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?

For more than 50 years, REACH Community Health Centre (REACH CHC) has been a trusted member of the East Vancouver community. REACH CHC provides comprehensive health and community services that address the needs of our community through our Primary Care Medical Clinic, Urgent and Primary Care Centre (UPCC), Pharmacy and Dental Clinic. In addition to this, in 2020 we created a Health Equity and Engagement Department (HEED). Consisting of our Multicultural Family Centre and Community Programs units, it serves to support our communities with programs dedicated to the social determinants of health. This occurs through outreach, 1:1 support, groups and psycho-educational groups. With a strategic focus on access, REACH CHC directly engages members of the Indigenous, Arabic, Vietnamese, Latin American and other often marginalized communities, including children, youth, Elders, seniors, families, parents, etc. We also work with many undocumented community members and those unhoused or precariously housed, struggling with addictions, and living with mental health conditions.

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?

The local East Vancouver community that REACH CHC serves has many people with intersecting vulnerabilities. Over the course of the pandemic this has resulted in negative outcomes for their wellbeing such as increased social isolation, food security, income security, addiction etc. During the course of the pandemic REACH CHC initiated a number of new programs across the clinic to support our most vulnerable community members. Our UPCC was established as a key COVID-19 community testing and assessment site and constantly adjusted its workflow based on PHO recommendations. With the start of the pandemic, our team of allied care professionals across the clinic met to discuss the challenges in the community sector landscape, including loss of service due to COVID-19 restrictions.  As a result of this, we initiative a number of new projects to support areas of vulnerability, including but not limited to:

• • • On-site food kits to support those needing to isolate
  • • volunteer calls made to vulnerable clients as a check-in
  • • support for seniors with registering and access to boosters; and
  • • implementation of mental health and addictions workshops

All of our departments remained open to on-site services in recognition of the fact that the most vulnerable in our community might not have the same access to services/technology during this time.

Additionally, we  realized that community education was also required to bridge knowledge gaps related to COVID-19 services and infection control. For example, in 2020/21 we piloted a COVID-19 workshop that demonstrated the importance of social distancing, infection control procedures and later on vaccinations, in preventing the spread of COVID-19. In this community outreach, we connected with 12 organizations to deliver information and PPE supplies (masks, sanitizer etc.), Indigenous Wellness Kits, smudge ceremonies, dinners, and Indigenous Elder-led talking/ healing circles to more than 1,000 community members at 20 sites.

All of this was done in an effort to support people in making well-informed choices to support their personal and community health.

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.

We designed our project to build on our goal of increasing community confidence and engagement with the vaccine booster campaign. We found through our previous COVID-19 education work that direct engagement with professionals and information was one of the best ways to support accurate information among our community, particularly those who might be more vulnerable. In order to do this we implemented a number of activities. Firstly, we conducted informal survey in our waiting areas about why people were, or were not vaccinated. Using this information we then developed a core “Myths and Facts” about COVID-19 information sheet, poster board and presentation. Using a number of mechanisms, such as social media, workshops and in-person conversations we disseminated this information to community members. Once available, we created a 2-part set of information which included these myths and facts, paired with the CVP National Project Survey as well. To date, we have over 150 responses to this survey.

As part of our committeemen to accessibility, we also translated the information into some of the core languages of our demographics, such as Spanish and Arabic, in order to improve accessibility as well. Finally, we usually used some of the funding to support a cross-cultural health fair. This event had about 285 attendees and over 25 health and social service agencies present. During this event we were able to also provide additional information about vaccinations as well.

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

For our vaccine project, we were not able to directly deliver any COVID-19 vaccinations due to local public health guidelines. As such we shifted our primary goals towards correcting misinformation. The primary tool that we developed was a Myths and Facts information sheet and presentation. As stated earlier, we connected with many people during a Community Health Fair but this was done in a more general manner. To increase engagement and reach people more directly, we also conducted a number of workshops in the community as well.

