Community Health Centres: An empowering and holistic approach to well-being

Whilst in Toronto, I attended the Ontario Association of Health Centre’s Conference – along with a few hundred others from across Canada and further afield. I was also fortunate enough to get the opportunity to visit a couple of Centres to see what goes on there.

Community Health Centres (CHCs) seek to provide services to those whose circumstances mean they may be vulnerable to poor health or face obstacles accessing the care they need  - they also aim to give people a voice and a choice about how their health care is delivered. An empowering idea of an approach if ever I heard one…but what’s the reality?

There are 1,500 Community Health Centres (CHCs) across North America but only 300 in Canada (most are in the States). Only 4% of the population of Ontario have access to a CHC and it is estimated that around 18% need access, so provision is lacking for many communities.

CHC’s provide primary care (and other services) to those with limited financial resources and focus on meeting the basic health care needs of their individual communities. They provide services to a range of groups living in poverty with who may otherwise face barriers to services e.g. homeless, residents of public housing, migrant workers, refugees, Aboriginal peoples. Centre's have an open-door policy, providing treatment regardless of an individual’s income or insurance cover.  They provide comprehensive care, including physical, mental and dental care.

As the opening speaker at the conference stated, CHCs;

“were born out of the struggle to create more equitable health and have a crucial role to play as catalysts of change”.

CHCs;

 “take a bottom up approach to serving communities….and recognise there is a circle of care that extends beyond clinical health.” 

 The Canadian model of CHCs has been heavily informed by the USA model where, it is claimed, the provision of CHCs has resulted in between 25 – 35% costs saved to the health care system (according to the National Association of CHCs - Centres save the US national health care system between $9.9 billion and $17.6 billion a year by helping patients avoid emergency rooms and making better use of preventive services).

The Community Health Centre model of care focuses on five service areas:

·         Primary care

·         Illness prevention

·         Health promotion

·         Community capacity building

·         Service integration

So - what are these Centres like....? I popped along to a couple to investigate...

North Hamilton Community Health Centre

I visited the North Hamilton Community Health Centre (NHCHC) about an hour from Toronto. Earlier this year, the centre moved to an environmentally friendly and very smart new building. The Centre is described as the “anchor” in the heart of the community it serves and is a place for community members, partners and staff to share together and work towards health and well-being - for present and future generations.

North Hamilton Community Health Centre

NHCHC uses a holistic approach to improving health of individuals and families and communities.  Elizabeth Beader,  Executive Director, shared with me their vision of, “No obstacles to health” and mission, “to enable health through healing, hope and wellness.”. So it’s not just about providing GP services (although primary care provision is based here too)…

NHCHC has around 180 visits per day and provides a wide range of services and facilities including:

1.       Community room

2.       Community kitchen

3.       Primary care services

4.       Children’s programs

5.       Pathways to education programme – encourages and incentivizes Grade 8 students at risk of ‘dropping out’ to stay in school by working with pupils and parents.

6.       Health Wellness Gymnasium – a smart new facility which is free to access. Helping address financial barriers to accessing private gym facilities for some community members.

7.       Health promotion

8.       Foot care

9.       Diabetes programs – including an outreach programme visiting shelters and  helping homeless people to manage their diabetes. Delivered using a partnership approach with Shelter Health Network and community centres.

10.   ‘Drop in day’ for seniors – to learn about services available, enjoy a healthy lunch and socialize with other older adults in the community

11.   Dietitians service

12.   Occupational Therapy

13.   Physiotherapy

14.   Client support services / counselling / social care

NHCHC also helps facilitate community outreach events with over 30 programs offered. Seen as essential for promoting the CHC programs and services available, these include:

·         Volunteer appreciation dinner – an annual event to thank the 200+ volunteers who lend skills and time to assist clients.

·         Community Health Day – which included an open house focused around healthy food (with a healthy lunch) and a discussion on the social determinants of health where the community were invited to share their thoughts on what could be done to create positive change around each determinant.

They also run a volunteer led Peer Support programme for people with chronic illness, which had some similarities with our Community Health Champion approach. The approach is based on the Stanford Programme and I’ve discovered this programme (or adaptations of it) are run by a number of CHCs…so will write a separate post on this later.

Access Alliance - Toronto

I also visited Access Alliance - a Community Health Centre based to the east of Toronto in an area with an extremely diverse community including many new immigrants and refugees. Their Vision statement reflects this – “Toronto’s diverse communities achieve health with dignity.” They seek to, “improve health outcomes for the most vulnerable immigrants, refugees, and their communities by facilitating access to services and addressing systemic inequities”.

The centre is based on a series of beliefs which inform their approach and strongly reflect the community driven, empowering approach to reducing health inequities:

·         All people should have access to the resources and supports they need.

·         Anti-oppression principles strengthen our work.

·         The strength and resilience of immigrants and refugees enriches our City.

·         Innovation thrives in a diverse environment.

·         Diverse sources of knowledge inform our practice.

·         Collaboration broadens our impact.

·         We are accountable for the provision of high quality services and programs.

Access Alliance CHC, Toronto

As we walked around the centre, in addition to the well equipped and pristine clinical and examination  rooms  - we were also shown the roof top community garden, the basement 'den' for young people to connect with each other in a safe environment, the Internet 'cafe' area where community members can access information and meet with each other and the range of art work on the walls which had been produced by community members and gave a real sense of ownership. All in all a great facility reaching and providing services to some of those in greatest need.

Some of the art work produced by local young people
 at Access Alliance.

The Access Alliance model of care can be found here.