Webinar: Surfing the Second Wave: Maintaining Access During the COVID-19 Pandemic

COVID-19 has increased the challenges faced by some of the most vulnerable populations, including people struggling with addiction and mental health. This webinar features an expert panel discussion on the implications that this pandemic has had on substance use services and supports. Our panelists will reflect on what measures and efforts were effective for their organizations during the first wave of the pandemic, and which were not, with the view to preparing for the likely second wave. Speakers include representation from a number of healthcare sectors, including treatment, primary care, virtual care, shelters, and community support and harm reduction services.

You can watch more of our past webinars on our Youtube.

00:00 Introduction
10:49 Surfing the Second Wave: Maintaining Service Access during the CVOID-19 Pandemic
11:23 Who We Are
14:22 Complexity of Client Population
16:25 Fallout of the Pandemic
22:50 Key Themes We Are Seeing in Ontario
25:07 Erin Knight
28:41 Virtual Care
32:07 Changes in Substance Use Patterns
33:44 Needs for Next Steps
35:41 About BC Mental Health & Substance Use Services
36:26 Defining Virtual Health
37:00 Primary Goals of the Initiative
38:00 Enabling Technologies
39:11 Successes to Date
41:43 Preliminary Data: Zoom
42:58 Preliminary Data: IMITS Videoconferencing
43:38 Preliminary Client Feedback on Virtual Family Visits
44:28 Sustainability Planning
45:28 Gilliana Soto
51:10 Q&A

00:00 Introduction

Rita Notarandrea: I want to thank you for taking the time to join us today. My name is Rita Notarandrea, and I’m the CEO of the Canadian Centre on Substance Use and Addiction. CCSA is excited to be hosting this webinar today during recovery month and we’re doing this together with EHN Canada, and the New Start Foundation for addiction and mental health. Surfing the second wave and maintaining service access during COVID-19 pandemic. CCSA has been involved in recovery month activities across the country for at least five years now. The topic of service access is important to us, especially today and it’s timely when we look at what’s happening across our country. As the people we serve face increased challenges on their journeys to wellness, it’s through events, such as these that we can all bring about some change, big or small. So, let me start with some housekeeping updates. This webinar is being recorded and will be sent out to participants early next week. It’s also going to be posted on the New Start foundation YouTube page. Also, if you have a question, please use the Q and A function to submit these. We will try to get to as many as we can during the QA session at the end. Now, allow me to introduce my co-moderator today. Patrick Maubert, and Patrick is a harm reduction worker and advocate with lived experience. He is the health and wellness lead at Halifax Pride as well as the Atlantic region community trainee at the community-based research center. Patrick is currently in his second year of his BSW at Dalhousie school of social work and is working on the SUNAR project that stands for substance user network of the Atlantic region. This is meant to build capacity and policy frameworks to enhance the lives of people who use substances across  Atlantic Canada. Thank you so much, Patrick, for joining us, over to you. 

Patrick Maubert: Oh, thank you. Thanks Rita. It’s really incredible to be here. I really appreciate it. As many of you know, September is recovery month across Canada and Reed, and I are really excited to be able to host this important discussion today with our addiction and mental health peers from across the country. So, I guess we have over 900 participants today. Wow. That is something. So, it’s a couple of things as well to add in this virtual space, we will treat each other with respect and dignity, regardless of age, race, gender expression, gender identity, sexual orientation, levels of ability, and all our other diverse identities. Everyone entering this online space and joining us today has a responsibility to uphold these values. CCSA, EHN Canada, New Start Foundation and all of our panelists today are committed to and encourage all those of you who gather with us today to be mindful of how long and how often we speak so that everyone has it chance to contribute, consider the impact of privilege and intersectionality on discussions, listening to each other, so we understand the various perspectives. Avoid crosstalk. Crosstalk is giving advice to others who have already shared speaking directly to another person rather than to the group and questioning or interrupting the person speaking at the time. We are all here to grow, to connect and to share our light in this space. We also recognize that Ottawa, which is, I guess, where our sort of online base is today, although we’re from all over Canada—we acknowledged that Ottawa is located on unceded territory of the Algonquin Anishinaabe nation. We extend our respect to all First Nations, Inuit, and Métis people for their valuable past and present contributions to this land. As mentioned, our panelists are from across Canada, as well as our attendees. Welcome. If at any time during this webinar, you feel triggered or require support of any kind, we do have a licensed social worker available for emergencies. Her name is Cathy Hume. You may call her on this secure and confidential line, which will be posted in the chat area of the webinar. So just for those of you who can’t see that chat, it’s a 1 877-385-4099, participant code seven, nine Oh seven one four six, pound. I think it would be easier to probably to read it in the chat function. Otherwise, yeah, Kathy can speak to one person at a time. So, if you cannot get through immediately, but require support, she will be available until 1:30 PM. Please also try the wellness together Canada portal. This is the government of Canada’s portal  and can provide free counseling, again, that link will be in the chat portal. Please note that any responses or activity on this platform are not being monitored. If you are in crisis or worried about harm to yourself or to others in any way, we urge you to contact immediate support services. So, over to you, Rita. 

