Annual Activity Report

Transcription

1 Access Alliance Multicultural Health and Community Services Annual Activity Report Annual Activity Report 2015 Page 0

2 This report is the property of Access Alliance Multicultural Health and Community Services, and has been prepared to provide accountability to the Board for the organizations programs and services. For any questions or concerns, please contact Akm Alamgir, Manager Quality and Accountability Systems, Access Alliance, Recommended Citation: Access Alliance. (2015). Annual Activity Report [Agency Report]. Toronto. Evaluation Audit 2014

3 TABLE OF CONTENTS 1.0 Executive Summary Background Methodology Key Findings Learning for actions Introduction Methodology Overall findings for Clients Profile of Clients Age and Gender distribution of Active Clients Sexual Orientation Preferred Language Activities of Language Services for the Clients of Access Alliance Racial and Ethnic Groups Countries of Birth of Clients Neighbourhoods Length of Stay in Canada Status of Current Immigration and Health Insurance Level of Education and Annual Family Income Disability Issues Addressed by Service Providers Primary Care Team Social Workers Team Settlement Workers Team Peer Outreach Workers (POW) Team Employees, Volunteers and Students Employees Volunteers and Students Conclusion Works Cited Glossary Appendices Program Logic Model Interactive maps with showing client information Annual Activity Report 2015 Page 0

4 Tables: Table 1 Overall Distribution of Active Clients by Gender and Age Group 6 Table 2 Preferred Languages across Locations of Access Alliance for Active Clients 7 Table 3 Activities of Language Services for the Clients of Access Alliance. 8 Table 4 Top 10 Neighbourhoods Where Clients of Access Alliance Live In. 12 Table 5 Distribution of Clients by Education and Annual Family Income 15 Table 6 Number of Encounters by Service Providers 17 Table 7 Activities of the Peer Outreach Workers Table 8 Staff Counts by Department and Employment Status. 22 Table 9 Volunteers and Students Figures: Figure 1 Distribution of Clients across Three Locations 5 Figure 2 Distribution of Clients by Self-identified Sexual Orientation 7 Figure 3 Distribution of the On-site Interpretation Requests by Access Alliance Clients 9 Figure 4 Distribution of Racial and Ethnic Groups among Clients 10 Figure 5 Percent of Clients by Country of Birth Outside Canada 11 Figure 6 Length of Stay in Canada for Clients.. 13 Figure 7 Immigration Status of Clients Figure 8 Health Insurance Status of Clients. 14 Figure 9 Diseases Addressed by Primary Care Team Figure 10 Percentage Distribution of Other Issues Addressed by Primary Care Team. 18 Figure 11 Risk Factors as a Percentage of Issues Addressed by the PC Team. 18 Figure 12 Important Mental Health Issues Addressed by the PC and Social Worker Teams 19 Figure 13: Distribution of Clients Top Issues Addressed by Social Workers.. 20 Figure 14 Distribution of Clients Top Issues Addressed by Settlement Workers. 21 Annual Activity Report

