Sherbourne Health Centre Annual Report 2011-12
10 Years’ Strong: A decade of building health and building connections in the community
CONTENTS “ It is health that is real wealth and not pieces of gold and silver.” – Mahatma Gandhi
2011-’12 The Year In Brief
1
Message from the Chair
2
Message from the CEO
Sherbourne Health Centre is a leading provider of quality health care and transformative support to those who face social, economic and other systemic barriers. We are particularly committed to those who are homeless or precariously housed, newcomers to Canada and the LGBT (lesbian, gay, bisexual and trans) communities.
3
Living with Hepatitis C
4
Valuing the Whole Person
5
Life as a
“ I have an enormous respect for Sherbourne. It tackles the underlying things that make people vulnerable, such as poverty, homophobia and transphobia. Ultimately, it is about dignity and respect for people who are too often ignored and mistreated.” – Robert, Board Member
Volunteer Nurse
6
Establishing Trust
7
A Focus On... Cancer Care & Diabetes Education
8
Women in Need ‘Klinik’ (W.I.N.K.)
9
Thank You
10
Making a Difference
11
Financial Summary
12
2011-'12 The Year In Brief
A look at some of the activities reflecting Sherbourne’s commitment to continuous quality improvement and community engagement.
Our new “Quality and Safety Dashboard”
In
began its first full year in April 2011. The
participated in the second European Meeting of
May,
The
LGBTQ
Parenting
Network
LGBT Families in Spain at their invitation, and
dashboard helps Board and staff monitor
met activists from the Network of European
trends and services quarterly, and checks
LGBT Families Association (NELFA). They also
we are on track for continuous quality and
launched Transforming FAMILY, a 10-minute
safety improvement for our clients and the
documentary reflecting an ongoing conversation
wider community.
among trans people about parenting. In
early
Trans
summer Health
we
launched
Connection
the
project,
increasing the capacity of health care providers across Ontario to serve trans people and build a community of practice. Specialized trainings with
local
providers
were
carried
out
provincially, and a weekly telephone mentorship program is providing additional support.
The Honourable Deb Matthews, Minister
In March 2012, Rainbow Health Ontario’s biennial conference offered over 50 workshops, seminars and plenary sessions on “Supporting LGBT Health Through Every Stage of Life”, in English and French. The only conference in Canada addressing LGBT health and wellness, it drew over 300 delegates to learn more about LGBT health concerns, explore research and network with academic, health and government sector professionals.
of Health and Long-Term Care, visited Sherbourne in November 2011, to learn more about our work. The Minister had a comprehensive tour. Highlights included not only our Family Health, Urban and Newcomer Teams, but also our wide-ranging LGBT programming and 3rd floor Infirmary. Strategic
Planning
consultations
with
clients, volunteers, staff, partners and the wider community started in early 2012, informing our new 3-year strategic plan, which will be launched later in the year. Community and staff engagement and insight are key to understanding and fulfilling the needs of those that we serve.
1
Message from the Chair This Fall we will celebrate Sherbourne Health Centre’s 10th anniversary and a decade of improving the health and wellbeing of individuals and families across Toronto - and, through knowledge transfer and mentoring, across Ontario. Over the past decade, Sherbourne has become a leader in primary care reform and a mainstay for diverse community members. We have much to be proud of. In a difficult economic climate, Sherbourne is actively helping to reduce practical and financial pressures on the wider health sector. We offer diverse and flexible entry points to health care, including our Rotary Club of Toronto Health Buses serving those who are homeless across Toronto, outreach to newcomers in St James Town and a wide range of LGBT programs. These initiatives promote health and wellbeing, strengthen community links, speed up access to health care and improve early diagnosis and intervention rates. Across Sherbourne, we offer clientfocussed, holistic support, high quality treatment and referrals. These encourage and help sustain positive health outcomes. Our pioneering initiatives supporting those who face some of the greatest challenges around health as well as systemic barriers, such as our trans clients, and homeless and vulnerably housed clients diagnosed with cancer and Hepatitis C, offer new models of care.
2
Sherbourne’s strengths are well-aligned with the government’s “Action Plan for Health Care in Ontario” – offering the right care, at the right time, in the right place. The Plan stresses the need for preventative care and that Ontarians need better and faster access to family doctors and nurse practitioners to save time, keep them healthier, and help them avoid trips to hospital. As you read through this year’s Annual Report, I hope that you will agree that Sherbourne does just that.