Rita Notarandrea: All right. Thanks so much, Patrick, we’re going to be sharing this, everyone. I saw the chat room. Yes, it’s okay. If you’re from the UK and we can all learn from one another. So, thanks so much, Patrick. We’ve all experienced, in the past seven months, the roller coaster. This is, we’ve experienced this in our communities, the country and the world. So, we’re all eager to learn and, COVID-19 has really impacted us all in so many ways. Certainly, in our fields of substance use addiction. Addiction medicine significantly, but also in our personal lives, our panel today will focus on the implications that COVID-19 has had on substitute services and support. Also, we’re going to reflect on what worked well and maybe what didn’t work so well, but all with the view to, how can we learn. How can we prepare for the second wave in terms of services and supports for those who use drugs and people living with substance use disorders? So, our panels will share information from their own experiences that they feel will help in these preparations. So, on that note, I’m going to turn it back to my co-moderator Patrick, to introduce the wonderful panelist. 

Patrick Maubert: All right. Thanks Rita. Yes, we do have some incredible panelists today. So, let’s get started. I would like to introduce you to our esteemed panel. I thank them all for joining us and sharing their experiences and expertise. I will introduce them in order of their presentations today. 

So, our first speaker of the afternoon is Adrienne Spafford. Adrienne is the chief executive officer of Addictions and Mental Health Ontario. She has held senior positions at the Ontario Long-term Care Association, Ministry of Health and long-term care infrastructure, Ontario with the former premier on Ontario. She is well known for commitment to quality and humanity in the delivery of care, in the area of mental health and addiction. Thanks so much for joining us today. 

Our second panelist is Dr. Erin Knight. Dr. Erin Knight is a family physician and fellowship trained addiction physician with the international society of addiction and medicine certification and a certificate of added competence, CAC in addiction medicine through the college of family physicians of Canada. Erin practices family medicine at the Aboriginal health and wellness center in Winnipeg, and addiction medicine at the health sciences center in Winnipeg and the Beatrice Wilson health center in Opaskwayak Cree nation. She is the medical director of Addiction Services at HSC and the co-medical lead for Rapid Access addiction medicine. That’s RAAM provincially. Thanks for joining us. Erin. 

Our third panelist is Kim Korf-Uzan. Kim is the director of E-mental health and special projects, BC Mental Health and substance use services PHSA. Kim’s role is specifically focused on supporting the implementation of virtual and digital health initiatives using technology to optimize wellness, specialty care, and outcomes for clients. Thank you, Kim. 

Our fourth and fifth panelist will work today. It’s a duo, we have Anne. Anne is the director of nonresidential programs at Atira woman’s Resource Society and not for profit organization, committed to the work of ending violence against women and holds a bachelor of human ecology degree, majoring in family violence and conflict resolution and child and adolescent development from the University of Manitoba. Gilliana Soto. Gilliana is a program manager at Atira’s sister space and provides women who use substances with a safe and supportive environment where they can use substances in the presence of peer support workers who are trained in overdose response. The program is run by Atira’s women’s resource society in partnership with Vancouver, coastal health, the city of Vancouver, BC, Housing BC, Women’s Hospital, and the Provincial Health Services Authority. Welcome.

Rita Notarandrea: Thanks so much, Patrick. So, the format today we’re going to get started. We’ll include a short presentation from each of the panelists, as we’ve mentioned before, and then there’s going to be a short Q and A. So, let’s begin over to you, Adrienne. 

Adrienne Spafford: Hey, thanks very much and thank you so much to Rita and Patrick for moderating today’s discussion and to CCSA and a New Start Foundation for hosting this. I’m just going to share my screen here. Bear with me. We’ll see if that works. There we go. 

10:49 Surfing the Second Wave: Maintaining Service Access during the CVOID-19 Pandemic

Adrienne Spafford: Okay, great. So, I’ll go over a little bit what our organization is, Addiction and Mental Health, Ontario. We were really, I’m here hopefully to reflect on, what our collective membership and the clients that they serve, experienced during the pandemic with sort of an eye on, what to think about for a second wave. And I would say beyond a second wave, because I don’t think we’re ever going back to the old normal myself. 

