are Portuguese, Italian and Filipino.

Income and Employment - Figures 4, 5, 6 (2011 Census)

Figure 4. Figure 5.

Median Household Income before % Individuals - Incidence of low Tax income before-tax 26.5 $70,000 30 22.7 23.3 24.9 23 24 $60,000 25 21.4 21.4 $50,000 20 $40,000 $30,000 15 $20,000 10 $10,000 5 $0 0

Figure 6. CW % Unemployment rate 8.4 9 8.1 7.5 7.7 8 6.5 6.6 6.9 7 6 5.2 5 4 3 2 1 0

Factors related to income and disparities in Central West Toronto Health Link • There is gentrification in virtually all the neighbourhoods in this area, which has decreased the availability of affordable housing and caused friction between groups, especially in communities such as Oakwood- Vaughan where there are few places and activities that draw people together from different socio- economic, ethnocultural groups and generations.

• The Toronto Central LHIN’s environmental scan observed that the 2008 economic downturn resulted in a sustained spike in food bank use in the Central West Health Link.

Snapshot of the communities most likely to be served by the Central West Toronto Community Hub (2011 Census)

Figure 7. Oakwood-Vaughan

Population: 21,073

• Higher seniors population (65 and over) than the City of Toronto average. • Most densely populated neighbourhood in Central West Toronto. • Oakwood-Vaughan and Wychwood are the two neighbourhoods with the highest number of seniors living alone. • 42.6% of people living in this neighbourhood have a mother tongue other than English. • Lower education than the Toronto Central LHIN and slightly lower unemployment. Consultations revealed that it is common for area residents to work multiple jobs and have precarious employment. There are slightly fewer low-income individuals in Oakwood-Vaughan (23.3%) than the TC LHIN (24%). However, 45% of households report an income of under $49,999, the second highest proportion in the Central West Toronto Health Link and higher than the City of Toronto. • Top birth countries – Philippines, Italy and Portugal. • Over one-third of Oakwood-Vaughan residents are part of a visible minority group, the largest of which is Black, followed by Filipino.

Figure 8. Caledonia-Fairbanks

Population: 9,951

• Age breakdown similar to the rest of the City. • 54.7% of residents have a mother tongue other than English; the main language is Portuguese at 27.9%. • 20% of seniors (65 and over) live alone. • A higher number of residents have educational attainment lower than high school (36.5%), compared to adjacent neighbourhoods. However, unemployment is lower than anywhere else in Central West Toronto (5.2%) and Caledonia-Fairbanks has among the lowest number of low-income individuals at 21.4%. However, in contrast, Caledonia-Fairbanks has one of highest proportion of any Central West Toronto Health Link neighbourhoods of people without a valid health card, a reflection of the relatively high number of “migrant workers” in the area with unstable employment. • Top birth countries – Portugal, other countries in Americas and Italy. • One-third of residents are from a visible minority group – Latin American, Filipino and Black.

Figure 9. Wychwood

Population: 13,986

• Much higher seniors (65+) population than the City – 21% vs. 14%, but a lower percentage of children and youth.

• 31% of seniors (65+) live alone. Wychwood and Oakwood-Vaughan have the highest proportion in the Health Link. • 9.2% mother tongue other than English. • Top birth countries – Portugal, Italy, other countries in Americas. • A lower proportion of visible minority groups (less than 25%) - Black, Chinese, Latin American.

Figure 10. Corso Italia-Davenport

Population: 13,743

• Seniors population equivalent to the City; higher percentage of working-age adults than the City. However, a lower number of seniors live alone than adjacent neighbourhoods (22%). • Unemployment and low income are both better than the rest of the TC LHIN. • Top birth countries – Portugal, Italy, other countries in Americas. • A lower proportion of visible minority groups (less than 25%).

Humewood-Cedarvale (in North West Toronto Health Link)

• A higher number of seniors (65+) live alone (33.3%) than any neighbourhood in the Central West Toronto Health Link (including Wychwood and Oakwood-Vaughan). • Individual low income 18.8%, lower that the Toronto Central LHIN; unemployment 6.6%. • High proportion of immigrants - 35.2%. • 28.5% of residents are from a visible minority group.

Population health and the factors impacting health and wellness in Central West Toronto Neighbourhoods

Chronic disease (as of April 2012) There is a relatively high incidence of multiple chronic diseases in Central West Toronto. Of the neighbourhoods of focus, there are the particularly high rates of the most common chronic diseases (diabetes, high blood pressure) among different age groups in Oakwood-Vaughan and Caledonia-Fairbanks. The table below shows that diabetes rates for adults in Oakwood-Vaughan and Caledonia-Fairbanks are higher than the Toronto Central LHIN and City of Toronto rates, while rates for seniors (65+) are higher in these neighbourhoods as well as in Corso Italia-Davenport. (see table 2) 17

Table 2.

Percentage of People with Diabetes

The prevalence rates for blood pressure are similar in Central West Toronto neighbourhoods.

Mental Health (as of April 2012) A higher percentage of residents of Oakwood-Vaughan, Corso Italia-Davenport and Wychwood have physician visits for mental health needs for different age groups compared with the City or Toronto Central LHIN overall. Of all the neighbourhoods in this Health Link, mental health-related visits for those aged 65 and over are highest in Wychwood. For Corso Italia-Davenport, the rates are higher for both males and females 20 and over, as well as adults 20 to 64 years old. The visit rate for 20 to 44 year olds is higher in Oakwood-Village than the Toronto Central LHIN and City rates.

Sexual health, high teen pregnancy (2012) Pregnancy and births Teen pregnancy and birth rates are higher than the TC LHIN in all but one of the seven neighbourhoods in Central West Toronto. Rates are also very high in Humewood-Cedarvale. The percentage of low weight babies is also higher in Corso Italia-Davenport, Oakwood-Vaughan and Caledonia-Fairbanks than the rest of Toronto Central LHIN and City. This is an indicator of poor nutrition and access to appropriate pre-natal care (see table 3)

Table 3.

Sexually transmitted infections (STIs) – 2011 Toronto Public Health Rates of some STIs are also higher in several neighbourhoods likely to be served by the Community Hub. Males and females age 15 to 19 in Oakwood-Vaughan, Caledonia-Fairbanks and Corso Italia-Davenport have significantly higher rates of chlamydia and gonorrhea than the City of Toronto as a whole.

Health/health-related services and programs in the Central West Health Link – gaps and needs

While a complete assessment of providers and health-related assets for the community was outside of the scope of this report, the needs assessment process provided important insights about the availability, gaps and opportunities related to health and health-oriented services in the area.

The main findings:

• There are fewer primary care providers in these Central West Toronto neighbourhoods than the Toronto Central LHIN and many of the primary care providers in these neighbourhoods serve people with multiple complex and interrelated health and social needs.

• There is less local access to comprehensive, team-based primary care models in the area

• There is a high proportion of physicians in solo practice without the support of a team or the capacity to consistently connect with or refer patients to other health care providers and agencies in the area.

• There are a high number of primary care physicians who are at or nearing retirement age and there is no systematic plan to transition their patients to other primary care providers.

• There is no acute care facility in this area of Toronto , which affects access to key specialist services.

Access to primary care Access to primary care is one of the most pressing and apparent gaps in the Central West Toronto Health Link - particularly the neighbourhoods of focus for the community hub.

Figure 11.