“We have much to be proud of.”
Sherbourne’s strong and focussed contribution to health care in Ontario, and its commitment to those who face particular barriers to health and accessing health care, will clearly be as relevant to the next ten years as they were to the last. On behalf of the Board of Directors, I would like to reiterate how proud we are to be part of Sherbourne, and we hope you will join with us and continue supporting the Centre’s work – and the health and wellbeing of our community - over the coming decade. Marianne Smith Board Chair
Message from the CEO As I reflect on Sherbourne Health Centre’s first decade, three things really stand out: our tremendous client service; our deep community engagement; and our remarkable staff and volunteers. These three achievements, and the connections between them, form the basis of my remarks and our Annual Report this year. We reach clients who face barriers to care and connect them to high quality health services and holistic support. Our range of services has grown tremendously over the years. People now access our family health team, counselling services, health promotion and education services, LGBT youth and family engagement and support programs, our mobile health buses, and our Infirmary for post-hospital support. We also provide knowledge translation and capacity building in LGBT care in both English and French through Rainbow Health Ontario. Sherbourne works with ‘the whole person’, recognizing that health services sometimes treat just the disease instead of the individual. We understand that the social determinants of health – the conditions in which we are born, grow, live, work and age – are all factors in our wellbeing. It is vital for individual and community health that people are able to access services that enthusiastically welcome and support them in a wider context. To this end, many clients engage with different programs and activities within Sherbourne to address their health and wellbeing. This year clients engaged more fully in our quality improvement and planning activities through advisory panels, client feedback surveys, strategic advisory groups and presentations to our Board of Directors.
Since its inception, Sherbourne has also been able to rely on the engagement of numerous community supporters and partners. As a result, we have developed services that respond to identified community needs in a cost-effective model. Increasingly, our services are offered through partnership with other agencies. This extends our ability to work with clients in a holistic way and to respond quickly to changing health care needs and system pressures. Our achievements over the past decade are the direct result of our enormously dedicated, flexible and talented staff and volunteers. Sherbourne now boasts over one hundred staff and many hundreds of volunteers. Each day our staff and volunteers put their compassion for our clients into action and connect with clients and the broader health system to improve the health of those most in need. The theme of interconnectedness is echoed in our “Building Connections, Building Health” approach, and throughout this year’s Annual Report. We are grateful that you share our vision for healthy and equitable communities and we look forward to another wonderful decade with your support. Suzanne Boggild, Chief Executive Officer
3
Living with Hepatitis C I was one of the first participants in the Hep C program at Sherbourne in Fall 2007 to clear the virus. I found out I had Hep C through an annual check-up with my family doctor at another centre. At the time I was a successful and young designer. I had high work pressures. Social drinking and recreational drug use were part of my life, but soon lead to harder drinking and unsafe self-medicating. My doctor said he was shocked by the diagnosis; he referred me to a well-known liver clinic. I experienced a lot of stigma, discrimination and judgment. They kept telling me I had to be “clean and sober” to be eligible for treatment, but they only gave me a 50% chance of clearing the disease. I said no. My signs and symptoms escalated as the virus took hold and my life began to fall apart. I later found out about the program at Sherbourne through a panhandler friend being treated in the Infirmary. It took 2 years for me to get through treatment, including 6 months of me going to the group, for me to decide to go ahead. I had a lot of fear around it. They told me there was an 80% chance of me clearing the disease and the emphasis was on disclosure [around using drugs/alcohol], not stopping. I liked the educational component of the program - I learnt so much; I learnt about harm reduction. When I got really sick, the support group calmed me down; it was very open and nonjudgmental. I had a great rapport with the clinical team too. I cleared the virus and started to volunteer, especially with art projects. I felt like I should’ve been happy, but I wasn’t. Some of the hardest work you have to do is once you’re clear and have the chance to decide what your new life is going to be like. I saw a counselor with the program for a year and he really challenged me. It was an amazing, awesome experience. That was the turning point for me. People need to talk.