11:23 Who We Are

Adrienne Spafford: So, who we are, Addictions and Mental Health Ontario, we’re a member-based umbrella organization and we represent over 200 providers of direct services and supports for people living with addiction and mental health or mental illness with addiction issues and mental illness and our collective vision as an organization is the best addiction and mental health system anywhere. I am sort of speaking because it’s my scope very much from an Ontario lens. Hopefully in the discussion we can talk a little bit more nationally about what we’ve seen is similar and what we’ve seen is different. Well, we really do represent the full continuum of services in both mental health and substance use. We have community-based organizations that are members, hospitals that are members, consumer survivor groups, community health centers, and some primary care organizations as well. Our role is really, to advocate to government on behalf of our membership and the clients they serve for higher quality and more services and support. To digest a lot of what is going on at government back to our members so that they can cooperate with government policy. And then thought leadership, among the rest of their health care sector, as well as through the media on how to advance services and supports for people living with mental illness. I’ll just pause briefly to say that, as an association, our job pretty much changed 360 degrees over the course of the pandemic. Six months ago, my main job was to attend meetings at Queen’s Park, which was our presidential legislature. I advocate for evidence-based solutions on behalf of our members. You know, we’ve got a large provincial commitment for this government, $3.8 billion in new services and support, for mental health and addiction. We’ve been trying to get that funding to the front line, and with the blink of an eye our job as an association really shifted to supporting members to be able to stay open during the pandemic. That was a real challenge. I’ll go through a little bit more of that in specifics. But I think like many of those on the front line, like many of you in your individual lives, the role of umbrella organizations like addictions and mental health Ontario has fundamentally changed. We’re not sure if it’s ever going to go back.

14:22 Complexity of Client Population

Adrienne Spafford: I think when we talk about the impact of COVID 19 on people living with mental health challenges and addiction that it’s important that we talk about it’s a very complex client population and it was already getting more complex. So, people with mental illness and addiction are more likely to die prematurely than the general population, based on CAMH, it can cut 10 to 20 years from life expectancy and many clients already have compromised immune systems where they have AIDS, hepatitis C, liver disease, chronic heart disease. Many of the medications that people might be taking in order to survive can contribute to obesity and diabetes. So, it was interesting during the initial wave of the pandemic, where in Ontario, we saw the government be quite, understandably and necessarily, caught with the issue of residents in long-term care homes and the needs that they had, that we really did need to remind decision makers that, the clients living particularly in some of the residential withdrawal management programs or the residential addiction treatment program that, that COVID-19 taking hold in those environments were also particularly risky and we needed attention to make sure that that didn’t happen. Then of course, housing, income support and social supports are already very challenging for many of the clients before the pandemic. I’ll speak a little bit to some of the phenomenal progress that actually happened, in terms of housing people who are sleeping rough or precariously housed that we have here in Ontario. I hope that we can take the tremendous effort that happened there and find a way to get some permanence for it.

16:25 Fallout of the Pandemic

Adrienne Spafford: In terms of the fall out of the pandemic, we’re really, really conscious that, I’ll go back to long-term care. But also, in acute care, that I think we’re going to see particularly, if we have a second wave that is as challenging as has been predicted, that healthcare workers are not just going to be going through stress or mild-to-moderate depression and anxiety, but that there’s going to be a level of trauma that occurs that never would have occurred if it weren’t for COVID-19. So, I think as a system, we need to be ready for that surge in demand and we need to make sure that those services are able to deal with trauma and the impact they think that there was some early research done at the beginning of COVID-19 that looked at the trauma that wasn’t incurred during the SARS pandemic. When you think about the limit of the SARS pandemic now versus COVID-19, it was predicting that tens of thousands of healthcare workers are going to need support for trauma. We’ve done a little bit of public opinion research and that public opinion research did show that people were concerned about the increase in their substance use due to stress related to COVID-19 and also concerned about their children’s use of substances. Use of cannabis, in particular, as well as video gaming on the non-substance side. So, I think generally when we talk to decision makers in government, they’re already there in terms of acknowledging this as a problem, and now we need to get to, so what’s the solution? The stress on families from the economic shutdown in isolation cannot get not be underlined enough. I’m a mom of two young kids. I’ve got a six-year-old and a two-and-a-half-year-old. You can see that I’ve been stuck here in my bedroom since the end of February and I never leave. And I’m a person of tremendous privilege and, you know, I have a house with multiple bedrooms and don’t need to work in the middle of a dining room with, with, you know, 10 people around me. I also think about, you know, the kids that are not living, the kids, the women, the people that aren’t all living in secure households, where, a lot of the, what they were able to access for support, was outside of their home and I think we really need to be mindful, especially if we go into a second wave that we’re going to be going into a really long period of time where the typical supports for people who relied on, a teacher, seeing something a friend’s parent being sort of a mentor to them, that those typical social supports are not, available anymore. Then the impacts are even more profound as I sort of spoke to a little bit earlier for people who are precariously housed, for low income people, for racialized and indigenous people in Ontario and there’s really two intersections and I recognize this. I speak to both of these things from an incredible place of privilege as a white woman, but there has been a huge intersection of the pandemic. The boiling over, as they say here of anti-black and anti-indigenous racism and oppression. I think that all of our members are experiencing it. We’re a very, when we look at our membership, it’s a very white led membership. And there’s a lot of frontline staff that are racialized. I think that some really important conversations that need to turn into action are happening among the leadership around how we can go encourage more indigenous and black led services for people in Ontario, but also how we can turn around services so that they’re safer, more accessible, so that indigenous and black people are not intersecting with the justice system in order to access services multiple times more than white people. We’ve also seen a horrible impact on the overdose crisis related to the pandemic. Ontario’s chief coroner recently said that overdoses on a weekly basis are up to 40% higher than they were before the pandemic. So that’s just in Ontario alone. I know there was some very troubling numbers to come out of Alberta yesterday, where they’re closing down supervised consumption services. This is, you know, I say this under knowing that Patrick is a harm reduction worker himself. There’ll be other people on the panel that will talk to this. But, but for harm reduction workers, this is a population that has been dealing with a crisis for a long time and seeing lives lost for a long time. I think that we all need to recognize the trauma related to that. Also seeing society act so quickly and swiftly and spend money on the COVID crisis when there’s this other crisis that is not getting the attention it needs. It’s painful. In terms of, just general health calls, we’ve run an organization called Connects Ontario, which was sort of like a, a directory of services. They’ve seen a 20% increase in anxiety related calls and a steady change in substance related calls—increase in stimulants for men, an increase in alcohol for women. 

