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Historic expansion of ICHA clinical programs to bring primary care, mental health and palliative care services to Toronto’s homeless population at every city shelter

May 14, 2021 – News

It’s official. The Ministry of Health has approved ICHA’s proposal to double its Alternative Payment Plan (APP) base funding, ensuring that all people experiencing homelessness in Toronto’s shelters and streets will have access to health care supports. It is equally exciting that ICHA can pursue other ambitious initiatives tied to the organization’s strategic priorities.

This critically important investment will increase ICHA’s annual physician funding from $5.6M to $13.5M in fiscal year 2022-2023 and increase health support for shelters from 40% current coverage to 100%. At maturity, the annual expansion funding tops $8,076,525 and includes allocations for administrative and virtual office support as well as one-time funding for monitoring and evaluation.

“Over the next few years, ICHA will more than double its reach and impact, offering people experiencing homelessness in Toronto more than 100 fully integrated, decentralized, virtually networked outreach practices with primary care, mental health care, population health, addictions medicine and palliative care,” says ICHA Medical Director Dr. Andrew Bond. 

This expansion has been a long time coming. ICHA submitted the proposal in August 2018 with support from health system officials, the homelessness sector, and academic leaders across the city and province. In the ensuing 2.5 years, discussions and deliberations between ICHA’s executive and board and senior Ministry of Health officials and political staff never ceased. And, ever mindful of the foundational relationship with the City of Toronto and other sector partners, ICHA ensured that its business plan for expanded coverage and increased service volumes informed, and aligns with, the City of Toronto’s Shelter Health Services Framework.

The proposal predates the pandemic, but the terms of funding reflect ICHA’s rapid pivot in 2020 to respond to the global public health crisis that continues to imperil the homeless community. That shift transformed ICHA from a physician organization to one providing inter-professional care and support, with ICHA leading the planning and delivery of medical and health services at COVID-19 isolation and recovery sites, physically distancing hotels, shelters, respites and drop-ins.

ICHA’s leadership and clinical teams collaborated with system partners and providers throughout all waves of the pandemic, and continue to work with them to quickly recalibrate approaches and adjust services and staffing models to meet changed and emerging needs.

The shift has been monumental, necessarily so. ICHA’s health system improvement strategy for people experiencing homelessness demands disruption, and at an accelerated pace given the enormous challenge and opportunity that COVID-19 presents.

“This historic funding will fuel ICHA’s transformation and, more importantly, help create an integrated, coordinated, community-based regional system of services to improve the health of our patients and Toronto’s homeless population,” said ICHA Medical Director Dr. Andrew Bond.

Building an integrated, coordinated system to bring services to the homeless community

ICHA is now positioned to go to scale with an integrated system of health supports for people experiencing homelessness. ICHA’s expansion will be aligned with the broader homelessness and healthcare sectors and integrated regionally and sub-regionally as part of Ontario’s broader Ontario Health Team reforms.  ICHA’s key contributions – from evidence-based compassionate clinical care, to population health planning to improve safety and up vaccinations, to innovative program design and coordinated services within a health system redirected to better serve people and improve population health — will continue, and grow. 

Retroactive Funding for COVID Recovery Efforts; Service Expansion Phased in over 3 Years

The increased annual funding will be phased in over three years, retroactive to fiscal year 2000-2021 to support ICHA’s COVID-related services.

During 2021/22, the APP expansion funding will predominantly support physician services as part of ICHA’s COVID-19 response, including the Isolation and Recovery Site, Enhanced Shelter Support Program, SCOUT (Street Clinical Outreach for Unsheltered Torontonians) and Population Health Service, including COVID vaccination.

An infusion of much-needed administrative funding will support ICHA’s Virtual Office which has absorbed many and new responsibilities during the pandemic. Current positions will be restructured to better reflect expanded double accountabilities and new team members brought on to fill remaining gaps and support clinical services expansion in 2022-2023.

Moving on (non-COVID) Strategic Priorities

The challenging work of protecting and caring for the homeless population during COVID-19 is not behind us. Indeed, COVID has worsened the health conditions of our patients and created new vulnerabilities – none of which will disappear when COVID abates. That said, the organization is ready to dedicate time and resources to other, and new, expansion projects that tackle our clearly delineated strategic priorities. To that end, we are eager to turn our attention to areas and innovative initiatives, including:

  • Health Services for Indigenous Peoples
  • Outreach to Encampments (SCOUT program)
  • Justice-involved people experiencing homelessness (Community Justice Centre in partnership with Ministry of Attorney General & Sound Times)
  • ICHA Rapid Access to Addictions Medicine (RAAM) Clinical Hub

Heartfelt Thank You to Members

The principled practice of every ICHA member – your dedication to giving each person experiencing homelessness excellent and wholistic clinical care – has powered this progress. We see it in how you work with each other and interact with a web of community partners to strengthen the health and quality of life of every individual in front of you.

This comes from a collective understanding of the need to create an integrated system of  services and supports to meet the many, complex needs of those without stable, safe housing. With your sustained advocacy, we can help shape a system that they can access and navigate, a system that surrounds and comes to them. 

COMMUNITY SUPPORT: Excerpts from letters of support for ICHA’s Expansion

“ICHA’s expertise and extensive experience in successfully working with homeless clients in shelter environments will be an important part of the new shelter health services model to achieve this vision of coordinated care planning between the health and homelessness service system.”

  • Toronto Mayor John Tory, May 2018

“…In addition to the importance of ICHA’s work for the community, the Faculty of Medicine would like to note your significant contribution to the education of numerous undergraduate and postgraduate medical trainees every year. This opportunity ensures that participating trainees are well prepared for the challenging work of caring for the homeless and is an important component in their professional and civic education.

  • L Trevor Young, Dean, University of Toronto Faculty of Medicine July 2018

“As a Department committed to providing the most skilled and socially accountable mental health career, we know just how essential the work of Inner City Health Associates is to maintaining the well-being and dignity of the most marginalized people in Toronto. We look forward to working with ICHA to expand educational and service opportunities. …This work will ensure that health human resource needs of the homeless health sector are met with the best community-engaged psychiatrists available.”

  • Benoit Mulsant, MD, MS, FRCPC, Professor and Chair, Department of Psychiatry, University of Toronto, August 2018.

“Inner City Health Associates has established itself as a national and international leader in specialist transitional homeless health care and has shown a tremendous ability to adaptively respond to the needs of the homeless on the streets, drop-ins and shelters. …I have full confidence that ICHA will be able to meet this increased demand for services with the greatest professionalism, quality, and collaborative service integration.”

  • Michael Kidd, Former Professor and Chair, Department of Family & Community Medicine, University of Toronto. August 2018.

“The work of Inner City Health Associates is a great example of alleviating pressure on hospitals by ensuring people get the right kind of care they need in the most suitable setting. The work to date has had a significant impact in reducing unnecessary ambulance call, preventing hospital readmission, and ensuring that patients receive the appropriate follow-up care they need.”

  • Ontario Hospital Association President Anthony Dale, August 2018