Some of the lessons that we learned during the project were that timing is very critical to the success of any public health initiatives. Between the time of the application and delivery of the program, there was a marked public shift in the public attitudes toward getting more COVID-19 information. Particularly with other respiratory viruses becoming more prominent in the media, organizations were not as willing to have in-person sessions. The public was also feeling very saturated with information. Additionally, although challenging at times, we found the best way to engage with marginalized communities was to meet them where they were at. We found more success in through a trusted community worker, translating materials into different languages or going to existing social or support groups

All of these initiatives resulted in significant community engagement, including 180 in-person surveys completed, 100+ online surveys, 2000+ postcards delivered to local agencies. As part of this outreach were able to complete 5 dedicated workshops for our local community partners as well. One of the biggest successes of our project is the wide cross-section of individuals that we engaged. This included: youth, seniors, people who primarily spoke languages other than English, unhoused individuals, and those with active addictions well. Our next steps areto analyze the results of these surveys to see where the specific barriers to vaccine uptake might be and how we can bridge those gaps.

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

As we stated earlier, any agencies reported that their clients felt saturated with COVID 19 surveys and information and were not interested in further engagement. We address this barrier by trying creative approaches to community engagement to shift away from dedicated COVID-19 vaccination information. In addition to some in-person workshops, we also offered the materials in an online info-graphic/survey format, talked to people in waiting rooms, dropped of 2000+ post-cards linking to our core information at cafés/libraries/local agencies and offered translated versions of our materials. Our outreach team attended 3 large events, a seniors fair, Santa Breakfast for the community and youth volunteer fair in an effort to reach the broadest population possible. We found that given the economic conditions and demands on peoples’ time, offering an incentive was supportive to increasing engagement. Given that food security was highlighted as one of the key social issues for our populations we chose to offer a food gift card to offset the cost of participation for those attending the workshops or reviewing our materials for the survey.

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 collaborated with over 40 organizations to engage a diverse cross-section of our community to include numerous ages and cultural groups:   Indigenous, Latin American, Arabic, Vietnamese, Chinese, seniors, families, young people, those living in shelters and 2^nd stage housing, and those struggling with addictions. Our partnerships varied in their level of engagement. For most of these organizations, they allowed us to come into their existing programs and groups to provide the booster related information and supported in bringing participants to the presentation. For the Arabic and Spanish speaking groups that we worked with, our REACH CHC Cross-Cultural Health Promoters, who work in those languages, supported with materials translation and also gathering feedback from the participants. This was a great way that we could leverage existing engagement in order to connect more deeply with these groups.

This project also allowed us to develop new partnerships, for example with Atira, a local low barrier housing agency, and Mission Possible, an agency supporting those with disability access employment opportunities.

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

Although we started a Peer Ambassador program and trained 5 cross cultural health promoters we decided to pivot away from the Peer Ambassador model. It would have been challenging for our team to get regular report backs from this model so we decided to focus on more direct engagement with community members.

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 stated earlier, given the timing of the new variant, there was less public engagement than we expected with people wanting information.

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

This funding was really important in allowing our CHC to continue to engage and serve the needs of our population. As we realized, the way that people engage with COVID-19 will shift as new variants, treatments etc come out, and sometimes it is hard to get them the correct information. As a result of this project, we know have many inroads in local organizations to continue to pass along information as new things may be developed.

As we highlighted earlier, some of the key negative affects for our community during COVID-19 was also social isolation and food/income insecurity. Indirectly, this funding supported us bringing diverse groups together, such as for a community health fair, and also providing some small respite for food security through our cards as incentives. With the outreach that we were able to conduct we have a strong base of engagement that we can build on for future community health projects.

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

We have just finished collecting the last of our surveys at the end of February. As next steps, we will analyze this data to identify what might be the systematic barriers for the groups that we engaged with. This will hopefully allow us to continue to tailor the information to best address any “myths” or misinformation that might be happening. Part of this next steps will also be compiling this information an accessible way and perhaps feedbacking with community partners. Going out into the community to deliver information creates trust and relationships between REACH CHC and its new partners, and we can then leverage this in the future to provide new information as it emerges.

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 Centre are at the forefront of delivering information and services to those who need it most. From our experiences, our CHC provided a wide range of health services during a time when other agencies were reducing service in response to a pandemic. Given the close relationship between the medical and outreach services, we were able to become a leader in COVID and Vaccine related information for our community and deliver information much more promptly. For example, we were doing COVID/Vaccine related presentations 2 years before this project because that was a need identified by our community partners. We also were able to quickly create a number of programs to support mental health, food insecurity etc. as those needs as they arose our community, in recognition that the social determinants of health were grossly affecting our community members well-bring.  The intimate relationship between the local community and CHC’s allows them to be a model well-suited to supporting community health during emergent public health issues.