5 1.0 EXECUTIVE SUMMARY 1.1 Background The Annual Activity Report provides a comprehensive overview of the characteristics and key issues of the clients visited by the service providers of Access Alliance Multicultural Health and Community Services during the financial year Important objectives for preparing this report are- I. Updating our evidence about clients attributes- demographic and service need II. Sharing relevant information with the stakeholders- e.g., teams, clients, funders, partners III. Designing evidence-informed program and service planning to meet clients actual need IV. Interpolating the information into quality improvement framework for future action plans. Information to identify the current and emerging trends for the demographic shift has been catered from the relevant databases, and reports from the concerned coordinators and managers of Access Alliance. The report also contains action items, designed from evaluation perspectives, for the agency s programs and services. Data has been presented in this report for clients with three categories- 1.2 Methodology I. Active clients who visited any of the programs and services of Access Alliance within the last three years (April 2012 to March 2015), and their records are available in the Nightingale-On-Demand (NOD) database II. Clients (old and new) who visited any of the programs and services of Access Alliance in the financial year (a sub-set of the active clients) III. New clients who have been on-boarded in the FY (a component of the two categories mentioned above). Data were imported through a retrospective review process from the NOD database, departmental dashboard database, and reports from other databases maintained by the concerned coordinators and managers. Descriptive analysis and relevant inferential analysis of data were conducted using SPSS software version 21. Relevant departments were consulted after initial data analysis for their suggestions about the findings, so that they feel on-boarded with the final report. 1.3 Key Findings Clients composition 10,040 active clients across three locations- AccessPoint on Danforth 46.7% (n=4,688); College 23.8% (n=2,386); AccessPoint on Jane 29.5% (n= 2,966) 3,970 clients were visited in FY, of whom 2,273 were new clients (an increase of 12.7% from the previous year) Average age of the active clients was 33.9±18.2 years. Over 40% of clients were of ages years 56.8% of clients identified themselves as female ; and over 12% clients identified themselves as parts of the LGBTQ+ community Country of Origin and languages Top countries of origin for clients were Bangladesh, Afghanistan, Portugal, India, Iran, Pakistan, Mexico, Nigeria, Hungary, and Colombia. Top languages preferred by clients were Spanish, Bengali, Farsi, Portuguese, Arabic Length of Stay in Canada Over half (56%) of the clients are in Canada for over 5 years, and this ratio increased over years Annual Activity Report 2015 Page 1

6 Immigration and Health Insurance Status 19.9% of the clients are refugees including refugee claimants 24.5% of the clients are non-insured (among clients who completed this question in the registration form) Language services Filled 2,456 Access Alliance requests for on-site interpretation, and supported 3,026 over-thephone interpretation calls Top numbers of requests for on-site interpretation were for Farsi, Hungarian, Spanish, Sgaw, Dari, and Portuguese. Encounters visited by the service providers A total of 61,718 service encounters were visited by the service providers of Access Alliance in the FY This includes the Primary Health Care Team (n=53,704), Settlement Team (n=5,848) and Peer Outreach Workers (n=2,166). The Primary Health Care Team included primary care (n=21,504), dietitians (n=26,994) and social workers (n=5,206). Most prevalent health issue of our clients Mental health related conditions were the most common (17.2%; n=1,858) medical issues addressed by the primary care team. Diseases of the musculoskeletal, respiratory, and genito-urinary system were also common. 1.4 Evaluation observation and next steps Indicators for ethnic/ racial groups, family income, disability, and sexual orientation were interpreted with caution, as the number of responses was very poor with minimum data before fall of Data quality has to be taken as the priority action items. Experiences from other agencies can be consulted for improvement on data quality Data quality issue can be taken as one of the indicators for staff performance evaluation, and relevant training with PDSA (Plan-Do-Study-Act) for relevant staffs can be a good tool to work on. Dissemination plan for this report (from the Manager, Quality and Accountability Systems): Findings were shared with the respective teams for their suggestions and opinion about the findings in this report. Team concerns or suggestions was either accommodated to the final report, or were explained to them with evidence if accommodation is not possible for data quality issue. This was completed by September 25, 2015 as the initial phase. The draft report was submitted to the Executive Director or the designate for final review on September 25 requesting feedback by September 31, The final report will be e-circulated to the Management Team on October 01, 2015, requesting feedback before October 05, The action items will be discussed at the following Management Team Meeting. The report will be sent to the Executive Director for the Executive Assistant to send it to the Board of Director of Access Alliance on October 07, In addition, the report will be presented to Board of Director as PowerPoint slides (high level) in October, with prior consultation with the Executive Director or the designate. The report will be presented to the All Staff Meeting in November. Annual Activity Report 2015 Page 2

