The HEED Project: Connecting community supports and health care for one of London's most vulnerable populations

 Stephanie McCulligh (left) and Mark Nixon (right) with the roaming education cart they used during the HEED project.

May 29, 2024

At London Health Sciences Centre (LHSC), we believe that everyone has the right to receive the highest quality of care and experience the best possible health outcomes. Today, individuals from equity-denied communities continue to face barriers when accessing and receiving care, and we are taking important steps to ensure that these barriers are addressed and dismantled, providing opportunity for everyone to have equitable access to care.

Among the many groups encountering disparities within the Canadian health-care system are people experiencing homelessness, individuals who use substances, and those who are living in poverty.  

LHSC is working to address these inequities through the development and implementation of a harm reduction strategy – a plan of action to improve care experiences and health outcomes for this community by emphasizing equity-oriented care.

Harm reduction is defined by Harm Reduction International as "working with people without judgement, coercion, discrimination, or requiring that people stop using drugs as a precondition of support.” Through the development of a harm reduction strategy, we will aim to improve care for people who use substances and dismantle existing systems and policies that can create harm.

Health Equity and Ecosystem Development 

Much of the work that will inform LHSC’s Harm Reduction Strategy stems from recommendations made by the Health Equity and Ecosystem Development (HEED) project. This project was a collaborative effort between LHSC’s Office of Inclusion and Social Accountability, London InterCommunity Health Centre (LIHC), and community partners who work closely with people who use substances.

When LIHC first reached out to LHSC’s Office of Inclusion and Social Accountability and Office of Health Ethics, it was to address barriers and gaps in services that many of their clients were experiencing while receiving life-saving care. This sparked a partnership with a shared desire to improve care delivery for this population.  

“The amount of advocacy, navigation and partnership that was required to create care plans for our clients was indicative of a system set up in a way that does not serve marginalized people,” said Sean Warren, Care Facilitator at LIHC. “Through this project, LIHC was able to connect with LHSC and collaborate on ideas on improving how care can be delivered to our clients more equitably.”

A proposal was submitted to the Public Health Agency of Canada to help bridge the gap between hospital and community health organizations. Through a grant from the Intersectoral Action Fund, two temporary positions were created to engage with Team LHSC, patients and community partners to gain an understanding of their experiences, learn about the barriers they each face, and hear their recommendations for supporting this population.  

Collecting information and data 

Mark Nixon, who held the role of Health Equity Specialist with the HEED project said, “We collected data from each of these groups, provided education to some members of Team LHSC, and worked to understand how community voice could be better represented in hospital policies, education and clinical pathways.”

Stephanie McCulligh held the position of Community Engagement Worker. “During my time with HEED, I was heavily involved with many different aspects of supporting patients while they were receiving care,” she said. “I ensured they had their needs taken care of, connected them with various hospital services, and followed-up with them post-treatment to make sure their discharge went smoothly.”

The information collected from Team LHSC, patients and community partners helped the team create a policy review framework with a focus on three critical lenses: trauma- and violence-informed care, harm reduction and cultural safety. A microlearning series was also developed to educate Team LHSC on how to enhance practices and policies using the three lenses and apply the framework at a system level. The framework and microlearning series went under a rigorous review process by a Community Advisory Committee, which included community partners and many people with lived and living experiences. This committee also developed recommendations for moving this work forward.  

“This Community Advisory Committee represented a fundamental shift in how LHSC partners with patients, community agencies, and individuals with lived and living experience,” said Jill Sangha, Director of the Office of Inclusion and Social Accountability at LHSC. “The close collaboration between LHSC, community agencies, and members of the public to advance this important work truly demonstrated social accountability in action.”  

Educating frontline staff 

As part of the HEED project, Mark and Stephanie engaged with frontline staff in their units with a portable education cart and shared vital information on providing equitable access to care to people using substances. They met with over 200 members of Team LHSC across 10 different units.

“Mark and I discussed how people use, what they might present like while using, and strategies to approach them while they are using,” said Stephanie. “During these discussions we shared the type of green and blue bags that people who smoke fentanyl, crystal or crack use to hold sterile gear acquired at safe consumption sites across the city, so teams know what to look out for.”

Mark said, “Team LHSC members were very interested in the education sessions. People wanted to gain insight into the realities faced by people experiencing homelessness, using substances, and/or living in poverty.”

Creating a harm reduction strategy 

When discussing the implementation of a harm reduction strategy at LHSC, hospital leaders agree on the significant impact that it will have.  

"It is critical that the community and LHSC are working together to address this,” said Heather Lokko, Corporate Nursing Executive at LHSC and an Executive Sponsor of the development of the LHSC Harm Reduction Strategy. “This strategic initiative is going to be vital for the improved health of our community, and will provide direction on practices, education, resources, and policies to ensure LHSC is well-positioned to provide equitable care to people using substances.”  

In addition to the work that the HEED project accomplished, a PhD candidate, Wisdom Avor, completed a literature review and conducted interviews to gather data and provide recommendations to help inform LHSC’s harm reduction strategy.  

The road ahead for LHSC’s harm reduction strategy is a path that will be built through further consultation with the community and members of Team LHSC. Next steps include an organization-wide Harm Reduction Needs Assessment Survey, the development of a project team, and the formation of a steering committee that will be made up of Team LHSC members and community partners.