Coming together for digital equity

October 25, 2023
Black Creek Community Health Centre joins CMHA Toronto’s Virtual Community Care Hub to increase the impact and reach of their virtual diabetes management services. 

Virtual Community Care Hubs (VCCHs), established by CMHA Toronto in partnership with a group of community health care agencies in early 2022, are greatly expanding the online and hybrid options available for one-on-one and group mental and physical health care. 

VCCHs are spaces equipped with video and audio-conferencing technology where clients, service providers, and the public can engage in health care services and access group sessions on a variety of mental and physical health topics. VCCHs also include a device lending library, which makes iPads with data plans available to people who don’t have access to technology. 

VIRTUAL CARE BEYOND THE PANDEMIC

The VCCH model takes advantage of the collective effort of the agencies involved to take the next steps in online service delivery that became even more urgent at the start of the pandemic. 

“It started out as an opportunity through the Ontario Health Teams to look at who wanted to expand their virtual care offerings and how we could do that collaboratively,” says Jennifer Pettigrew, Manager, Primary Health Care & Nurse Practitioner (NP) Stepped Care, CMHA Toronto.  

The agencies collaborating on the VCCHs are learning together what works and how to improve the use of the different VCCH components to engage more people in programming and enhance their experience.  

“Depending on what partner is involved in the VCCH, I think they'd all tell you about different benefits,” says Michelle Rehder, CMHA Toronto’s Chief Clinical Officer, who led the successful multi-agency funding application to establish the hubs and, along with Jennifer, has overseen their growth. 

THE BLACK CREEK EXPERIENCE

Black Creek Community Health Centre (BCCHC) provides a range of healthcare, social assistance, programs, and services to families in northwestern Toronto. BCCHC joined the virtual community care hub initiative in March 2023 to increase access to virtual services for their clients engaged in diabetes management. 

 “When the pandemic began, we had to move very quickly to providing services virtually and transition our in-person groups to virtual,” says Michelle Westin, BCCHC’s Senior Analyst of Planning, Quality and Risk. “Connecting with the good work that CMHA Toronto had already been doing, this was an opportunity for our organization to take an existing model and expand it, using some of those resources to address the need for managing chronic disease in the community,” says Michelle. 

AIMING FOR DIGITAL EQUITY

Michelle Westin, who also serves co-chair of the digital health committee of Northwest Toronto Health Team, says that what drew her to the VCCH model was the opportunity to address digital equity and what that looks like in BCCHC’s northwest Toronto community. 

“Many members of our community are lower income. They may be living in apartment buildings where they don't have access to Wi-Fi. We see people who don't have email addresses or devices or access to internet or even an understanding of how to use technology. Nowadays, not to have an email means you can't do things like fill in forms or do your banking or, really, be able to participate fully in society.” 

It's not easy to learn something new, especially as we get older or when it’s something that we find scary. This has been totally life changing for people.
MICHELLE WESTIN, BLACK CREEK COMMUNITY HEALTH CENTRE

BRINGING A NEW PERSPECTIVE TO THE TABLE

For BCCHC, helping people acquire basic digital literacy was an essential foundation that needed to be laid so that the delivery of care could happen. Peter Mancuso, Project Coordinator for BCCHC’s virtual diabetes care program explains that “besides the actual barriers that are posed in terms of not having devices or being able to use the devices in certain ways, it's imperative that our community is brought up to speed” in terms of their knowledge of today’s current technology, “so they're not left behind any more than they already have been.” 
As seniors, we enjoyed the program, we learned a lot, especially some of us that weren't exposed to the computer age. So many things in the technological age are changingGovernments want everything online, so seniors need to be equipped. We learned a lot being able to join groups [by Zoom].
PARTICIPANT, BCCHC VIRTUAL COMMUNITY CARE HUB

Both Michelle and Peter wanted BCCHC’s clients to be able to do things like watch YouTube exercise videos or cooking demonstrations, and they also wanted to be able to educate clients more broadly about Internet safety. As Peter says, diabetes management is the focus “but we want participants to use the devices to enhance their life in general, whether it's connecting with friends or family, reading a book or watching a movie online, paying bills online. So it's really just to scaffold all of that with the focus on chronic illness management.”  

That meant not just providing the hardware, connectivity, and teaching people how to use it but also providing unrestricted access to the internet.  