Distribution of Physicians by Neighbourhood 9 8 8 7 6 6 5 5 5 4 3 3 3 2 2 2 2 2 2 2 2 2 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0

30-39 40-49 50-59 60-69 70-79 80-89 NA

• As the chart above indicates, Oakwood-Vaughan has seven primary care physicians. A more recent review (October 2015) indicates that there are eight primary care physicians registered to practice with addresses in the Oakwood-Vaughan neighbourhood. Four of these physicians practice out of a walk-in

clinic at 2045 Dufferin, one is a satellite location of the Humber River Family Health Team and two are family physicians with psychologist/psychotherapy practices. Five of the physicians (more than half) are over the age of 60, one of whom is over 80.

• There are only four physicians in the west part of Wychwood, which is part of Central West Toronto, and all are over the age of 60.

• Caledonia-Fairbanks has no primary care providers within the neighbourhood.

• There are two Community Health Centres (CHCs) in Central West Toronto area – Davenport Perth Neighbourhood and CHC (catchment area defined as Corso Italia-Davenport, Weston-Pelham Park and the south part of Caledonia-Fairbanks and a part of Keelesdale-Eglinton West) and Unison CHC has a satellite at Keele and Rogers. There are no CHCs located in or directly serving the area between Caledonia to Christie or north of St. Clair. Some residents of these neighbourhoods report that they travel to CHCs, FHTs and other patient enrollment/registration practices outside of the Health Link, including the Toronto Western Family Health Team and Four Villages CHC (most commonly mentioned outside of the Health Link area).

Other Providers in Central West Toronto Health Link

Figure 12.

The figure above indicates the location of the closest hospitals and community agencies in Central West Toronto (red).

There are a variety of community support service, social service and prominent cultural organizations within and serving Central West Toronto. However, in addition to the lack of primary and acute/specialist care in the area, Central West Toronto has a very low rate of long-term care beds per 1,000 population (age 75+), especially given the high proportion of older seniors and seniors living alone in some neighbourhoods (TC LHIN Environmental Scan, Central West Toronto Health Link, Sept. 2013).

Health care utilization, quality and access gaps and variations

There are a number of indicators that show that residents in the neighbourhoods of focus are not receiving appropriate or timely access to primary care and the supports they need in their communities, leading to a relatively high use of Emergency Departments (ED) and avoidable hospitalizations.

Figure 13.

Emergency Department Use

Central West Toronto - Distribution of Emergency Department Vists by Hospital - FY 2011/12 30% 26% 25% 24% 20% 15% 10% 10% 8% 8% 8% 6% 5% 5% 2% 2% 1% 0%

Within the neighbourhoods of focus, most residents go to Toronto Western Hospital’s ED, followed by St. Joseph’s Health Centre. There is a similar trend for inpatient separations.

ED visits • Oakwood-Vaughan – 25% go to the Toronto Western Hospital, followed by St. Joseph’s Health Centre and Humber River Hospital. • Caledonia-Fairbanks – most residents go to St. Joseph’s Hospital, followed by Toronto Western and Humber River hospitals. • Wychwood – the vast majority of patients go to the Toronto Western Hospital, followed by Mount Sinai Hospital and the University Health Network’s General site.

Central West Toronto has a higher than average ED visit rate per 1,000 population than the Toronto Central LHIN.

The rate of unscheduled emergency visits for conditions that could be treated in an alternative primary care

22 setting is highest for Corso Italia-Davenport (68/1000), followed by Oakwood-Vaughan (38/1000).

• Central West Toronto has among the highest rates of ED visits for 0 to 9 year olds in the Toronto Central LHIN. • 48% of all ED visits for Humewood-Cedarvale are low triage2; 45.9% of ED visits in Wychwood are low triage and 40.9% of ED visits in Oakwood-Vaughan are low triage, indicating that residents are turning to EDs for minor or non-urgent health issues that could be resolved by a primary care provider. o Low triage visits (Canadian Triage Acuity Scale or CTAS 4 and 5) for those aged 5 to 19 are particularly high o Humewood-Cedarvale has more low triage visits for all ages than the Toronto Central LHIN average o A 2011/12 analysis showed that youths aged 15 to 19 in Central West Toronto Health Link stated no access to primary care as the reason for an ED visit, more than any other group

Of Central West Toronto neighbourhoods, Wychwood has the highest rate of ED visits per 1000 for those aged 65 to 74 and Oakwood-Vaughan the highest rate for those 45 to 64. The number of older adults (75+) with one or more ED visit per year is also higher in some Central West Toronto neighbourhoods compared to the TC LHIN rate.

Central West Buildings with the most EMS calls - January 1, 2014 – June 30, 2015 Location ER visits 1775 Eglinton West – Doug Saunders building, Oakwood -Vaughan 251 61 Pelham Park, Weston-Pelham Park 196 600 Melita Crescent, Wychwood 174 707 St Clair West, Humewood-Cedarvale 160 2339 Dufferin, border of Oakwood -Vaughan and Caledonia-Fairbanks 154 1884 Davenport, Corso Italia-Davenport 105 2353 Dufferin, border of OakwoodVaughan and Caledonia-Fairbanks 100

Three of the seven buildings in Central West Toronto with the most calls to EMS are in Oakwood-Vaughan and Caledonia-Fairbanks. One building is in Wychwood; one in Corso Italia-Davenport; one is in Humewood- Cedarvale; and one is in Weston-Pelham Park.

Baycrest did an analysis of ED visits at the Doug Saunders seniors’ building in the Oakwood-Vaughan area (Toronto Community Housing) and noticed a fairly substantial increase in monthly ER transfers following the loss of on-site primary care at the building in late 2015.

Alternate Level of Care (ALC) and Hospitalization Corso Italia-Davenport and Oakwood-Vaughan also have the highest number of avoidable hospitalizations of the Central West Toronto neighbourhoods included in this review. In the Central West Toronto Health Link, the highest proportion of hospital days that are ALC is in Oakwood-Vaughan at 22.3, followed by Wychwood at 20.7. These neighbourhoods also have the highest ALC length of stay (TC CCAC, 2014).

High-needs clients

2 Low triage ED visits (also known as CTAS 4 and 5) are visits for non-urgent or less urgent situations. The investigation or interventions for some of these illnesses or injuries could be delayed or even referred to other areas of the health care system. Examples of types of conditions include sore throat, mild abdominal pain which is chronic or recurring, with normal vital signs, vomiting alone and diarrhea alone. (CIHI) 23

Of the TC CCAC’s current clients, a greater proportion of Oakwood-Vaughan, Caledonia-Fairbanks and Wychwood residents have high to very high needs (compared to other neighbourhoods in Central West Toronto). (TC CCAC, October 2015)

Preventative health care Cancer screening rates are also lower in Central West Toronto neighbourhoods than the rest of the Toronto Central LHIN.

Neighbourhoods with the low cancer screening rates: • Colorectal screening rates in Oakwood-Vaughan, Caledonia-Fairbanks, Corso Italia-Davenport and Wychwood are somewhat lower than TC LHIN rate. • Mammograms: Weston-Pelham Park has the lowest mammography rate (52.5%) • Pap Smears: The lowest rates for different age groups are: o Ages 21-69: Keelesdale-Eglinton West (61.4%) o Ages 21-34: Corso Italia-Davenport (57.8%), Oakwood-Vaughan (58.3%) o Ages 35-49: Dovercourt-Wallace Emerson Junction (56.7%) o Ages 50-69: Weston-Pelham Park (48.3%)

What We Heard from the Community and Stakeholders

The following community and health care stakeholders were consulted regarding their experiences and perspectives about health-related needs, priorities, gaps and disparities within Central West Toronto. Santis Health used a combination of methods including interviews, questionnaires, focus groups and small group meetings.

