Population Health

Our Story | Our Services | Our data | Our Team|Our Work


Our Story

ICHA’s Population Health Services was launched in October 2019 to add data-driven and community-level programming and dedicated public health capacity to ICHA’s foundational clinical programs and services.

In March of 2020, ICHA’s Population Health Services developed a regional strategy to respond to COVID-19 in shelters, ensuring that COVID-19 positive individuals had access to dedicated facilities where they could receive health services and supports during their isolation at Canada’s first dedicated COVID-19 Recovery Site. ICHA clinical and Population Health services opened the Site and, working with city and community partners, transitioned the program to operate through a clinical partnership that sustained it over the intervening months.

In April 2020, ICHA Population Health launched the COVID Assessment and Risk Evaluation (CARE) program to respond to the complexities and risks faced by people experiencing homelessness (PEH). The program offered individual and shelter-level COVID prevention and mitigation interventions as well as COVID immunization planning and supports in shelters across Toronto. This provided a deeper understanding of clients’ needs across our partnering shelters and individualized services targeted to enhance autonomy among the homeless community and to support the ultimate goal of ending homelessness.

The high demand for our vaccination efforts and health promotion work drove the development of the Community Health Ambassador Program (CHAMP) which strengthen health promotion capacity in the shelter system. The CHAMP program propels COVID-19 recovery among PEH by creating a cadre of community-based shelter providers better able to support COVID-19 outbreak prevention and management, to promote and enhance immunization uptake, and to serve as a bridge between shelter clients and healthcare providers. Working within a health promotion and community-based model, and provided with the training, resources, and compensation to successfully perform their role, health ambassadors are important and supportive partners for the shelter community and the health sector.

Our evolving efforts and programs work at an organizational, shelter, and individual level. They present a new lens for understanding shelter/individual risk scores, provide site-specific supports and create opportunities for high-risk clients to receive support designed to reduce COVID-19 exposure risks and to leave the shelter system. The grassroots service delivery that underpins CARE and CHAMP allows us to deploy and distribute our team and expertise more effectively and precisely, strengthening the support and services we bring to program partners supporting PEH. Shelter leaders continue to reach out for COVID-19 prevention and mitigation support, vaccine delivery and health promotion. We are answering the call.

Our Services

ICHA Population Health delivers programs and services that improve health and access to safe, supportive housing at the population level. Our programs are driven by the most pressing client health needs, and based on a philosophy of health promotion, community capacity-building and evidence-based practices.

Our services address the complexity of health care for people experiencing homelessness, bridge gaps between health care and social services and support ICHA’s clinical operations with interventions best delivered at the population level.

Our services include:

  • Community-led health promotion: We deliver community-based health promotion that is guided and led by people with lived experience of homelessness. With an initial focus on COVID-19 and other communicable diseases, infection prevention and control, immunization uptake and outreach to high-risk individuals, our health promotion program positions people with lived experience as health champions and leaders within their communities.
  • Direct health services: We deliver direct clinical interventions at a population level, with a focus on enhanced communicable disease management services for shelters across the Greater Toronto Area (GTA). This includes accessible testing for priority communicable diseases and enhanced immunization services in shelters across the GTA through low-barrier mobile vaccination clinics.
  • Data-driven practices: We generate and provide clients and shelters with the data they need to enhance services and end homelessness. This includes individual and shelter-level rapid needs assessments and sector-wide analyses. Our partners use these data to target services to the people who need them most, and to design programs that meet the most pressing client needs.

Our Data

Using the CARE risk assessment tool, we work closely with shelter staff to capture clients’ health and support needs. This gives shelter and healthcare providers a snapshot of their population, enabling them to provide customized services based on the specific needs of their clients. We have also developed an interactive electronic dashboard for accessible knowledge translation of risk stratification data across our varying partner organizations.

For more information about our services and/or opportunities for collaborate, please contact Dr. Aaron Orkin, Director of Population Health Services.

Our Team