22:50 Key Themes We Are Seeing in Ontario

Adrienne Spafford: This is my last slide. Just keep seeing things in Ontario. There was a huge shif, and others will speak more specifically to this, and I know we’ll deal with it in the Q&A. A huge shift to virtual care. For some that meant a lot more access, particularly some teens or single moms who had childcare issues, maybe they were able to access virtual care more than they were able to go in person to a session before the pandemic. But for others that’s meant less virtual care. The research is still out in terms of where that virtual care was really beneficial and where it’s not good enough. There’s also a lot of hospital-based substance use services like residential withdrawal management, as well as mental health services. Like we’ve got mobile crisis intervention teams which is a healthcare professional working with police to respond to crisis calls and where the hospital was the funding recipient or the employer for those services. A lot of times those healthcare professionals were pulled out of that service so that they could be ready for the ICU patients that would be coming in with COVID-19. And we don’t know, like other people have talked about cancer surgeries being cancelled or being put off. We don’t know what that impact is going to be on those services being shut down. We have such a long-standing issue of performance measurements and data in community mental health and addiction. I thought, like so clearly during the pandemic, how that lack of data is thwarting attempts to secure funding and meet demand. We just hear over and over and over again because we don’t have the data that says “this is a perfect evidence-based solution that could deliver us X outcome, we can’t give you more funding for that program, even though your waitlist are two years long.” So, I just think it’s really important that we get the data that shows the programs have particular outcomes to that decision maker and funders impact peers feel well making those investments in those services. I’ve already spoken about the overdose stats and I’m just going to end on the amount of energy that happened between the province and the municipalities to get people, that needed shelters that were looking for shelter spaces housed in hotels was phenomenal and why we can’t be as good at housing outside of a crisis, because we can be inside of a crisis. So, I think we all need to do some thinking about what that is, and really putting pressure on decision makers, to look at more permanent solutions. They’re happy to see housing be part of the throne speech yesterday. But we all know that commitments can be made and it can take a very, very long time to act. We don’t have a long time with winter coming down the road and housing is such an important part of recovery and able to live, if you are someone who is dealing with substance use or mental illness, so, I will look forward to the Q and A, that’s it for me back to you, Patrick and Rita.

Rita Notarandrea: Wonderful. Thank you so much, Adrienne. I’m now going to turn it over to Erin Knight.

25:07 Erin Knight

Erin Knight: Thanks very much Rita. So, I don’t have any slides to share. So, I’m just going to speak throughout this portion of the presentation. I am speaking from the perspective of a frontline addiction physician, working in both the hospital setting and in the community, and in my role as the medical director I also have some interface with leadership and with government as well. So, we’ll speak a little bit about that, but mostly in terms of frontline services. So, the services that are under our umbrella are the, we have a hospital-based withdrawal management service. We have a hospital based, addiction consult service for inpatients at our largest tertiary care hospital. Just recently expanded to our second tertiary care hospital, as well as a number of outpatient addiction consult clinics and the rapid access to addiction medicine clinic for walk-in care. Very happily, we didn’t have any of those services negatively impacted during COVID. I was asked very early on, whether we should be qualified as essential services, and happily I was able, with the support of people around me, we were able to advocate that these are all essential services and that we should not have had any decrease during the initial parts of COVID. So, we have maintained all of those services. We’ve actually expanded our hospital-based consult service and expanded some of our rapid access services during this time. That’s with the support of the hospital and the community and with some additional funding from government as well. I will speak specifically on three kind of main points. One, is that what we’ve learned from transitioning over to virtual care. One, around the changes in overall substance use patterns that we’ve seen. And then a couple of thoughts about needs for next steps. 