• Local residents, reflecting specific population groups • Clients/patients • Community leaders and groups • Health service providers • Primary care physicians/practices • Other health professionals • Partner agencies/organizations • Decision-makers and planners (e.g., LHIN, Health Links) • Political representatives

(See Appendix B for list of those engaged and the methods used and Appendix C for standard questionnaires for residents/patients and providers)

Key Themes These are the most common themes expressed by the populations, community groups and other stakeholders who were engaged for this report.

Community Hub A common theme emerging from consultations was an interest in a community hub model. According to the Ontario governments recent work on Community Hubs3:

“Community hubs provide a central access point for a range of needed health and social services, along with cultural, recreational, and green spaces to nourish community life. A community hub can be a school, a neighbourhood centre, an early learning centre, a library, an elderly persons centre, a community health centre, an old government building, a place of worship or another public space…. community hubs are gathering places that help communities live, build and grow together. No community hub is like another, as each brings together a variety of different services, programs and/or social and cultural activities to reflect local community needs. It is this diversity of activity that allows community hubs to play a critical role in building economic and social cohesion in the community.”

Opportunities do exist for stakeholders spanning the range of health, social, recreational and community services/supports to come together with the Oakwood Vaughan community to explore the notion of collectively developing a community hub.

Irrespective of hub development, health services can and should be strengthened and enhanced to meet community needs utilizing a variety of models/approaches.

3 Community hubs in Ontario: A strategic framework and action plan: https://www.ontario.ca/page/community-hubs-ontario-strategic-framework-and-action-plan 25

Key Health-Related Services are not Accessible Residents across Central West Toronto and in Oakwood-Vaughan and surrounding neighbourhoods, specifically, are experiencing a range of challenges accessing needed health care and health-related services.

The nature of the access issues varies depending on the population group, location and health needs. However, they generally have to do with lack of key services in or near certain neighbourhoods, long waits and wait lists for services, language and cultural barriers, low awareness and knowledge about services and how to access them, difficulty getting to the services (immobile, limited transportation), and limited and inflexible hours of service.

Another factor is that people are often not receiving the most appropriate level or type of care. The most obvious example is the high number of individuals who are visiting the ED for conditions that could have been managed earlier by a primary care provider.

Primary care

Most people consulted for this report across the seven neighbourhoods say they have a primary care provider. However, upon further exploration, it is clear that primary care is often difficult for people to access.

The most common complaint is that primary care hours are restricted and people have to wait too long for appointments or, once they arrive, in the waiting room to get in to see a physician. As a consequence, it is common for people to go to an ED or walk-in clinic for urgent and time-sensitive issues, even if they have a regular primary care provider. A group of seniors at Doug Saunders apartments, including older immigrants, new Canadians and Canadian-born individuals, reported waiting anywhere between one to three hours and one month for appointments with a primary care provider.

Another challenge, particularly expressed by residents in Oakwood-Vaughan and Caledonia-Fairbanks, is that there are few primary care practices in their neighbourhoods. Central West Toronto Health Link residents, particularly those living north of St. Clair and west of Landsdowne, commonly travel for primary care and other health care services, which reduces access for some people.

“I have always gone out of neighbourhood for services” – Oakwood-Vaughan resident

The ability and willingness to travel for primary care and other core health care services appears to vary depending on a person’s age, abilities and culture (e.g., some cultures are more accustomed to/comfortable with traveling for services, others strongly prefer local availability).

Providers consulted pointed out that having to travel for laboratory and other tests is known to impact follow- through on tests.

“I have a family doctor, but they are in the east end and only there once a week. I would benefit from something more local.” – Oakwood-Vaughan resident

Low access to continuous primary care

It is notable that those who are enrolled/registered with a comprehensive primary care practice reported a different experience than those who have a solo practitioner or go to different walk-in clinics. Seniors

26 registered at different CHCs discussed the value of being able to speak with their physician on the phone and having nurses and other physicians available to them if their physician is out of the office.

In contrast, some patients who are not enrolled or registered with a comprehensive practice report feeling rushed during their appointments and, at times, feeling uncertain about whether their problems and concerns have been understood or addressed.

“I see doctors in the area, but they don’t have time to hear me.” – Senior resident, Caledonia-Fairbanks

Related to the low access to primary care generally and comprehensive primary care practices specifically is an observation by many (residents, providers and others) that coordination of care is a significant issue. In Oakwood-Vaughan and Caledonia-Fairbanks, for example, there are no common entry/triage points for people to health care and health-related community services.

“What is missing (in Oakwood-Vaughan) is a front door.” – Josh Colle, City Councillor

Access will get worse as physicians in the Central West Toronto Health Link retire; the majority of physicians in these neighbourhoods are at an age where they are considering or in the process of retiring. The patients and primary care physicians that we consulted are worried about what will happen once family physicians retire, but most do not have a plan for transitioning to a new primary care provider.

Cultural and language-specific services needed Another prominent access challenge is the general lack of services that are either culturally sensitive or culturally competent. Both those who immigrated to Canada decades ago from Portugal, Italy and other parts of Europe and the Caribbean and newcomers from different countries in South and Southeast Asia expressed they did not feel their needs and perspectives were being understood and valued by health care providers.

“When I go to the walk-in clinic I always get Tylenol. It takes several visits to get attention.” – Punjabi senior

Access to specialists Residents consistently expressed that they are experiencing challenges getting timely access to specialists. Challenges to access ob-gyns for young women and pediatricians were mentioned most frequently.

Residents mentioned that they are unsure whether the process for specialist referrals was as effective as it could be. They highlighted that they experience extremely long wait times for certain specialists, and that they are often left on their own to coordinate appointments.

“Sometimes you get a courtesy call about your appointment and sometimes you don’t. It’s easy to forget about an appointment a year later. Sometimes you get charged if you miss the appointment.” – Portuguese senior with Abrigo

Toronto Central LHIN’s Environmental Scan for Central West Toronto found that: “Central West is an underserved community often not serviced by regional and specialized providers due to geography and catchment definitions.”

Approach to service delivery critical Residents from all demographic groups spent as much time discussing the way in which services are delivered as they did the services themselves.

In order to design services that meet the needs of and will be used by the diverse residents of Central West Toronto, they need to be created together with the people for whom they are intended.

Residents in Oakwood-Vaughan and nearby neighbourhoods conveyed suspicion about “outside” groups that come into the neighbourhood with the intention of improving services. It will be important to invest the effort and time to build positive relationships and, over time, trust with community members. There are many people from the community who would be willing to assist with relationship-building within the community, if they are given a meaningful role throughout the process. A combination of working through existing social networks, partnering with agencies and community groups, and communicating through community and multicultural media will be needed to engage people in hub development.

Residents emphasized that activities need to be tailored to different ages and interests and sustained over time. There was also some skepticism about whether a common space would appeal to all ages and groups equally, at the same time. For example, youth expressed that they are concerned about confidentiality when seeking health services – particularly related to sexual health, relationships and mental health and addictions. Some said they are uncomfortable going to the same family physician as their parents and would value anonymity. It became clear from speaking with youths and seniors alike that co-locating seniors and youth services would be a challenge and it would be difficult to effectively brand the physical space to both of these distinct groups.