4
Dedicated Hep C Support - An all-women’s group has now been added to the comprehensive Hep C program run by Sherbourne and its partners, South Rob’s artwork Riverdale and Regent Park Community Health Centres. The group is showing early signs of success, with up to 14 women attending at a time. The “working up” alone can take 6 months, but one of the women in the group has already started treatment and is doing well. To date 8 clients in total have cleared the disease with the dedicated support of the team and facilitated peer groups. Though the antibodies will always remain in their systems, clients should now be able to avoid a liver transplant or the potentially fatal onset of liver cancer.
I’m much happier now. I’m working almost full-time, and being creative. I’m a Hep C worker, and a community representative for Sherbourne’s strategic planning process. I’ve also started volunteering as a mentor with SOY’s Monday Night Drop-In. There weren’t a lot of people from the community giving back and I realized I could do that. The most important thing is to just listen, but I’m also someone with lived experience of using drugs and alcohol. There are a lot of kids that are living on the streets for whatever reason. They’re suffering. It’s really important to me to be there for them. Rob M, Client and Volunteer
SOY (Supporting Our Youth)’s Monday Night Drop-In welcomes as many as 50 homeless and streetinvolved LGBT youth - who comprise up to 40% of homeless youth in Toronto – each week. They share a home-cooked meal and engage in arts and recreational activities as well as facilitated discussions on topics ranging from harm reduction to healthy relationships. The drop-in provides access to safe ‘out’ adult mentors. who provide support and encouragement. Youth also get connected to health providers, housing and employment support and other key resources.
Valuing the Whole Person May 2012 saw the 9th annual Trans Pride Day held at Sherbourne Health Centre, in collaboration with Sherbourne’s community partner Fred Victor, and this year included a special intergenerational focus. A series of workshops, “Living Trans Pride”, supported by SOY’s Trans Programs Coordinator and 4 trans youth facilitators, engaged trans youth in artsbased activities in the leadup to the event, and much of their vibrant and moving work was then showcased on the night. Around 100 youth and adult community members and staff joined together to enjoy the art, and performances ranging from music and singing to readings.
“ This is my dream job. I was waiting a job like this.”
“This is my 30 years to have dream job. I was waiting 30 years to have a job like this.” Rupert has worked for LGBT-positive organizations before, but is inspired by working somewhere where his lived experience and his activist experience are as valued and validated as his professional experience. Sherbourne for him – and for many others, he points out – is like an extended family.
Rupert has been with Sherbourne’s mental health counselling program since it started in December 2002. He was 1 of 4 counsellors then, but is one of 10 today. The team also works with various groups including Gender Journeys for anyone thinking about their own gender change, which Rupert co-facilitates, and the Women In Need ‘Klinik’ (W.I.N.K.), which his colleagues in the Urban Health and Newcomer teams support. Rupert reflects on the immense diversity of clients they see and the different ways in which they engage with them, and adds, “There’s a really gratifying feeling that we can play such a role in their lives.” Rupert had been interested in psychology and mental health since he was a teenager, and after 20 years of carrying out more informal peer counselling with trans people and their loved ones, he finally started counselling more formally just over a decade ago. His support goes beyond his day-to-day role. In 2004, he instigated the first Trans Pride Day at Sherbourne, which both raises awareness of the struggles that trans people face and focusses on the positive and celebratory aspects of being trans-identified. Rupert, Mental Heath Counsellor
5
Life as a Volunteer Nurse I’ve been a volunteer nurse with the “ ...it wasn’t HIV that was Health Bus for more than a decade. I had going to kill them; it was my diploma in nursing when I started, but over time I’ve also completed my their social conditions.” undergraduate studies and now I’m doing my Masters. Working full-time in various positions throughout my studies – including roles in emergency rooms and mental health – has given me a lot of experience, but volunteering on the Health Bus really grounds me with my work. I first got involved when I was working for an HIV/AIDS facility in Toronto in the late ‘90s. Clients would often stay for a while, get better and then go into decline again when they left. I realized that, it wasn’t HIV that was going to kill them; it was their social conditions. There needed to be more support and outreach on the streets themselves, which is what the Health Buses do – they’re trying to work with people from a different place. I’m on the 5 a.m. Health Bus stop on a Wednesday morning at the moment; it makes for a long day. This morning I treated two women who’d selfharmed – cut themselves – and another who had been assaulted by her partner. There’s often an educational side to what I do – teaching the basics of wound care, or letting a woman know about places she can go when she’s ready for more support – as well as a bit of informal counselling. We try and connect clients to health care providers so that they can get ongoing support. The Health Buses are an important entry point. People feel safe with the bus; they have a relationship; they trust the staff. Lisa, Health Bus Volunteer Nurse
6
The Health Bus program – founded by The Rotary Club of Toronto and the Wellesley Central Hospital Corporation – has been operating at Sherbourne since 2002, and it epitomizes our “Building Connection, Building Health” concept. Many clients interact with the Buses before joining other programs, and the team now has over 2000 visits from homeless and vulnerably housed individuals every month. Over 60 volunteer nurses support the program, along with key community partners.