28:41 Virtual Care

Erin Knight: So, in terms of virtual care, we were able to pivot quite quickly to offering virtual care. This has never been a part of our clinical services in the past, but for our outpatient services, we, fairly quickly, were able to transition into offering the option of telephone or web based visits for both initial assessments and for follow-up care. There was some initial hesitation, from our hospital essentially and our health authority in terms of the security of the virtual platforms. Happily, we had leadership that told us that patient care was more important and so we were able to pivot to that with the support of our leadership and with informed consent from the patients who were accessing care through virtual services. One of the initial concerns, from a variety of people was how many of our clients would be able to successfully access virtual services either by phone or by internet based modalities. One of the lessons that we have learned is that actually quite a large portion of people have been able to access those services despite the requirement of having some kind of device and some kind of access to internet. So, we have continued to offer a mixture of in-person and virtual services throughout. But there certainly are subsets of the population who have really responded well to the virtual option. That includes, some people who we had never seen in service before, who had concerns about confidentiality and stigma. Who are able to access services through the comfort of their own homes, but who wouldn’t necessarily walk through the door of our clinic. The other population that we’ve noticed and received really positive feedback from is people who have childcare issues, which is extremely highlighted in the context of the pandemic where people, even if they have school aged kids now have kids at home, for a large portion of the time and aren’t necessarily able to access services. Those have been two real highlights of success. The other thing that virtual care has helped us to do is actually in some contexts connect with really highly marginalized people who have a connection to perhaps a peer support worker in the community, or have a connection to one of our outreach services in the city and feel comfortable going in to see their outreach worker and can then connect with us through their outreach worker by virtual care. Whereas, it had been difficult to coordinate them coming in to see us in person. So, some really positive aspects in that regard. 

32:07 Changes in Substance Use Patterns

Erin Knight: If I move on to just talking briefly about changes in substance use patterns, that’s been, something that has been very, very obvious in Manitoba, over the last two to three months. So one of the things that we’ve seen in general is an overall increase in substance use related presentations to crisis services, and to emergency departments in hospitals. That’s across the board. There’s a lot of theories about why that’s happening, but certainly stress and time at home. For some people the financial impacts. But what we’ve seen locally as a transition from, predominantly, lots of, presentations with crystal methamphetamine in Manitoba over to illicit opioids, over the last number of months. Part of the, the thought behind this is that some of the border closures have impacted the drug supply quite significantly. We’re seeing a really strong uptick in people using some of the illicit fentanyl and carfentanil products that have been reported in our neighboring provinces for a number of months and years that we didn’t previously see in Manitoba. So, this is leading to increases in overdose related EMS, responses over dose related presentations to the hospitals and more need for access to opiate agonist therapy in the communities. 

33:44 Needs for Next Steps

Erin Knight: Then the last thing, that I am going to comment on is just some needs for next steps. So, one of the big things in our outpatient services that has been required in terms of our access to services, throughout this pandemic is limiting the number of people in the waiting rooms. We’ve done that partially through, the option of people accessing virtual care. But it also has meant that we’re limiting how many people can come into the physical space of the waiting rooms. And as we move into winter, that’s going to be a really, really big issue for us, especially in Manitoba where we have quite a severe winter conditions. So, that’s something that we’re already, training to troubleshoot as we will. It’s easy to ask somebody to stay outside, in the summer months. While we’re screening somebody for COVID before they can enter the building. But we certainly need to address that before the change in the weather for the winter time. Then, in terms of other next steps, we’re certainly seeing with the surge of opiate use, that there’s a huge need for continued progress in terms of harm reduction services, where we’re unfortunately, quite far behind in Manitoba, and in expansion of availability of opiate agonist therapy within the communities.

Patrick Maubert: Okay, well, thank you so much, Erin. our next up we have, Kim. Kim Korf-Uzan. 

Kimberley Korf-Uzan: Hi, everyone. Thank you so much for having me today. So as mentioned in the introduction, I work with BC Mental Health and Substance use Services. So just a couple of words about them. 

35:41 About BC Mental Health & Substance Use Services

Kimberley Korf-Uzan: BC Mental Health and Substance use Services provides highly specialized treatment for people across the province, with serious and complex mental health and substance use challenges. We also serve individuals in custody and people who have been referred by the courts for assessment and treatment. So, I’ve just provided a list of our programs here, but you’ll see that we serve, through, a combination of bed based or inpatient programs as well as, serving clients, in an outpatient basis through our regional forensic psychiatry clinics and clients in correctional health services, as well as a serving a number of contracted mental health and substance use beds, including residential substance use treatment beds. 

36:26 Defining Virtual Health

Kimberley Korf-Uzan: Through our work at BC Mental Health and Substance use Services, we work really closely with The Office of Virtual Health at PHSA or The Provincial Health Services Authority. So, I just provided their definition here of virtual health, but they really see virtual health as being a patient centered care model. That’s focused on connecting patients, families, and providers, and using technology to optimize wellness, specialty care and outcomes. So, it’s really this way of connecting patients and having them be able to access care that they need from anywhere. At any time.

37:00 Primary Goals of the Initiative

Kimberley Korf-Uzan: So, when COVID hit and we realized we were going to need to make a really quick shift to be able to deliver virtual health services, one of the first things that we talked about were what are the key goals of our initiative. So, first and foremost, we wanted to enable our clinicians to be able to deliver services via virtual health when working remotely. We also wanted to provide our clients with tools that would facilitate access to treatment and resources. We wanted to enable our clients to have connections to their family, friends, and loved ones, especially in our inpatient programs where visitation and access to the sites was limited due to physical distancing measures and risks around transmission. Then, finally we wanted to look at virtual mechanisms to facilitate a lot of the group-based programming that was a big part of a lot of our programs, but which in some cases had to be temporarily suspended because of physical distancing measures. It’s also a way to ensure that we can have one way for our care providers to collaborate, even when they’re not physically in the same space.