Residents of Oakwood-Vaughan and Caledonia-Fairbanks generally find the idea of a one-stop shop for multiple services appealing. The ability to offer new services that are not currently available close to home and to use the space for recreational and other healthy activities would enrich community life.

Access to core services that are not publicly funded It is particularly difficult for low-income adults without private insurance to access core services such as dental care, optometry/eye care and drug therapy. There are a high proportion of “migrant workers” and newcomers doing manual labour and other physically demanding jobs in the neighbourhoods of focus. These individuals are at higher risk of workplace injuries and often lack adequate insurance for therapy and prescriptions when they get injured.

Social Determinants of Health are Critical Social determinants of health have a major impact on health and wellbeing of the populations living in close proximity to the hub. The most commonly mentioned factors are: isolation, poverty, food security, lack of recreation, and low literacy about health and wellness.

Social and physical isolation was mentioned more than any other factor influencing people’s health and wellbeing. Residents and providers recognize a clear link between isolation and poor health. Isolation has many causes: lack of integration of newcomers and racialized groups into the broader community, poverty, physical and mental health and substance use challenges, and language barriers/difficulty communicating.

There is a great deal of interest within the community about being part of a community space. In Oakwood- Vaughan and Caledonia-Fairbanks, in particular, people consistently observed that there is no central place that draws people together. There are spaces for some seniors (e.g., Fairbanks Memorial Community Centre), some youth activities (e.g., libraries), but there is no common community place or places for different groups.

“The Oakwood-Vaughan community does not have much in the way of family groups or women’s groups. There is nothing to rally around.” – Pastor Barnett, Bethel Restoration Ministries

High rates of diabetes, cardiovascular disease as well as mental health and substance use are being linked to a lack of access to and knowledge about nutritious foods and affordable recreational services in Oakwood- Vaughan and Caledonia-Fairbanks. Members of Oakwood-Vaughan’s West Indian community identified inactivity as the chief contributor to a host of health problems in their community.

People identified that there is a dearth of current, relevant and visible information and education about health and wellbeing topics. They also emphasized the importance of customizing information for different populations, and that residents, patients and caregivers in the neighbourhoods should be meaningfully involved in developing and even delivering communications and educational programs.

Mental health and addictions Mental health and addictions was the most commonly mentioned and challenging health care concern in all groups consulted. Mental health is strongly influenced by the determinants of health including poverty, education, immigration and social inclusion, social and family environment.

Mental health Across all the resident, provider and stakeholder groups consulted, there is a view that people get mental health services when they are in crisis, but it is difficult to access – and to know where to turn – to get help early. A number of cultural and community agencies said that they have difficultly knowing where to refer people when they ask about support with a mental health concern. Stigma is a general issue holding people back from seeking help and getting support.

Culture and race intersect with mental health in the communities engaged for this report. Stigma is different and often deeper and more complex in certain ethnocultural groups. For example, a group of South Asian women noted that there is shame associated with mental health and addictions challenges in some communities. Families risk being rejected by their communities if a family member’s mental health struggles are revealed. As a result the individual often avoids seeking help and suffers in silence.

Substance use/Addictions The most frequently mentioned issue was excessive drinking in the Caribbean community, linked to the fact that bars are a centre of social activity in the Oakwood-Vaughan area.

Another issue in a number of neighbourhoods is addiction to pain medication among construction workers and other manual and seasonal labourers – male and female. Many newcomers doing physical labour are the main or sole source of income for their families and extended families living elsewhere. When they are injured, they want to get back to work as soon as possible, which makes them particularly susceptible to dependence on pain medications.

There is a lack of capacity to meet the mental health needs of the diverse populations living in Central West Toronto – particularly providing multi-language/culturally appropriate care, care to children with behavioural challenges and transitional age youth (going from the children’s to the adult system), early intervention for group’s facing stigma, and supports for people with serious mental health challenges.

“People are now waiting six months to a year for case management and ACTT teams.” –Steve Lurie, Executive Director, Canadian Mental Health Association, Toronto

Safety The Police (13th Division) noted a recent increase in street-level drug use and other associated community safety concerns among transient populations moving between St. Clair and Eglinton, in particular.

While gangs are not a pressing issue in the area now, there continues to be a common perception that the area is unsafe – a perception that is reinforced by visible drug use in public spaces.

Many in the community point out that there is a difference between the perception of safety and the true risks in the area. As a result of gentrification, people who are new to the neighbourhood may have outdated perceptions from a decade ago when there was a wave of high-profile shooting incidents in Oakwood- Vaughan.

A number of local residents observed that more outreach services for those with mental health and/or addictions challenges is needed.

Vulnerable and underserved populations There is a need to address the needs of vulnerable and underserved populations. There is a need for existing service providers to partner, support coordination, referrals, and cross-sector planning for a range of high- needs groups. The most underserved groups identified through the consultations are:

• Children with behavioural challenges • At-risk youth: sexual health risks, mental health and substance use, particularly those at a transitional age • Pregnant teens • Isolated seniors - in Toronto Community Housing buildings, private subsidized housing, and basement and storefront apartments • Newcomers, particularly those with mental health and addictions challenges, LGBTQ, refugees • People who are undocumented/lack OHIP

Specific Findings

Children Consistently those consulted identified an absence of programs for infants through the school-aged children, particularly in Oakwood-Vaughan and Caledonia-Fairbanks. Many noted that there are no local early years programs or other models that work well in other communities such as the Program without Walls, led by the Macaulay Child Development Centre together with a group of other agencies, to support the health and development of children out of different community sites.

Another notable finding is low uptake of infant and children’s testing – eyesight, hearing, cognitive etc. – among some newcomers and a need to educate parents about the importance of these tests for child development.

A lack of after-school programs and affordable camps for children are seen as major barriers for low-income families. It was also noted that the children’s and parent’s support programs such as the Ontario Early Years Program are not geared toward teenage/young mothers and that these young women often stop attending.

“Working two jobs, parents often don’t have much left at the end of the day.” – Staff, Abrigo

Youth All groups who were consulted mentioned the absence of programs, recreation options and positive community spaces for youth in Oakwood-Vaughan and Caledonia-Fairbanks. Within Oakwood-Vaughan, residents observed that funding (federal and municipal) for recreation programs had “dried up” over the last decade. There is a sense that youths in the community are underserved and that this is negatively affecting their health and social development.

“There is nothing that caters to people over 3-years-old.” – Young adult, Oakwood-Vaughan

Similar to youths from Oakwood-Vaughan with whom we spoke, youths in Weston-Pelham Park who were part of the Davenport Perth Neighbourhood and Community Health Centre’s 2012 needs assessment expressed that their needs were being overlooked. Lack of a community space or a recreation centre for youth in or near Weston-Pelham Park was highlighted, as was the fact that youth have to leave the community to access age-appropriate programs.

At the same time, Oakwood-Vaughan community members are encouraged by the prospect of a community hub and want play an active part in improvements for youth. Teenagers and young adults in the community would embrace opportunities to be healthier.