Establishing Trust Gayathri is a physician with Sherbourne’s Newcomer Family Health Team, a busy and challenging role that brings her into contact with people from all around the world. Her clients are often still struggling to put down roots and to negotiate their way through Canada’s various official systems. Many are refugees from wartorn countries, and members of LGBT communities who have fled societies where their sexual and gender identities are not accepted, who are often very traumatized by their experiences. Gayathri comments that, “they have no trust; no idea how to navigate this complicated bureaucracy.”
“ Literally, I think I fell in love with Sherbourne Health Centre the first week here – with the people, the clients, with the passion people brought to work every day, with their dedication… I think the way I practice medicine now is a lot more holistic.”
Like many staff at Sherbourne, Gayathri has multiple roles - she is also involved with Sherbourne’s HIV Drop-in and Women In Need clinics, both of which offer services to clients who are homeless and street-involved. Regardless of which program or service she is supporting, establishing trust is one of the most important aspects of her work, and “getting a sense of who the person is, not just what you’re treating them for.” Breaking down barriers doesn’t just apply to working with clients; Gayathri also praises the openness and resilience that the staff she works with demonstrate. Literally, I think I fell in love with Sherbourne Health Centre the first week here – with the people, the clients, with the passion people brought to work every day, with their dedication… I think the way I practice medicine now is a lot more holistic. Gayathri, Physician
“ They need someone that treats them well, respects them… there are so many instances where we’ve prevented something more serious from happening, because clients have trusted us and told us about their health problems.” – Isolde, Volunteer Nurse, Health Bus 7
A Focus on… Cancer Care & Diabetes Education Home Care for the Homeless
Tackling Diabetes
Cancer care in Canada is increasingly based on a homecare model, which means that those who have no real ‘home’ face an impossible situation. With no fixed address, people are often excluded from traditional treatment facilities; and a shelter or even a rooming house can’t guarantee a safe, hygienic environment and designated bathroom – or safely dispose of the toxic waste produced when clients undergo chemo or radiation therapy. Without after-care options, people are literally unable to receive treatment.
Sherbourne’s Diabetes Education program continues to raise awareness about the disease and how to both prevent and manage it. As well as taking on over 100 new clients this past year, the team has started a weekly diabetes education group in adjacent St James Town. St James Town is the most densely populated area in Canada, with more than double the city average of low-income families. It has a significant newcomer population, who face barriers to diabetes prevention and self-management such as high stress levels, a new food system, and limited access to healthcare. Up to a dozen community members gather each week to learn about living healthily with diabetes.
In 2011 our Infirmary undertook a new initiative to admit clients with cancer, including end-stage cancer, who are actively receiving chemotherapy, and they now regularly represent 20% of our available bed-space. Clients may need to be readmitted 6-12 times over the course of treatment, so the schedule has to be very carefully managed. Our approach also includes linking clients up with wider community services. Through collaborative working with partners we’re finding that we’re increasingly able to ensure that recuperating clients find more suitable accommodation with external support, rather than returning to the streets or the shelter system. SHC is also committed to preventing cancers, and over the past few years we have been working hard to increase screening. Our cervical, breast and colo-rectal cancer screening rates are all on the rise.
Dr Ed Kucharski, Sherbourne’s Medical Director, was recently appointed as Regional Primary Care Lead for the Toronto Central LHIN (south region). He will help to engage other primary care providers in implementation of the Ontario Cancer Plan.