38:00 Enabling Technologies

Kimberley Korf-Uzan: So, some of the enabling technologies that we’ve been working with, many of you are familiar with. I think folks have mentioned some of the video conferencing services that have really ramped up. We’ve been using things like Zoom, Skype for business, and MOVI to facilitate video conferencing connections. We’ve found that having a variety of platforms has really served us well in terms of options and flexibility. We’ve also introduced some new web based and online interventions. All of this has been supported through the addition of mobile devices, which was really new for us in our healthcare services. We’d primarily been used to using, you know, desktop and laptop computers. Now we had our clients and our care providers using tablets and cell phones to deliver care. We also introduce the use of a secure file transfer platform to enable the transmission of personally identifying information securely for our providers who are working remotely. We most recently introduced an email to fax technology or our prescribers who are needing to submit prescriptions and who may be working remotely, but don’t have access to a fax machine. So, lots of changes and lots of new different aspects of technology that have been supporting providers and working remotely and delivering care remotely.

39:11 Successes to Date

Kimberley Korf-Uzan: So, I won’t go over everything on this slide, but just a few examples of some of the successes that we’ve had to date. We worked really closely with our clinical leadership and our direct care staff, as soon as the COVID pandemic hit. In order to understand their current state workflows and develop future state workflows, which resulted in a number of new procedures being developed that really helped to, I think, support and direct our healthcare providers in delivering virtual care. We were also very fortunate to be able to have tablets and flip phones secured for our clients in our inpatient programs, to be able to connect to family and loved ones. I’ll speak a little bit more about that later because that’s been a very successful initiative. We onboarded some new virtual health nursing physicians who supported our physicians primarily who were delivering care remotely. We were able to do dermatology consults using our secure file transfer platform for our forensic clinic clients on an outpatient basis, we were able to have psychiatrists connect to them in their homes via Zoom. Therefore, limiting the need for them to access the clinic. For our forensic clients, all of our review board hearings have been moved to virtual as well. So, lots of shifts in the way that we’re delivering service. We also had the opportunity to temporarily expand access to an online substance use relapse prevention program. We’d been trialing this program and had a partnership with the organization that offered it through one of our inpatient services. Because of the pandemic, they really wanted to make a difference. Through our partnership with them, we were able to temporarily expand that access to clients across the province. Anyone who had a substance use challenge and wanted to access that service was able to do so for free for a time, which was particularly useful when a lot of community-based services, which weren’t considered essential, were no longer available to some of those clients in community. I mentioned an email to fax solution already. We also have enabled virtual interpreter services. So, these were services that again, previously were only available by phone or in person. Now we can have them enabled and connected through some of our virtual platforms. Finally, we’re starting to do a lot of group work virtually as well to minimize the number of people that need to be together in a room, but it’s still allowed for that type of face to face contact. So, we have clients that are now joining virtual community programs, such as AA and NA programs from our inpatient units, virtually.

41:43 Preliminary Data: Zoom

Kimberley Korf-Uzan: So, just a bit of data to show you kind of how this explosion of virtual health has happened in our programs over the last few months from March to August, we had over 1500 virtual visits and spent over 1100 hours in virtual visits across our different programs, and that was just in Zoom. So, we haven’t been able to, necessarily measure all of the different modalities that we’ve used, but Zoom has been where we’ve seen the biggest increase. We also deployed about 245 accounts right across our different sites. We saw representation in all of our different program areas and used by many different types of staff, including our physicians, direct care staff and leaders and administrators. So, this graph, I won’t go into detail, but basically you can see that there was a huge ramp up in the first couple of months after COVID in terms of use and it’s kind of varied across our programs depending on the need and the nature of our populations. With a really big spike up until June and then some numbers decreasing in July and August. We’re not totally sure why that is if it was just, you know, the numbers were stabilizing at that time. So, it’ll be very interesting to see whether there’s another upshoot in the fall, as we’re starting to see numbers rise again.

42:58 Preliminary Data: IMITS Videoconferencing

Kimberley Korf-Uzan: Then we also did look at our use of kind of traditional video conference modalities. It’s interesting. If you look here, you can see that, between April and August, we actually saw a decrease in some of our room based and traditional video conferencing methods, as Zoom and other web-based systems were going up. Again, that’s potentially to be expected given that a lot of our room-based systems are dependent on people being able to be on site or on our network. Many of the new web-based systems actually provide a lot more flexibility. However, you still see here, there are still significant number of visits happening through our traditional telehealth systems. It’s good to have different options available.