“We don’t have a drop-in for youth. East of Vaughan to Rogers and from Winona up to Eglinton – the communities are so varied and there is no one thing for young people. The Libraries have good programs, but they are not a draw for all youth” – Pastor Barnett

According to youth involved in focus group and interviews in Oakwood-Vaughan and Caledonia-Fairbanks, the following are the most important attributes of a community-based hub and the programs/services that they would like to see a hub offer and support:

Attributes

• Comfortable, welcoming place for youth. A youth-oriented space. • Anonymity and discretion. A number mentioned they are embarrassed to talk about sexuality and mental health. They want to have a different primary care provider than their parents and are concerned about family and neighbours knowing they are seeking help – i.e., seeing them in the waiting room to see therapist or counselor. • It is important to have professionals as well as peers with whom they are comfortable speaking about their problems and questions. • Some feel that it is important that youth view a hub as an open space they can drop into offering a place to socialize with peers and take part in activities • A community hub could possibly offer health care services, but this would need to be a “soft sell” allowing youth to find their own way to these services. • No-cost and affordable facilities and programs. Many youth expressed that cost inhibits their participation programs and activities. Their parents cannot afford camps, lessons and recreational activities. • Effective communications about community, social and health service availability is crucial: use social media, and inform principals and guidance counselors at school, as they are key information sources for students. • Location: proximity is very important. Youth consistently expressed how important it is to feel like the hub is part of the community in which they live; that it is “their space”. For example, youth and young adults who have lived in Oakwood-Vaughan for a long time remarked that the Fairbanks Memorial Community

Centre is difficult to get to on foot, bicycle and TTC, is outside the core neighbourhood, and caters to seniors and not youth.

Services and Programs • Access to outdoor and indoor recreational programs and facilities was the most frequently mentioned service that youth are looking for. • Youth are looking for reliable, clear and useful information on a variety of topics related to health and wellbeing. The most mentioned topics are sexual health, birth control, pregnancy, relationships, and mental health. It was mentioned that homophobia and transphobia in different communities discourage some young people from getting good information about sexual health and relationships and this is contributing to high rates of STIs. • Safe, confidential access to mental health support. It is important to understand the additional stress that newcomer teens feel – that they often internalize the stress of the family trying to adjust to Canada. • Access to free contraception is important. • The youths with whom we spoke affirmed what providers (e.g., Toronto Public Health, Davenport Perth Neighbourhood and Community Health Centre) said – parenting and early years programs are not designed to meet the unique needs of teenage mothers and there is a stigma associated with teen parents. Programs geared to teenage/young mothers would make a positive difference in the community. • Youth mentioned a range of health care and other activities that they believe are missing from the community. Following were the most frequently mentioned: o Free wifi and computer use/lab o A place where youth can participate in activities they are interested in: skills-building, learning from experts – e.g., training for different sports, cooking, fashion, career planning, financial planning for college/university. o Free tutors

Other observations • Youth and other community members in Oakwood-Vaughan expressed concern about the rumored closure of Vaughan Road Academy. They indicated that the high school has very good recreation facilities, including a pool, that are not being fully utilized for the community. Given the limited, affordable recreation options in the neighbourhood, many community members think the high school should be used for the community rather than sold.

Seniors There were two distinct groups of seniors consulted for this report.

Group 1 • Relatively able seniors who are connected with cultural and community groups and agencies and informed about and actively involved in their health. These seniors tend to be younger.

Group 2 • Isolated seniors with complex health and or social needs. These seniors range in age, some are homebound, and all are isolated for a variety of reasons including one or more of marginalization, language and cultural barriers, poverty, lack of a social support network, and poor physical and mental health and/or serious substance use issues.

Group 1: For the first group of relatively able seniors we consulted, the following are the most important needs, attributes of programs/services that they mentioned.

Needs and concerns

The seniors with whom we spoke expressed concern about isolation and feel that involvement in community and cultural groups and activities has a decisive impact on their health and wellbeing.

“My biggest issue is solitary living. It affects my health.” – Portuguese senior

There is also a great deal of concern about losing independence. They mentioned worries about loss of mobility and falls and the ability to manage pain without relying too heavily on medications.

Many seniors are looking for support to manage chronic diseases such as diabetes and hypertension. They want opportunities, information and tools to help themselves and feel fortunate to have access to some programs through organizations such as the South Asian Women’s Centre, Abrigo, and Davenport Perth Neighbourhood and community health centre. However, they would value having greater access to these types of programs, closer to where they live, and recognize that many of their neighbours and friends are not connected to health promotion, prevention and self-care programs.

Attributes Seniors emphasized the importance of having accessible services – that are available during flexible hours when they need care, physically accessible and comfortable for seniors.

Seniors who speak little to no English stressed how difficult it is for them to be informed participants in their health care without language and interpretation support. Although some would prefer to have a physician/other health professional who speaks their language, they think that interpretation support including telephone interpretation would be very helpful.

Seniors from different backgrounds commented that they did not always feel included or listened to when receiving health care. They would value having better communications with a physician and team.

Services and Programs

“When I am home I don’t feel like cooking. It’s more enjoyable to cook here (at the community kitchen).” – Senior, Doug Saunders’ building

The two most frequently mentioned service needs are access to primary care and preventative and social/recreation programming.

Most seniors felt that they have a family physician. For example, eight out of 13 South Asian seniors (Indian, Tamil and Pakistani) said they have a regular family physician. However, less than half said they visit a primary care physician when they have an immediate concern or problem. One has a physician in Collingwood and half of the group said they tend to either call 911, go to walk-in clinic, or call Medvisit. Others in the group have medical home visits. In contrast, one senior was registered with a community health centre and talked about the value of having access to a team and getting advice by phone.

A number of seniors are aware that their physicians are retiring and there is a general perception that physicians in the area (Corso Italia-Davenport, Oakwood-Vaughan, Caledonia Fairbanks) are not taking on new patients.

Some seniors commented on fragmentation between the different services and agencies that they use. For example, primary care physicians are not well connected with community and recreation services in the area

33 and rarely refer patients to these services. They also noted long wait times to see specialists, a lack of information and follow up, and finding waiting for appointments to be confusing and stressful.

Group 2: Isolated seniors with complex health and or social needs. Residents of the Doug Saunders apartments as well as a sample of Meals on Wheels clients living in the Oakwood-Vaughan and Caledonia-Fairbanks area identified that it is necessary to have mobile/itinerant services and clinics that are delivered where the seniors live and gather.

Residents said that the most important programs to have on-site in a seniors’ building are: health prevention, social programs such as a communal kitchen that offers cooking classes, and a regular primary health care provider/clinic.

Meals on Wheels clients/homebound seniors The clients interviewed want to be as independent as possible. All seemed to struggle with isolation and some do not leave their homes for services. While some clients appear to be resigned to their seclusion, others want to be more involved in activities and groups in their community. Clients cited a lack of mobility and poverty as the greatest barriers for not receiving services.

Women Needs and concerns The women consulted for this report identified a number of distinct health and wellness needs and concerns, the most frequent being reproductive and sexual health, parenting support, and specific gender-related mental health issues.

Young women highlighted that they have to travel far and wait long periods for gynecologist appointments and do not know where to address sexual health concerns in Oakwood-Vaughan and Caledonia-Fairbanks, in particular.

Domestic violence and other forms of violence against women and children were mentioned as an issue that traverses age and ethno-cultural groups.

Toronto Public Health and others working in the community observed that there are isolated mothers in the Oakwood-Vaughan and Caledonia-Fairbanks area who will accept home visits but are reluctant to go out and join programs. Programs Without Walls, a mobile new Mom’s program delivered by Macaulay Child Development Centre and other agencies at various sites in Central West Toronto, is the type of model that might appeal to some new mothers and parents.