8
Dr Jamie Read with Sherbourne’s Urban Health team has been appointed as the primary care lead for the new Toronto Central Diabetes Regional Coordination Centre. The Centre will support the Ontario Diabetes strategy and improve diabetes care across the region.
Women In Need ‘Klinik’ (W.I.N.K.) Sherbourne staff and volunteers have been supporting homeless and streetinvolved women and trans-women through a Wednesday morning ‘klinik’ for over a year now. Women often learn about the ‘klinik’ through the sex workerfocussed Health Bus stop that starts at 5 a.m. that day. Many of the women are isolated and experience significant abuse, discrimination and stigma. They have specific health challenges, but are often too wary to approach a more traditional clinic. In 2011, the ‘klinik’ provided 328 consultations with doctors, nurse practitioners, registered nurses and counselors. It also offers information about health and health care, and social and emotional support. One client commented, “Everyone treated me the way I wish I could treat myself.”
‘WINK’ is an excellent program; it’s like no other drop-in in the city... When you come to WINK it’s to better yourself and to get help all-round; and to make you better mentally and physically. And it just makes you achieve goals and get out of the rut you’re in. It gives me the encouragement and the moral support I need to make better choices in my life. I make friends here; and they’re like-minded, they want to better themselves.
“ I’ve come a long way since I started coming here. And this is the only place that gave me the motivation I needed to get going.”
If they can’t do it at WINK, they’ll point you in the right direction and send you to the right place to get the help that you need. The staff are very supportive and you want to make them proud of you.
...It’s the first time in ten years I’ve been to a doctor, and now I see a doctor – I see a nutritionist; I see a chiropractor; I see the staff here, and the outreach workers. And they’ve referred me to an ID clinic, one-on-one addiction counselling, housing. I’ve come a long way since I started coming here. And this is the only place that gave me the motivation I needed to get going. Janet, W.I.N.K. client
9
Thank You Our volunteers, donors and partners inspire us and strengthen our work. Our heartfelt thanks go out to you all for investing in the health and wellbeing of the community with us and for making so much more possible. Every single contribution makes an impact.
We also want to give particular thanks to our monthly and annual donors; to those who fundraise for or who donate gifts-in-kind to support programs; and to those who make bequests to Sherbourne programs in their wills, helping to ensure the continued success of programs for future generations. You make all the difference.
10
Our generous donors in 2011-’12 included: The Ontario Government The Government of Canada The City of Toronto ArtReach Toronto The Big Carrot Natural Food Market BMO Financial Group Community One Foundation The Dusan Nedelko Foundation exeQutive Fly and Fire on the East Side The Geoffrey H. Wood Foundation Howard and Diane Taylor Family Fund at Toronto Community Foundation The Marjorie & Joseph Wright Memorial Foundation M·A·C AIDS Fund Mountain Equipment Co-op (MEC) Outer Layer Ltd. The Paloma Foundation Pride Toronto The RBC Foundation and RBC Financial Group The Rotary Club of Toronto The Sam Sorbara Charitable Foundation The St Andrew’s Society of Toronto/St Andrew’s Charitable Foundation TD Bank Group Tippet Foundation The Imperial Court of Toronto (TICOT) and Dusty Balfour Toronto Arts Council Toronto Gay Ski and Snowboarding Club Xtra! USW (United Steel Workers) District 6
Making a Difference - A Donor’s Story Robert recalls coming out as a young gay man, living an isolated existence in the suburbs of Winnipeg in the early 1980’s, and being fortunate enough to find one of the few openly gay doctors who made a point of welcoming and providing a safe space for LGBT patients. That experience has given him a deep appreciation of Sherbourne’s inclusive approach. It also helped motivate him to give back – initially as a monthly donor and SOY mentor in 2005, now also as a Board member, in what he describes as a natural evolution. Robert’s monthly gift helps support SOY’s ongoing services for queer and trans youth. These include the “CLICK” mentoring program, weekly groups and other empowering activities. He describes hearing a number of SOY youth talk about what they get from both SOY and their mentors at a get-together. “They were amazing. It was so moving to hear what some of them had been through and how they’re making their way in the world, with help from SOY and each other. I thought, ‘this is what it’s all about; this is the difference we’re making’.”