7 2.0 INTRODUCTION The Annual Activity Report is a routine practice of Access Alliance Multicultural Health and Community Services. It is intended to share an overview of the service activities and client characteristics with the stakeholders to ensure organizational accountability. The report contains: Demographic attributes of the current clients, Encounters visited by the service providers, Assessment of clients health conditions, and clients reasons for visit the service providers at Access Alliance, Data on corporate administration, and volunteer resources, and Data on language services. This report has been prepared by collecting information from multiple databases, such as Nightingale on Demand (NOD), and departmental database (administration, language services, volunteer services, and peer outreach workers). The data were analyzed to understand the relationship among various indicators, and ultimately to understand the pattern and context of the findings. Conventionally the report is shared with multiple levels of stakeholders, and is published on our website for public access. Structured dissemination plan for the report coupled with the critical appraisal items make this report more inclusive. Although the sources of data have not changed since the 2013 report, this year s report incorporates new sociodemographic indicators, including Toronto Central Local Health Integration Network (TC LHIN) health equity indicators, and Geographical Information Systems (GIS) mapping of clients demographic and health indicators. Annual Activity Report 2015 Page 3

8 Preparing this is report a routine practice though, important objectives for preparing this report were- I. Updating our evidence about clients attributes- demographic and service need II. Sharing relevant information with the stakeholders- e.g., teams, clients, funders, partners III. Designing evidence-informed program and service planning to meet clients actual need IV. Interpolating the information into quality improvement framework for future action plans. 3.0 METHODOLOGY The process started with two unidirectional (null) hypotheses as the evaluation guidelines: Changing demography of our clients needs leveraging our service resources to meet their needs. Complexity of the encounters by our clients requires more integrated care. Primary retrospective data were collected from NOD and saved into Excel spreadsheets. Information on human resources, peer outreach workers, and languages services was collected from databases of the respective departments. Sorted data were cross-checked by the research team for reliability. Data were coded using format consistent with Health Quality Ontario (HQO), Local Health Integration Network (LHIN), and Tri-Hospital Initiative for Measuring Equity initiative. Access Alliance is one of the three piloting CHCs for the Tri-Hospital initiative. Data were then imported to SPSS statistical software in coded form for analysis. Multiple members of the research team were involved in reviewing the data for accuracy. Three data sets were created- All Active Clients, Clients Seen and New Clients. Data analysis was conducted following standard methodology. Data from each database were analyzed separately. Descriptive statistics and cross-tabs were used for frequency, percent, and distribution by groups. Sensitivity and specificity of the indicators were considered for interpretation. Some indicators were recoded into newer groups in the database in order to maintain criterion validity when compared to meta-data. Linear or Curve Logistic Regression analysis for testing correlation among indicators was restricted frequently due to empty fields in the database. In those cases, advanced tools like Compound Logistic Regression analysis were used to test statistical significance or correlation. Analyzed information was interpreted into easy-to-understand language, tables and charts in this report. Stratified strategies for knowledge translation and exchange (KTE) have been designed to make this report more useful. Annual Activity Report 2015 Page 4

9 4.0 OVERALL FINDINGS FOR CLIENTS In total, 10,040 clients have visited the programs and services of Access Alliance over the past 3 years ( Active Clients ). During the FY period, 39.5% (N=3,970) of the active clients visited Access Alliance programs and services. Access Alliance had 2,273 new clients recorded in NOD during the period April March There were 2,017 new clients in the previous year showing an increase of 12.7% new in the current year. Access Alliance has three locations- referred to as AccessPoint on Jane (APOJ), College, and Access Point on Danforth (APOD). Using client chart codes, 10,040 active clients were distributed across these three locations. Clients visited at the Greenwood clinic and Paul Steinhauer clinic were included in the APOD clients, while clients of Non-Insured Walk-In Clinic (NIWIC) were included in the APOJ clients. The distribution was: College 23.8% (n=2,386) AccessPoint on Danforth (APOD) 46.7% (n=4,688). This included clients visited at the Greenwood (n= 79) and Paul Steinhauer Clinics (n= 445) AccessPoint on Jane (APOJ) 29.5% (n= 2,966). This includes Non-Insured Walk-In Clinic (NIWIC) (n=700; 23.6%). Figure 1 Distribution of Clients across Three Locations (N=10,040) College, 23.8% APOJ, 29.5% APOD, 46.7% 5.0 PROFILE OF CLIENTS This section provides an overview of client socio-demographic characteristics, mainly using descriptive statistics. For more detailed analysis of subpopulations, such as age or cultural groups, please contact the Program Planning and Evaluation Department of Access Alliance Multicultural Community Services. Annual Activity Report 2015 Page 5