Another gap is a lack of visible or known pre-natal programs in Oakwood-Vaughan. For example, there are no Canadian Nutrition Prenatal Programs near Oakwood-Vaughan and the closest program at Woolner Avenue and Jane Street is far to travel and not easily accessible by TTC.

In certain cultures, there is a major stigma associated with women with mental health and substance use issues – particularly women who are relied upon to take care of children and aging parents. Several women discussed post-partum depression. They observed that services are there during a crisis, but that women are often not getting connected to an ongoing support system after the crisis subsides.

Immigrant communities Language barriers will become an increasing issue in neighbourhoods with growing newcomer populations such as Oakwood-Vaughan and Caledonia-Fairbanks. Some older immigrants who arrived in Canada after the Second World War continue to have low English literacy and rely on their children and other relatives for translation. Some have physicians who speak their language, however, some of these physicians are nearing retirement, leaving these seniors in a precarious position. Newcomers told us that some people avoid walk-ins and EDs when they are sick because of language barriers.

The most commonly mentioned unique mental health issue for newcomers are trauma and post-traumatic stress disorder (PTSD) as a result of experiencing war and violence.

There is a wide perception that there is a tendency for senior men from the West Indian community as well as other older immigrant groups to avoid health care until they get seriously ill.

Primary care physicians Approach We took a two-track approach to engage primary care physicians.

1. One of the Toronto Central LHIN’s Primary Care Physician Advisors, Dr. Yoel Abells, who practices in the Central West Toronto area interviewed primary care physicians in Oakwood-Vaughan and adjacent neighbourhoods who are 65 years of age and over. These physicians are primarily in solo practices. 2. Santis Health interviewed primary care physicians who are part of the Davenport Perth Neighbourhood and Community Health Centre, Toronto Western Family Health Team (Newcomers Program and Family Inpatient Service) and West Park Family Health Team.

Central West Toronto primary care physician engagement findings The goal was to have a primary care physician speak with physicians, peer-to-peer, about the realities of practice today, the patient care needs and challenges they see, and their concerns and any plans regarding preparing for retirement and transitioning their patients to other primary care practices.

These conversations are the first step in building an ongoing relationship with physicians in the neighbourhoods of focus. A next phase is to organize group sessions in the community on practice management, including furthering the discussion about how to support retiring physicians to transition patients to other practices.

Engaging solo primary care physicians is challenging and takes time. Given that most area physicians have stand-alone or walk-in practices, it is difficult to coordinate with them and for them to find the time to participate. The key to engaging them is clearly communicating that the intent of the discussion is to find ways to support them in their practice and to enhance patient care. It took considerable time and effort to reach these physicians. However, once Dr. Abells was able to arrange a conversation with them, physicians openly shared their experiences and perspectives.

Retirement age physicians Each of the five physicians with whom Dr. Abells spoke are concerned about what will happen to their patients after they retire. Many of their patients are medically complex, socially complex or both.

Some hope to make a modest income from selling their practices, but are not confident that their paper-based practice (no Electronic Medical Record) will be attractive to younger physicians. Some physicians have a plan for transitioning their practices, but others do not and say they cannot find the time to think about it right now. They would value assistance in transitioning their practices and connecting their patients with other primary care providers. Administrative support, including contacting patients, is what they need the most. 35

Another finding is that some younger physicians are moving from Central West Toronto neighbourhoods to other areas inside and outside of Toronto to join a Family Health Organization, which is contributing to loss of physicians in Central West Toronto.

Primary care physicians in CHCs and FHTs serving Central West Toronto Health Link area All of the CHCs and FHTs interviewed have patients from the different neighbourhoods in Central West Toronto including Oakwood-Vaughan and Caledonia-Fairbanks.

From the vantage point of these physicians, partnering with other providers to deliver mobile and outreach services to homes/community sites for residents who have difficulty accessing care, especially isolated and homebound residents could contribute to residents’ health and wellbeing. Increased service coordination and integration could also help link people with community-based services and for system/service navigation.

Conclusion and Recommended Next Steps: Towards Meeting Community Needs in Central West Toronto

The age, gender, ethnocultural, and socio-economic groups in Oakwood-Vaughan and surrounding neighbourhoods have significant and varied needs. These needs are compounded by multiple access challenges including that services are not available locally, not accessible or designed to meet residents’ needs, and not well coordinated or integrated.

The needs assessment and gap analysis reinforced that many of the programs and services that enable people and their communities to be healthier and more resilient need to be locally designed and delivered. However, given the magnitude of the gaps and needs, it is not feasible to attempt to tackle all of these needs with same intensity at once. Community planners will need to carefully prioritize and sequence populations of focus, programs and services. Certain groups with much greater needs and less access to primary care and other health resources may be targeted first for action.

Primary care is a clear gap and a foundation for people’s health and wellbeing. The most pressing physician/primary care access issues identified are: attaching people close to home who have high needs and poor access, and transitioning people whose physicians are retiring. There is also a recognized need for more primary care resources – services that are available after hours and the weekends, culturally appropriate and linguistically diverse, delivered through teams, and well-coordinated with other levels of care.

There is also a need to support physicians currently practicing in the neighbourhoods of focus, including those who are not part of a team or group and would benefit from wrap-around health and community services.

Numerous service providers, community members and groups have expressed great interest in contributing to initiatives to improve health and wellness in Central West Toronto. However, organizations generally operate in siloes, in part, because there has not a platform to bring groups together to develop a common plan and coordinate efforts.

The Central West Toronto Needs Assessment and Gap Analysis did not include a complete inventory of services or asset map. However, through this process, many health, community and social service organizations provided insights, information, and shared examples of programs, services and collaborations in

36 the area. The crucial next step is to gain a comprehensive picture of the resources and services that can be leveraged, coordinated, and enhanced.

We do know that in the fall 2016, the Toronto Western Family Health Team (Garrison Creek site) will be opened in the Oakwood-Vaughan area. The Family Health Team (FHT) will provide primary health care for up to 15,000 patients and will accept new patients living within the area surrounded by: Bathurst Street to the east, Keele Street to the west, Eglinton Avenue to the north and Dupont Street to the south. The team will consist of 12 family doctors, a nurse practitioner and other health professionals including nurses, pharmacists, social workers and mental health workers. The diverse expertise of the staff will allow for a wide range of services to be provided to patients, in addition to primary care. For example, the FHT will be able to hold education sessions so patients and their families can learn about different health conditions and learn how to maintain their health. Patients will be seen by the health professional best suited for the care they need.

The FHT will be a welcome development in the Oakwood-Vaughan neighbourhood. Local health service providers, and other community partners are now in a position to leverage the results of this report to further inform local planning.

During consultations, discussions of a “community hub” were had. The community will now need to explore what how best to purse the identified health and social needs of Oakwood-Vaughan. A “hub” of services and supports may be an asset to the community.

There is a risk that if the hub is seen to be a general space for everyone, it may not be an attractive/welcoming venue for the groups with the greatest or unique needs. Community partners will need to carefully look at different ways gaps and service eeds for key populations can be best addressed. There is a general agreement among those involved in the consultations that the populations of early focus should include: children and young parents, youths, isolated and homebound seniors, high-needs patients whose physicians are retiring, and groups requiring mental health and addictions coordination and support.