A couple of years later “I thought, ‘this is what Rob decided to get involved beyond what it’s all about; this is the he calls the “more difference we’re making’.” serious services”, to become a major sponsor of SOY and the Triangle Program’s annual ‘Pride Prom’ as well – something he never had the chance to enjoy in his own teenage years. “I thought it was a really creative and fun way to celebrate these young people – and to provide a safe, accepting space for their coming out. I thought ‘that’s something I can get behind’.” Several years on he’s still behind it and, having taken the chance to watch a bit of the Prom from the sidelines one year, he’s seen first hand the impact it makes. “We need to create more spaces where LGBT youth experience joy in who they are. That’s part of making our community healthy as well,” he says. We couldn’t agree more.
Robert joined Sherbourne’s Board after working with them for a while as a community member on a Board Committee. “I have a lot of respect for them,” he said. “They make a huge contribution… a huge difference”.
11
Financials 2011-2012 Sherbourne Health Centre Corporation Statement of operations year ended March 31, 2012
Revenue
2011
Expenses
2012
2011
$ 1,561,504
$ 1,633,613
Finance
$ 490,673
$ 356,037
Information systems
$ 471,874
$ 517,623
Administration
$ 534,529
$ 483,434
$ 26,737
$ 28,191
$ 272,088
$ 359,677
$ 77,558
$ 77,361
Ministry of Health and Long-Term Care (“MOHLTC”) and Central Local Health Integration Network (“Toronto Central LHIN”) funding
$ 7,212,540
Amortization of deferred capital contributions (Note 6)
$ 1,196,974
$ 1,288,109
$ 2,642,862
$ 2,366,617
Fundraising
$ 230,270
$ 135,929
$ 3,773,741
$ 3,601,419
MOHLTC Health Research Grants
Primary care and Family Health Team
$ 904,740
$ 920,360
$ 1,402,452
$ 1,323,027
Other grants and guarantors
$ 44,400
$ 60,351
$ 1,746,017
$ 1,403,216
Health bus/mobile
$ 567,962
$ 611,612
$ 171,633
$ 2,391
Naturopathic clinic
$ 37,842
$ 38,648
$ 53,420
$ 53,420
Trans Health
$ 171,633
$ 2,391
Rainbow Health Ontario
$ 783,693
$ 770,303
$ 135,719
$ 83,027
Amortization of capital assets
$ 1,223,714
$ 1,308,948
––
$ 13,626
$ 13,142,017
$ 12,515,500
$ 12,592,558
$ 12,312,097
$ (549,459)
$ (203,403)
Family Health Team
Trans Health Grant Supporting Communities Partnership Initiative Other revenue and recoveries Interest
12
2012
Building services and utilities $ 7,388,267
Communications Human resources Fundraising Clinical service
Infirmary
LGBTT primary care
Deficiency of revenue over expenses
Financials 2011-2012 Sherbourne Health Centre Corporation Statement of financial position as at March 31, 2012
ASSETS
2012
2011
$ 5,573
$ 77,689
Current assets
Cash
Accounts receivable
$ 303,661
$ 316,325
HST receivable
$ 162,873
$ 235,287
Prepaid Expenses
$ 134,872
$ 113,572
Inventory
$ 62,970
$ 86,762
$ 669,949
$829,635
$ 21,087,776
$ 22,222,396
$ 21,757,725
$ 23,052,031
2012
2011
$ 372,903
––
$ 1,316,379
$ 1,313,923
$ 477,399
$ 441,849
$ 2,166,681
$ 1,755,772
$ 20,315,025
$ 21,470,781
$ 22,481,706
$ 23,226,553
2012
2011
$ 772,751
$ 751,615
$ (1,496,732)
$ (926,137)
$ (723,981)
$ (174,522)
$ 21,757,725
$ 23,052,031
Capital assets (Note 4)
Liabilities Current liabilities
Line of Credit
Accounts payable and accrued charges
Deferred revenue (Note 5)
Deferred capital contributions (Note 6)
Fund balances (deficit) Invested in capital assets Unrestricted
13
Sherbourne Health Centre 333 Sherbourne Street Toronto, ON M5A 2S5 Tel: Fax:
416-324-4180 416-324-4181
Email: info@sherbourne.on.ca www.sherbourne.on.ca Registered Charity # 86577 6827 RR0001