10 5.1 Age and Gender Distribution of Active Clients Average age of the active clients was found to be 33.9±18.2 years for the year (Median 34 years and mode 36). In 2013 the average age of clients was 33.5±18.6 while in 2011 it was 31.6 years. Over 40% of clients were in the age group years (Table 1). Population composition of the city of Toronto also showed highest numbers of residents (30.6%) was in this age group (Stat Canada, NHS 2011). For APOJ, average age of clients was 34.8 ± 17.7 years with 64.1% female. Mean age of APOD active clients was 32.0 ± 17.6 years with 52.2% female. Table 1: Overall Distribution of Active Clients by Gender and Age Group (N=10,040) Clients Age in Year Gender Total Female Male Transgender Other Up to (8.4%) 956 (9.5%) 0 0 1,796 (17.9%) (7.2%) 552 (5.5%) 0 1 1,281 (12.8%) ,653 (26.4%) 1,624 (16.2%) 1 3 4,281 (42.6%) ,153 (11.5%) 933 (9.3%) 0 1 2,089 (20.8%) 65 and above 331 (3.3%) 255 (2.5%) (5.8%) Missing (0.1%) Total 5,704 (56.8%) 4,324 (43.1%) 1 6 (0.1%) 10,040 (100%) Overall gender distribution (Table 1) of active clients showed 56.8% female, and 0.1% transgendered or other. Analysis of Variances (ANOVA) shows a borderline significant variation of male female ratio as a whole and also within age groups (F p=0.05). Since the representation of transgendered clients is so small in this sample size, further analysis of this variable could not be conducted. 5.2 Sexual Orientation We started collecting information for sexual orientation from September 2014, so fields remained empty for clients who were registered before that date. For this reason, an analysis of sexual orientation among Access Alliance clients cannot be completed as it is likely to be less valid. However, Access alliance has implemented a number of evidence informed activities to improve the data quality. Annual Activity Report 2015 Page 6

11 Figure 2: Distribution of Clients by Self-identified Sexual Orientation (n=1,389; N=10,040) Lesbian 2.7% Queer 0.4% Two-spirit 0.1% Other 0.1% Heterosexual 65.5% Do not know /Prefer not to answer 21.5% Gay 3.9% Bisexual 5.8% As shown in Figure 2, responses for this indicator could be collected from 1,389 clients out of 10,040 active clients (0.1%). Among the respondents, 65.5% self-identified them as heterosexual, while 21.5% did not know or preferred not to answer for this question. Over 12% of the clients self-identified themselves as the members of the LGBTQ+ community. 5.3 Preferred Language Preferred languages reported by the registered active clients has been generated from the NOD dataset and displayed as Table 2 according to the locations. Table 2: Preferred Languages across Locations of Access Alliance for Active Clients (N=10,040) Corporate (n=9,982) APOD (n=4,636) College (n=2,385) APOJ (n=2,961) English (4,666; 46.7%) English (2,263; 48.8%) English (1,021; 42.8%) English (1,382; 46.7%) Spanish (913; 9.1%) Bengali (618; 13.3%) Portuguese (290; 12.2%) Spanish (533; 18.0%) Bengali (657; 6.6%) Farsi (206; 4.4%) Farsi (233; 9.8%) Karen/ Sgaw (159; 5.4%) Farsi (471; 4.7%) Spanish (200; 4.3%) Arabic (184; 7.7%) Portuguese (152; 5.1%) Portuguese (456; 4.6%) Arabic (150; 3.2%) Spanish (180; 7.5%) Somali (135; 4.6%) Arabic (382; 3.8%) Urdu (147; 3.2%) Mandarin (58; 2.4%) Hungarian (74; 2.5%) Annual Activity Report 2015 Page 7