43:38 Preliminary Client Feedback on Virtual Family Visits

Kimberley Korf-Uzan: I included this slide here just with some quotes from a focus group that we ran with some of our clients at our forensic hospital, about their experience using tablets to connect with family and loved ones. As I mentioned earlier, we deployed tablets that had, they were iPads, that had either a Zoom or FaceTime installed on them and just saw some really fantastic feedback from the clients in terms of how meaningful it was for them to connect with family members. This goes beyond just, you know, the ability to connect during COVID. But really for some of these clients whose families weren’t able to visit them because of where they were in the province. Or just other factors that made that difficult, it’s been a really beneficial addition to our programming and to our clients who are in their recovery journeys. So, it’s something that we really want to see continue beyond COVID as well.

44:28 Sustainability Planning

Kimberley Korf-Uzan: So, in terms of just concluding around some of our next steps, we had to obviously ramp all of this up very quickly. So, we’re looking at ways to kind of take some steps back and look at how we can better monitor, evaluate, and continually improve the way that we’re delivering virtual health services. We want to really sustain and enhance some of this innovation that’s happened. A lot of it, we see benefit in continuing to be able to offer to our clients beyond COVID or whatever the new normal looks like. We’d like to see this be part of whatever that is. We’re currently working on a virtual and digital health strategy. That’s going to really lay out the roadmap for how we will sustain that over the next three to five years. So, that’s it for me and I look forward to the discussion at the end. Thank you.

Rita Notarandrea: Thanks so much, Kim. Thanks so much to Erin as well for just the data that’s been presented. It’s really, really helpful. We’ve heard so much about it. So now, our last panelists are Gilliana Soto and Anne. Welcome, and it’s over to you.

45:28 Gilliana Soto

Gilliana Soto: Can you hear me? Okay. Sorry about that. I’m just going to give you a little bit of oversight of who we are. Sorry. I’m nervous. So, Sisters’ Space is the world’s first and only Women’s only community accessible overdose prevention site in North America, we opened up on May 16th, 2017 in the Vancouver’s downtown East side. The program is run by the Atira Women’s Resource Society in partnership with Vancouver Coastal Health. We can accommodate up to 30 women at any given time. We provide clean harm reduction supplies, connect the women to resources in the community, such as counseling, housing, housing outreach, legal advocates, etc. We also do drug checking. We provide snacks, warm comfortable place they can seek refuge and use their drugs safely. If they choose, we can also connect them with addiction services and healthcare. We know from our own experiences at Atira and Downtown east side, that women often face significant barriers in accessing coed services. Where they are faced with having access to resources such as safe consumption sites with their abuser. At this point many of the women make the decision to use alone in the alley. For example, they think it’s safer, but in reality, we know this can cause more harm and put them in jeopardy. Just as much, if not more. Also, the risk of overdosing increases. That’s where Sisters’ Space comes in. Sister space is a safe and respectful, clean, supportive program that is peer led. The peers are the women who run Sister Space. They live in the community with addiction and multiple barriers, which makes it easier for the women who come through the space to be able to relate with the peers and the peers understand what they’re going through. They’re truly concerned for their safety and wellbeing. The staff and peers recognize that the women are the experts in their own lives and the decisions whether or not to make changes in their lives and what kind of changes, is theirs alone. COVID-19 has majorly impacted the women in the Downtown East side, it has taken away money resources, limited access to places that are open, increased overdoses to people, women using alone and increased violence against women. During the pandemic, Sisters’ Space capacity was capped at 8 women to be using in the space. Which came down from 30, thus turning away women and having time limits in this space, which we never had in the past. Before the pandemic Sisters’ Space did not have a time limit, and this was beneficial as we saw very few overdoses and have been fortunate not to have any overdose related deaths, knock on wood. Due to limited numbers and time limits of the women accessing the space, went back to using it in the alleys or alone and putting them at risk of overdose without any support. The space had strict guidelines put into place to keep everyone as safe as possible. We saw overdose response procedures change daily, sometimes multiple times in the day. We’re all trying to navigate through the pandemic. With the restrictions and the amount of women allowed in the space, as well as the resources everyone used in the Downtown East side being closed down or with limited accessibility it’s here we opened up Sisters’ Square in partnership with the City Center Foundation. A Sister Square is a tent located in the parking lot of one of our residential buildings, where we’re able to sit up to 30 women with social distancing and it’s open 24 hours a day. Unlike Sister’s Space, which is only open for 18 hours a day and it’s closed from noon to 6:00 PM. It was a very fast decision that happened pretty much overnight. It was difficult as we were piecing things together to make things run efficiently, and we’re still learning as we go along of what works and doesn’t work. The peers have definitely made this possible. The tent was put into place to ease the impact of the women in the Downtown East side, creating a safe refuge for them to go to, even if they’re not active users. Women can safely inject or smoke their drugs. We provide warm, supportive place for women with several amenities, such as showers, washroom facilities, clean harm reduction, housing outreach, meals, juice, coffee, tea, and hot chocolate. It’s a safe refuge for any women to go. COVID-19 has been a huge culture shock, and this had been a difficult transition for everyone. Once again, the women of Downtown East side have shown how amazing, strong, and resilient they are. That’s all I have for you. Sorry. I’m very nervous.