This is when BCCHC uncovered a disconnect between the original assumptions made about the use of the iPads and their ability to achieve BCCHC’s goal to “look at health in a more holistic manner,” while building people’s capacity to “use technology in a way that's safe for them, but also allows them to participate just like the rest of us,” says Michelle. 

Initially, “we heard we had to put restrictions on the iPads,” said CMHA Toronto’s Jennifer Pettigrew. But iPad restrictions ran counter to BCCHC’s desire to boost digital literacy and create digital equity. “We learned we needed to remove those restrictions in order for the learnings to take place,” adds Jennifer. It was all a part of the process as the collaborating partners discovered together what would work best for their own communities, staying flexible and open to change. 

Digital equity is a social determinant of health now.
MICHELLE WESTIN, BLACK CREEK COMMUNITY HEALTH CENTRE

LEARNING TOGETHER

BCCHC’s journey has been rich with learnings and successes. Consistent with their organization’s values and operating style, “this was very much a co-design process. The participants helped to inform their own learning,” says Michelle. 

In March 2023 BCCHC identified their first cohort of 15 people to engage in an in-person curriculum of 12 sessions. The group met once a week for about three months and has just graduated. 

“We're trying to address the three aspects of diabetes self-management: the medical aspects, the behavioural aspects and the psychological aspects,” explains Peter. “The medical aspects would be using the devices, email and other ways to connect with healthcare providers and to attend virtual groups. The behavioural aspects would be helping to modify diet or introduce exercise through various apps. And the third component would be the psychological stress associated with managing chronic illness [which] we're attempting to address with apps like Smiling Mind, a meditation app that proved to be pretty popular amongst the first cohort of participants.” They are also tapping in to the VCCH course calendar, which allows BCCHC to add their own content regularly and then offer their clients content from across the other VCCH partnering agencies. 

Regular weekly evaluations surveying the learners about how they're using the devices, what they're using them for, and where they are noticing gaps have guided program adaptation. Feedback from these evaluations has been overwhelmingly positive. 

Everyone's requesting more information, more classes, more development of their skills, which has been so good.
PETER MANCUSO, BLACK CREEK COMMUNITY HEALTH CENTRE

There are other signs of success. Peter recently worked with a long-standing group within BCCHC that included some of the graduates of the first cohort and heard that they’ve been “emailing each other about different virtual groups to attend. Just hearing that, I was able to see that the patience really paid off,” he says.  

He added that another marker of the effectiveness of the program is the fact that people show up and work hard: “People showed up, seniors, even when the weather wasn’t great. They come in and really participate. A lot of times we would go an hour and 45 minutes straight without breaks and would keep their attention. I think I'm most proud of hearing not only that they’ve acquired the skills but that they’ve applied them and continue to apply them even after graduating.”

[The program] gave me confidence to talk about technology. Just today I told two people about the program and that you can learn a lot. It’s helping a lot of people, people are talking about it.
PARTICIPANT, BCCHC VIRTUAL COMMUNITY CARE HUB
Both Peter and Michelle have heard from diabetes providers that they’re also experiencing the impacts of their clients’ improved digital literacy. “They’re saying, ‘hey, here's my client, now all of a sudden, she's emailing me, I can email her and we can meet online and now she's joining a group and she wasn't able to do that before’, Michelle reported.

LOOKING AHEAD

As for the future, BCCHC hopes to expand the program to the management of other diseases such as COPD (chronic obstructive pulmonary disease). They are looking now at ways to sustain people’s involvement after they complete the three-month training – Peter is excited about the possibility of partnering with community organizations such as libraries, which offer internet access on site and also have device lending libraries.  

BCCHC is also working on sorting out compatibility issues between tablets or smartphones and health monitoring devices “so that information can be sent in real time to healthcare providers that can then manage quickly, send an email or an updated care plan. Then, you're managing health care at a much faster and better pace,” Peter says. 

It's just been extremely enjoyable being part of this initiative, which is the future of healthcare in many ways. 
PETER MANCUSO, BLACK CREEK COMMUNITY HEALTH CENTRE
At the sector level and in the longer term, BCCHC’s vision is a broad one: “One of the things that I hope we can move towards is embedding the lens of digital equity when it comes to the planning of health care services and social services. Just like we have navigators and health workers to help move you through the health system, there should be a digital navigator to help connect you with the digital supports that you need in order to participate,” Michelle says. You can't have health equity without digital equity. 

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