This interview is part of a series that highlights the work of Community Health Centres (CHCs) across Canada through the Community Vaccination Promotion (CVP)-National project and discusses the realities of COVID-19. Visit CACHC’s Addressing COVID-19 webpage and listen to CVP-National related episodes of our Community Matters podcast to learn more about the frontline response of CHCs across Canada to COVID-19.

Briefly tell us about your organization, where it is located, the services and programs provided, and the communities/population you serve?

Carea Community Health Centre is a non-profit organization based in Durham region, with locations across Oshawa, Ajax, and Pickering. Carea CHC provides a range of programming for all age groups, in addition to case management supports for underserved populations – for low-income individuals, racialized individuals, individuals with disabilities, as well as newcomers/refugees.

Over the last 3 years the COVID-19 pandemic presented unforeseen challenges in all sectors, and the vulnerable population has been one of the hardest hit groups. What has been the impact of the COVID-19 pandemic in your community, how have you been able to address it and how is your organization navigating providing care and services to your clients during this time?

COVID-19 has had devastating impacts on our communities, due to lay-offs, introducing financial troubles for already-vulnerable populations. Carea CHC was able to continue in-person programming in this time with provision of PPE to cater directly to clients – as virtual care is not an option for those who have limited access to technology, or for older adults. We continue to provide care through our HPC programming – where we provided service navigation (PPE, food security, isolation supports, testing, and vaccination) to communities within Durham region. Our services were as low-barrier as possible (we provided drop-in vaccine clinics, mobile vaccine clinics where possible at community residences, free PCR testing, as well as free grocery support during COVID).

Your CHC is one of the recipients of the CVP National (PHAC funded project). Could you tell us about your project and its goal? Include any activities and programs carried out and resources created.

The High Priority Community strategy was developed and implemented for lead agencies across Ontario to provide supports for those disproportionately affected by COVID. The High-Priority Community Strategy Team at Carea CHC worked to resolve discrepancies in access to vaccination, testing, antivirals, as well as PPE. Populations that were disproportionately affected by health inequities prior to COVID suffered as a result. The HPC team provided service navigation for financial assistance during COVID, transportation support, alongside assisting communities experiencing isolation (specifically with food security and allowing for a safe space to isolate through our hotel program with the Holiday Inn).

What milestones or achievements (including uptake of the vaccine) have you achieved, and lessons learned during the project so far?

Findings highlight that newcomers experience many barriers in COVID-related care (Vaccines in other countries also vary, which resulted in increased hesitancy). Translated resources and in- person interpreter services are significant to the success of the program, as access to technology is typically a barrier for low-income newcomers. In addition, appropriate evaluation of programs is required – there was a lack of focus on quality improvement/research efforts, so the data available on evaluation of programs is quite limited.

Have you and your team experienced any challenges or barriers to vaccine promotion and uptake in your community? How have you managed these challenges?

The challenges in implementation included existing staffing constraints that made COVID outreach efforts very difficult, specifically when it came to hosting a booster clinic (we had high uptake and had people waiting for vaccines, but we weren’t able to serve them all due to lack of supply). Information was changing consistently, so service users were often confused, and community ambassadors constantly had to “re-educate” themselves on updated information.

Moreover, appropriate planning for culturally sensitive care is significant. An example of this – we had our South Asian vaccine clinic, but the uptake was lower because boosters were not of high interest in February – everyone was able to retrieve their vaccination in December or early January. When fourth doses became available, the majority of individuals were no longer interested in receiving vaccines – or did not see the purpose. It became difficult to promote the vaccine as individuals experienced “pandemic fatigue” of sorts. We try to resolve these issues by ensuring we enter communities with resources, and meet clients where they are, whether that be through mobile vaccination clinics, as well as bringing rapid antigen tests to any of our outreach events.

Did your project involve any partnerships or collaborations? If yes, please describe. What relationships if any did you leverage to ensure the delivery of your project.

We worked with multiple stakeholders, specifically other community health centres such as TAIBU CHC, Durham Tamil’s Association, GOVAXX, and BPAO for health education purposes.

Please tell us about your work with Peer Ambassadors/Community Connectors? What specific challenges and successes come with having Peer Ambassadors/Community Connectors?

Our project utilized peer ambassadors to promote vaccine confidence. This had a significant impact, as the HPC team is very diverse. We were able to represent our own communities (Black & South Asian communities), and appeal to them specifically utilizing culturally-focused care. We were able to utilize community connectors to build trust with clients.

With new variants and the approval of booster doses, what effect have these had on the work your centre carries out as well as the CVP National Project, in other words how are you adapting to this ongoing public health issue?

As we have developed the High-Priority Community Strategy, we adapt to the needs of the community. We understand the sources of vaccine hesitancy, and we continue to adopt approaches to ensure we are being culturally safe. Our communities do not express many COVID concerns, especially as more booster doses become available. We ensure to promote safe practices, including social distancing.

How has the funding through the CVP National Project helped your centre and the community it serves?

We have been able to support our clients through community health fairs that include vaccine promotion – specifically our Black-focused and South-Asian focused community health fairs, in addition to mobile clinics, as well as our PCR testing clinics.

We have been aiding clients financially through COVID with isolation supports. Most service users do not have access to a vehicle, and public transportation isn’t feasible for many residents in Durham region. Providing transportation support, in addition to financially assisting with costs during isolation periods when service users cannot leave the home, had an improvement on their stress-levels (this was self-reported by the service users and their feedback). It is important to advocate for culturally targeted care, as our outreach efforts were the most successful when we had representatives of the community.

What are the next steps for your centre after the CVP project with regards to COVID-19 and your hope for the future?

Our hope for the future is that low-barrier approaches continue to be implemented – whether that be through walk-in vaccine clinics and testing clinics. Our hope for the future is that COVID- 19 resources are always accessible, as the virus isn’t gone, and continues to evolve. Having contingency plans set in place should outbreaks become more common is important. Vulnerable communities have been significantly impacted by COVID, and it is important that we continue to provide isolation supports, if lockdowns were to arise again.

What do you think your experiences throughout the pandemic say about the ability of Community Health Centres to adapt to emerging social and public health issues, and the importance of CHCs within our health and social service systems?

Community Health Centres are able to support vulnerable communities in accessing care – they are able to provide isolation supports and low-barrier approaches that are unavailable in our current health system (financial support during COVID leave, allowing for safe space for isolation, free walk-in PCR testing, provision of PPE and rapid antigen tests directly to homes, if needed). Community health centres adopt a preventative approach, in which clients can feel safe reaching out to us.

Is there anything else you would like to share with our readers?

It’s important to “know” your community – conducting a needs assessment or environmental scan is imperative to understanding what kind of supports need to be provided. Meet clients where they are at, so they are able to build trust and understand what services you are providing. Our population is extremely diverse – having diverse representatives, in addition to materials in different languages, is needed to support our communities to the best of our ability.