51:10 Q&A

Patrick Maubert: Thank you so much, Gilliana. We really appreciate your insights. We will now begin the Q and A portion of our webinar. This will be a dynamic Q and A, so I guess, first question. I’ll take from this list here and then we’ll open the floor. So, were services closed or was capacity decreased during the pandemic shutdown? Has the system capacity returned to pre-COVID levels? And what do you think will happen in a next wave?

Adrienne Spafford: I can start, in terms of whether services were closed, I think it depended on the date. And I’m speaking from an Ontario perspective here. There was an initial pause while people sort of quickly adjusted. It also depends on the type of services. So, if services were primarily community based, meaning outpatient services or walk-in services. Then, it was a tremendous feat, but the work was done to shift over to virtual as quickly as possible. I actually think that our system providers in Ontario have just shown a tremendous amount of dedication to their clients and mobility to move over to virtual quickly. It was not done with government support. It was done in the absence of government support, I would largely say. Then the residential services, obviously that’s much harder. So, there were some services that shut down and then figured out what they needed to do, which was often about changes to their space to allow for proper physical distancing or isolation. Like if they had shared bedrooms that didn’t work anymore, being able to access testing for new people, new clients coming into the program, they wanted to get negative COVID tests before someone could be admitted to a residential program. Then I spoke to a lot of the hospitals about these services that are closed. So right now, in Ontario, we feel like a lot of those virtual services are still very robust and in place. People on the community side had just started getting back to both virtual plus in person and that’s sort of up in the air with the rising cases now again. In terms of residential capacity, we’re at about 40%, not in terms of who has their doors open but the number of beds that are available and so we’re really worried about those wait lists.

Erin Knight: That’s a very similar situation to in Manitoba where, a lot of our services and the outpatient services have pivoted to offering virtual care. But the residential services have been significantly impacted, in terms of access to treatment beds and access to withdrawal management beds outside of the hospital system. There are some programs that still have not opened up. The ones that have opened have significantly decreased capacity just to allow for physical distancing. It is creating a backlog in terms of long wait lists and difficulty for people to access services.

Rita Notarandrea: Thanks for that. That’s something we’re hearing as well, but, you know, I think Adrienne had suggested the issue of data. There are experiences of that, but the data isn’t really showing just how the capacity has decreased. So, thanks to both of you for saying that, in the essence of time, I’d like to move to a couple of things for when we go back to our own jobs and communities. What would you say are the top two initiatives, priorities that could be put into place within the next four months, six months to help prepare for and mitigate the risks of a second wave? So, any comments on that as we walk away from this, what would be your top two?

Kimberley Korf-Uzan: I could start. So, you’re asking about top two priorities for initiatives or specific things that we could do to be prepared?

Rita Notarandrea: Both actually it could be both. So, go ahead. Thank you, Kim.

Kimberley Korf-Uzan: Yeah, so, I mean, I think for us, we need to be prepared for if and probably when numbers start to increase and we see the second wave coming. For us, it’s really about, having the structures and the infrastructure, I would say in place to be able to respond quickly. I think the first time we were really caught off guard and people weren’t prepared and ready. So, we’ve done a lot of work within our programs, I would say over the last six months to put in place all of our pandemic plans. Have our business continuity plans in place to do advanced planning around if this and that situation happens, what are we going to do, how are we going to respond? So, I think those are the pieces that I am hoping are going to serve us really well going into these next few months, in terms of having had that time to prepare and having had the experience that we did in the last six months.

Rita Notarandrea: Thanks so much for that, Kim, any final words from the others, panelists?

Adrienne Spafford: I would say housing, I would say that, where we have people who are in hotel spaces that are precariously housed or sleeping rough. That we need to secure solutions for that now, so that we’re not catching up in winter. That we also expect we’re going to need more than we did during the spring and summer, just because of the cold. I would really like to see some decisions, some government decision and direction on what essential services are and then local planning that happens to make sure that those central services are available in whatever part of the healthcare sector or social services sector. It makes sense. That, for instance, if we can’t solve the problem that Gilliana was speaking to about the capacity within the overdose prevention site, and the number that they can serve. That at least the local community is planning to do something to deal with who’s not getting served.

Rita Notarandrea: I’m looking at the time and, I really want to thank you all. I think we could have gone on with some of the things you’d want to put into place, but I want to be respectful of everyone who is participating. So, first of all, thank you so much to the panelists for your presentations, much appreciated. That the hour has gone by way too quickly for me. But I didn’t even get a chance to say a few words on this, but I do appreciate what everyone has said and I want to thank Patrick for acting as my co-moderator during this session. So, Patrick, over to you for the last final words, thank you very much panelists.

Patrick Maubert: Thank you. What a pleasure Rita and thank you all to our panelists. I know I certainly have learned a lot, some great takeaways and thoughts, as to how we can all safely surf this next wave. So, thank you all so much for your time and thanks for joining us today to the folks out there that are participants. Thank you, be safe.

Rita Notarandrea: This has been recorded. I want to jump in and say, and it will be sent to all of you. So, thank you so much participants and panelists, the recording will be sent to you next week. Take care and have a great day.

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