Key Considerations Moving Forward

While this is not an exhaustive list of the requirements for further planning through the Needs Assessment and Gap Analysis, a number of considerations were identified so frequently that it is important to restate them. • Engagement and creating a community solution is key. It is important to build confidence and trust in services so that they truly reflect community need, evolve with the community and contribute to community development. • There is skepticism in Oakwood-Vaughan – There has not been any significant expansion in health and community services in the neighbourhood for some time. The Toronto Public Health building that used to be at 524 Oakwood was originally open to the community then closed its doors to the public, which created a barrier. People do not tend to think of 524 Oakwood as a welcoming address. At the same time, some community members are uneasy and discontent about the Cornerstone shelter opening in the neighbourhood, contributing to potential wariness about the that location. • Services/supports need to be accessible in every way – Culturally competent, and provide language support, extended hours, flexible service delivery, telephone and email communications, easy referrals, coordination, and team-based care. Mobile services and programming should be an option. • It important to learn from and leverage culture-based programs in the area – e.g., More than a Haircut. • Anonymity is important to consider. There is a need to address the stigma associated with mental health, substance use and sexual health.

• Language support is crucial given the large number of non-English- speaking residents and growing newcomer population. • There is a need for high-quality, customized information and education about health and wellbeing.

Next steps The most critical next steps are: 1. Determining governance and who will lead and be involved in next stage of planning.

2. Creating an asset map of services and opportunities for collaborations and joint planning – particularly related to youth, mental health and addictions, and isolated/high-needs seniors.

3. Strategize with stakeholders about how to work together to meet the needs of local populations and strengthen neighbourhoods, including maximizing community resources. The relationships that were initiated during the Needs Assessment planning provide a strong foundation upon which to build.

4. Formalize and dedicate capacity for engagement of community members and primary care physicians, in particular. Maintain and build on the momentum and goodwill created through the needs assessment and gap analysis.

Appendix A.

Central West Toronto Hub Governance – Steering Community Hub Committee and Council

Background

A Community Hub Steering Committee will be created to ensure that those with the most direct involvement and stake in primary health and community care in the Central West Health Link are steering the community hub planning process and collaborating on key decisions for the project’s first phase – current state, gap analysis and blueprint.

The Steering Committee will be accountable to the Toronto Central LHIN as the funder and executive sponsor. The LHIN is accountable for guiding and approving the phase 1 report and blueprint and will determine the implementation process that follows.

A Community Hub Council will be created as an avenue for a broader group of key health and community stakeholders to be informed about, and provide input on the gap analysis and blueprint.

Reconnect Mental Health Services will provide project leadership for the first phase, including overseeing consultant services and supporting the Steering Committee.

Roles and Responsibilities The Steering Committee (SC) for phase 1 of the project is accountable to the Toronto Central LHIN for making strategic decisions about the key project deliverables and for steering all aspects of the project. The SC will review project progress reports at each meeting and determine mitigation steps for project risks.

Key project deliverables: • Community and stakeholder engagement and communications plan • Setting Council meeting agendas • Communications materials • Supporting/participation in resident, primary are and stakeholder engagement • Gap analysis findings and prioritization • Blueprint development • First draft and final report submitted to the Toronto Central LHIN

Membership Mohamed Badsha, Chief Operating Officer of Reconnect Mental Health Services. (Chair) Rishika Williams, Director, Central West Toronto Health Link Antoinette Larizza and Rose Cook, Senior Consultants, Toronto Central LHIN Teri Arany, Executive Director, Toronto Western Family Health Team Kim Fraser, Executive Director, Davenport-Perth Neighbourhood and Community Health Centre (DPNCHC)/Tammy Décarie, Director, Health Services, DPNCHC Mark Campbell, Executive Director, Nia Centre for the Arts Dr. Yoel Abells, Toronto Central LHIN Primary Care Lead/Advisor

Timeframe • May - November 2015 • Bi-weekly meetings for the first 2 months; and consider monthly meetings after that

Central Toronto Community Council Mandate

Roles and Responsibilities

The Community Council will provide a formal avenue for a broader group of key health and community stakeholders to be informed about, and provide input and insights for the gap analysis and blueprint. Specifically the Council will: • Support information-sharing with a broad stakeholder group • Provide expert advice and input on the current state and gap analysis, priorities related to populations and services, and the Community Hub blueprint • Support engagement of key community and stakeholder groups

Chair The Council will be chaired by Mohamed Badsha, Chief Operating Officer of Reconnect Mental Health Services.

Membership • SC members • Toronto Central CCAC • Reconnect Mental Health Services • United Way • Toronto Public Health • Toronto Community Housing • St. Clair West Services for Seniors • Christie-Ossington Centre • Planned Parenthood • Emergency Management Services

Timeframe • 3 meetings between May and November 2015

Appendix B.

Stakeholder Who Approach type/population Youth Youth Work, Parks, Forests and Recreation, City Interview of Toronto Oakwood Village Library Youth Council Focus group For Youth partnership Focus group Oakwood-Vaughan youth Interviews in collaboration with Seg’z restaurant and Kevin Clarke Seniors Seniors at Doug Saunders’ building – tenants Focus group (multiple languages) and community members Meals on Wheels clients in Central West Health Interviews Link area Abrigo Portuguese Seniors Group Focus Group (multiple languages) South Asian Women’s Centre Focus Group Women Young women in Oakwood-Vaughan Interviews in collaboration with Seg’z restaurant Parents Macaulay Child Development Centre, Parent Focus group with parents Advocacy Training Oakwood-Vaughan parents Interviews in collaboration with Seg’z restaurant South Asian South Asian Women’s Centre – Wellness Group Focus Group (multiple languages)

Residents - City of Toronto Community Consultation Town hall general

Oakwood-Vaughan Community Working Group Facilitated discussion

Stakeholder Who Approach type/population Community Josh Colle, Councillor, Ward 15, Eglinton- Meeting leaders/members Lawrence Pastor Barnett, Bethel Restoration Interview Scott Baptist, Superintendent, 13 Division Interview Central West Rishika Williams, Director, Central West Toronto Toronto Health Link Community Hub – Antoinette Larizza and Rose Cook, Senior Steering Consultants, Health System Integration, Design Committee and Development, TC LHIN Teri Arany, Executive Director, Toronto Western Family Health Team Kim Fraser, Executive Director, Davenport-Perth Neighbourhood and Community Health Centre (DPNCHC)/Tammy Décarie, Director, Health Services, DPNCHC

Mark Campbell, Executive Director, Nia Centre for the Arts Dr. Yoel Abells, TC LHIN Primary Care Lead/Advisor

Central West • Steering Committee members Toronto - Council • Aleen Banji, Toronto Central CCAC • Lorraine Duff, United Way (Toronto) • Sujata Ganguli, St. Clair West Services for Seniors • Lynn Daly, Christie-Ossington Centre • Sarah Hobbs, Planned Parenthood Toronto • John Klitch, EMS • Lisa King, Toronto Public Health • Dulce Gaspar, Toronto Public Health

Providers and Toronto Public Health Interview agencies • Urban Issues Community Health Officer • Manager, Health Babies, Healthy Children Program • 2 area Healthy Family Managers

Anishawbe Health Toronto, Babishkhan Unit, Interview Executive Director; Concurrent Disorders Counsellor, Aboriginal Mental Health & Addictions Program Canadian Mental Health Association (Toronto), Interview Executive Director Baycrest, Stakeholder Relations and Special Interview Projects Loft Community Services, Director of Adult and Interview Youth Services Mothercraft, Executive Director Interview Macaulay Child Development Centre, Executive Interview Director Metropolitan Action Committee on Violence Interview Against Women, Executive Director COSTI Immigrant Services, Executive Director Interview and Staff Stakeholder Who Approach type/population Primary care Five physicians from Oakwood-Vaughan and Interviews and group discussions physicians adjacent communities at/nearing retirement

Davenport-Perth Neighbourhood and Community Health Centre – primary care physicians

Toronto Western FHT – two primary care physicians

Dr. Weinstein, Unison - home visits to TCH buildings in CWT Health Link

West Park FHT – Executive Director and physician

Health Davenport Perth Neighbourhood and Interviews and group discussion professionals and Community Health Centre staff • Director of Health Services • Settlement Counsellor • Nurse Practitioner • Early Years Program Manager • Seniors’ Services Manager

Appendix C.

