Partnerships Help Fill Important Gaps in IPAC and Testing during COVID-19’s First Wave

OHA Introduces New Series Spotlighting Partnerships Aimed at Strengthening Mental Health and Addictions Care

COVID-19 has exposed gaps in access to mental health and addictions services in Ontario, especially with respect to the continuity of services during the pandemic. This has largely stemmed from the challenges introduced by COVID-19, such as isolation needs, access to testing, infection prevention and control (IPAC) demands, and availability of personal protective equipment. However, even before COVID-19 arrived, there was broad acknowledgement by government and system leaders that much more capacity was needed to meet the current and rising demand for these critical services.

This is why health system partners – hospitals and community organizations – have come together to address these gaps and develop innovative approaches to mental health and addictions service delivery. In this respect, COVID-19 had a silver lining. It helped accelerate existing partnerships, and at times, forged new ones that paved the way for creative solutions to service these gaps in care.  

This mental health and addictions series was initiated by Addictions and Mental Health Ontario in partnership with the Ontario Hospital Association to profile a number of these successful collaborations that developed in response to the pandemic. They illustrate the value of partnerships in solving system issues and underscore the responsiveness, commitment and creativity of health care providers in meeting Ontarians' most pressing health care needs.

Nothing brings people together like a crisis. When COVID-19 arrived in Ontario earlier this year, that's exactly what happened for many health care providers who moved quickly to respond to the global pandemic, knowing fully well that swift action was critical due to a rapidly spreading virus. With many unanswered questions, providers looked to one another for support and resources, drawing on the strength of existing relationships, some that were forged only when the province introduced Ontario Health Teams (OHTs) in 2019.

These relationships made all the difference for St. Michael's Homes, a Toronto-based organization that provides residential and out-patient addiction treatment, transitional housing, mental health drop-in, and psychotherapy services.

"When the pandemic first hit, we were very worried for a number of reasons – personal protective equipment was becoming hard to source, and we were also learning about COVID-19 in real-time," said Robin Griller, Executive Director of St. Michael's Homes. "Our partnerships were like a lifeline for St. Michael's Homes on a couple of fronts."

Michael Garron Hospital Offers IPAC Support

In the early spring, Griller immediately reached out to Michael Garron Hospital (MGH), a partner with the East Toronto Health Partners (ETHP), an OHT in East Toronto.  MGH partnered with St. Michael's Homes to provide advice on infection prevention and control measures (IPAC) needed to keep staff and clients safe, such as safe protocols for donning and doffing personal protective equipment (PPE).

On March 11, the first among many weekly IPAC phone meetings was held with representatives from ETHP's extended partners. About 30 people joined each time, representing 80 different agencies. During these calls, Dr. Jeff Powis, Medical Director of Infection Prevention and Control at MGH answered questions from the partners who asked about day-to-day challenges. MGH also shared various resources, such as human resources policies, to help guide partners through unchartered territory.

"We all have a role to play in the fight against COVID-19 and working with exceptional community partners like St. Michael's Homes helps lay the foundation for a truly integrated response to this pandemic," says Dr. Jeff Powis. "We know that a highly collaborative and integrated model of care is most effective when it comes to addressing the healthcare needs of our communities in East Toronto. In many ways, our experience with COVID-19 has highlighted the tremendous value of partnerships; the East Toronto Health Partners OHT has accelerated our ability to come together and rapidly respond to a global health crisis."

Griller notes that because there were no existing support systems in this area, being able to mirror what the hospital was doing with respect to IPAC measures was extremely valuable. This guidance helped St. Michael's Homes to continue providing much-needed services to clients who greatly depend on them, including shelter and rehabilitative supports for mental health and addictions. Thanks in part to MGH's support, St. Michael's Homes was able to implement good infection prevention practices that helped contain a small COVID-19 outbreak in April before it could spread among residents or staff.

This continued engagement during the pandemic significantly accelerated the integration work already underway, and more importantly, helped increase the level of trust among the partners. Similarly, challenges that may have gone undetected emerged during these conversations allowing system partners to take a collective approach to problem-solving. For example, MGH together with their community partners set-up seven COVID-19 pop-up testing sites in six different priority neighbourhoods that are experiencing high COVID-19 positivity rates and/or low COVID-19 testing rates. The collaborative, community-based approach breaks down barriers to healthcare access and addresses the social determinants of health that may make it difficult for some populations to seek or access care during the COVID-19 pandemic.

Women's College Hospital Offers Much-needed Access to Testing

For organizations like St. Michael's Homes, access to testing for staff, clients and for the intake of new clients, was essential during wave 1, in order to prevent transmission, protect staff and clients and also to continue running the program. With limited province-wide testing in wave 1 because of capacity constraints, from the early days of the pandemic, Women's College Hospital (WCH) was a valued partner in providing much needed COVID-19 testing to St. Michael's Homes and many other providers requiring testing supports to help identify and stop the spread of the virus.

"Women's tested the very first person we admitted to the program during wave 1 who turned out to be asymptomatic," said Griller. "If it had gone undetected, we would have likely had an outbreak which would have forced us to temporarily shut down our program."

The hospital understood the dire need for access to testing among its many community partners whose clients included individuals coming out of incarceration, those in shelters or facing homelessness, who don't have the resources to self-isolate or protect themselves from COVID-19. WCH developed a structured approach to service their testing needs through its assessment centre and committed to testing all those who needed it.

"Setting up the assessment centre was an extremely moving and rewarding experience for me," said Victoria Noguera, Clinical Director, Perioperative Services at WCH. "Being on the frontlines, I witnessed first-hand the many struggles individuals were going through, and I felt fortunate to be able to help with their needs whether it was a place to stay overnight or getting them tested so they could access treatment services."

Community partners also stepped in to assist hospitals. Clients and staff from St. Michael's Homes got to work sewing hundreds of cloth masks donated as part of MGH's #1000masks challenge. By working together, providers were also often times able to meet clients' health care needs in the community so they wouldn't end up in emergency rooms as a last resort. For example, staff from St. Michael's Homes and other community agencies have been working throughout the pandemic at the OHT's Harm Reduction and Health Services Hub to support residents in the underserved Warden Woods community.

There have been and continue to be many lessons learned from COVID-19. According to Griller, the pandemic exposed how under-resourced community providers are; many congregate living settings have multiple-occupancy rooms which was identified as a significant risk for transmission during the first wave. He adds that there need to be standards around IPAC practices across the system, which should be appropriately resourced, including adequate access to safe isolation spaces. Perhaps, one of the greatest take-aways is how the COVID-19 crisis fostered broader and stronger partnerships among health care providers. No doubt, this will help build greater momentum for system integration to enable seamless care for patients and clients across the system.