Central West Toronto Community Hub Questions for Health care providers and community agencies

The Toronto Central Local Health Integration Network is working with local health care organizations, the City of Toronto and other partners to plan a community hub at 524 Oakwood Avenue. This hub will provide multiple health and community services to Oakwood-Vaughan and other nearby neighbourhoods.

The community hub in CWHL will be designed to serve residents living in these neighbourhoods today and to respond to future needs as the community changes.

The hub will provide a range of health, medical and social services that the community needs.

To determine what the community needs and what is most important to the health and wellbeing of area residents, the Community Hub Steering Committee planning the community hub will be holding sessions and interviews with people who live in Central West Toronto.

Your feedback will be taken into consideration when the Community Hub Steering Committee designs the community hub and the programs and services delivered out of 524 Oakwood Ave and potentially other locations.

Part I - General Questions

1. What do you do/activities do you do to stay healthy? 2. Do you have a regular family doctor/clinic that you see when you or your family is ill? 3. Where do you go if you/family member has a common illness like the flu or red and irritated eye? 4. What health issues are you most concerned about? 5. What kinds of services or assistance are most important to have in your neighbourhood? 6. If you could ask for one or two improvements to the way health services are provided, what would they be? 7. What local health and community programs and services work well and why? 8. Describe a time when you/your family had a positive experience seeking health care in your community. 9. Describe a time when you/your family had a difficult experience seeking health care in your community.

Part II - more probing questions that can be used in focus group/facilitated sessions

Community members have talked about their difficulties accessing services as well as what basic health and community services are important to them – e.g., such as family physicians.

We would like to know more about what these mean to you.

(Optional - ask people to rank in terms of importance and impact)

(Facilitator- read qualities identified and probe as needed – one quality per flip chart sheet).

1. Having the health services I need available at different times of the day and weekends (probe whether this means an after hours clinic, being able to get advice from a physician by phone, seeing another member of the health care team such as a nurse practitioner. May need to explain what a nurse practitioner is) 2. Not having to wait a long time/be on a wait list. 3. Services available in my own language (incl. telephone interpretation) and/or professionals who speak my language. 4. Receiving services from the same team of health professionals every time. 5. Having health professionals who listen to me, try to understand all my health needs, and give me good information. 6. Having knowledgeable professionals who are able to refer me/my family to different services and supports that I/we need (e.g., medical, community, housing, legal). 7. Having a one-stop shop/one location where I can receive a range services that I need to be healthy and when I am sick. (ask them to describe what this looks like to them)

Before voting, ask if there is anything else that’s important to them that is not listed and that should be captured?

For certain groups, ask a small number of specific questions pertaining to their health situation. Here are a few examples:

Diabetes (Tailor preamble/introduction according to population and neighbourhood).

• Do you know where to get information and support for yourself/family related to diabetes? • What is needed to improve diabetes prevention and management?

Cancer Screening (Tailor preamble/introduction according to population and neighbourhood).

• Do you know what cancer screening tests are available and when people are supposed to be screened? • What would help you/your family get screened for cancer?

Mental Health (Tailor preamble/introduction according to population and neighbourhood).

• Do you know what is available in or near your community to help people stay mentally healthy to help them cope with emotions/stress/mental wellbeing? • What kind of services and supports are needed to help people who have mental health concerns?

Pregnancy and Childbirth (Tailor preamble/introduction according to population and neighbourhood).

• Do you know what services for pregnancy and childbirth are available in the community? • What services would you like to see for pregnant women and newborns?

Seniors

• Do you know someone who is housebound or unable to leave their home because of illness or disability? • What is needed to support these seniors to live more safely at home/in their communities so that they do not end up in the Emergency Department or hospital?

Central West Toronto Community Hub Questions for Health care providers and community agencies

The Toronto Central Local Health Integration Network (LHIN) is working with local health care organizations, the City of Toronto and other partners to plan a community hub at 524 Oakwood Avenue. This hub will provide multiple health and community services to Oakwood-Vaughan and other nearby neighbourhoods.

The community hub in CWHL will be designed to serve residents living in these neighbourhoods today and to respond to future needs as the community changes.

The hub will provide a range of health, medical and social services that the community needs.

Background Go through a few slides to describe the neighbourhoods and population in CW Health Link and specific neighbourhoods.

1. Which populations/groups do you serve/see/are your patients/clients? 2. Can you provide a sense of the proportion of your patients/clients that are from neighbourhoods in CW Health Link area? 3. What are the main health and health-related issues in these residents? 4. What are the most significant health care gaps you see/are aware of (probe about age groups, populations affected and how) in these communities? 5. What are the reasons for these gaps/unmet needs? 6. What changes and improvements would address these gaps? 7. What are some of the ways your organization is/and can help to address these gaps? 8. How could a community hub contribute? 9. What do you think the community hubs priorities should be – immediate and over the long term? 10. Are you aware of initiatives/programs/services in and around CW Toronto that could be leveraged for the populations in the seven neighbourhoods in this area? 11. Can you suggest some programs and services that could be better coordinated with the support of a community hub?

Appendix D.

References and Data Sources

Data Sources

Canadian Institute for Health Information. National Ambulatory Care Reporting System Abstract Database (NACRS), Discharge Abstract Database (DAD).

City of Toronto Neighbourhood Profiles.

Statistics Canada. Census 2001-2011.

Toronto Central Community Care Access Centre (TC CCAC).

TC CCAC - Client Health Related Information System (CHRIS).

Toronto Emergency Medical Service. Community Referral by EMS database (CREMS), EMS utilization history data.

Toronto Transit Commission. www.ttc.ca

Urban Heart database

Reports and Grey Literature

Health Quality Ontario, Quality in Primary Care: Setting a foundation for monitoring and reporting in Ontario.

Central West Toronto Health Link – Environmental Scan, Sept 2013

David Hulchanski, University of Toronto, Neighbourhood Change Community University Research Alliance, St. Christopher House and Cities Centre, The Three Cities within Toronto: Income Polarization Among Toronto’s Neighbourhoods, 2007-2005, Nov. 2015

DPNCHC Community Needs Assessment (Dec 7, 2012) Media reports

425 Bloor Street East, Suite 201 Toronto, ON M4W 3R4 Tel: 416 921-7453 • Fax: 416 921-0117 Toll Free: 1 866 383-5446 www.torontocentrallhin.on.ca