12 Evaluation Observation: At corporate level, the total numbers increased, but there was no shift in orders for language preferences by the clients. In APOD, preferences for Urdu passed that for Korean after Arabic compared to the year before. At APOJ, Portuguese and Somali interchanged their positions (Portuguese went up) and the same to the positions for Arabic and Spanish at College location (Arabic went up). 5.4 Activities of Language Services for the Clients of Access Alliance Language Services provides translation, sight translation, on-site interpretation, over-the-phone interpretation (OPI), and video remote interpretation services for both the clients of Access Alliance (internal) or all other Access Alliance Language Services customers (external). Data for the FY is shown in Table 3. Table 3: Activities of Language Services for the Clients of Access Alliance in the FY LANGUAGE SERVICES FY Languages offered 102 Interpretation provided for Access Alliance clients Document Translation Top languages requested for on-site interpretation (N=2,970) Top languages that were requested for on-site interpretation, but unfilled / no interpreters available (N=2,970; n=259; 8.7%) On-site RIO Farsi Hungarian Spanish Sgaw(Karen) Dari Portuguese Farsi Hungarian Spanish Sgaw(Karen) Dari Portuguese 2,067 3, (91 assignments) 508 (17.1%) 338 (11.4%) 335 (11.3%) 304 (10.2%) 214 (7.2%) 203 (6.8%) 6% 7% 0 13% 4% 1% Overall, 69.6% (n=2,067) of the on-site interpretation service requested by the clients of Access Alliance were completed by the Language Services, and 8.7% (n=259) were unfilled/ no interpreter was available (Figure 3). Detail for the Language Services is available as an annexure. Annual Activity Report 2015 Page 8

13 Figure 3: Distribution of the On-site Interpretation Requests by Access Alliance Clients in the FY Rescheduled to Fill, 7 Short-Notice Cancellation, 184 Unfilled/No Interpreter Available, 259 Client No Show, 195 Interpreter No Show, 28 Care Provider No Show, 10 Cancelled, 220 Booked, 2,067 Farsi was the most frequently requested language internally in the FY (n=508) followed by Hungarian (n=338), and Spanish (n=335). Other top languages requested internally this year include Sgaw, Dari, Portuguese, Arabic, Somali, Nepali, and Tigrinya in order. Planning Implications Leverage existing agency partnerships to support Language Services in initiatives to meet the language support needs for emerging and rare languages. Design evaluation framework for the functional aspects of the Language services regarding the resource needs for interpretation, status of interpretation usage (e.g., services requested, filled, and unfilled), and mode of interpretation service (e.g., on-site, RIO). 5.5 Racial and Ethnic Groups Clients data on racial and ethnic group were collected using the validated tools of TC LHIN. Race has been considered as a social construct, and the combination of race and ethnicity as a group provides more objectivity to the response. The Top 10 racial and ethnic groups comprised over 91% of the total clients (Figure 4). South Asians are ta the top of the list followed by Black African and Latin Americans. While the data indicate extensive diversity in the client profile at Access Alliance (Figure 4), the results should be interpreted with caution as we started to collect data for racial and ethnic group from September 2014, capturing only 15% of total clients data (Figure 4). Clients Annual Activity Report 2015 Page 9

14 often did not indicate their racial identity or selected options such as Prefer not to answer and Do not know. The overall low response rate to racial group questions indicates the values may be vulnerable to bias. Figure 4: Distribution of Racial and Ethnic Groups among Clients as Percentage (n=1,497) Black Caribbean, 7.8 Asian South East, 6.5 Middle Eastern, 5.6 Asian East, 4.3 White North American, 2.5 Indian Caribbean, 1.7 White European, 14 Black North American, 1 First Nations, 0.1 Do not Know / Prefer not to answer, 4.4 Latin american, 15.7 Asian South, 19.1 Black African, 17.3 Evaluation observation: Collecting information for this indicator has begun from September 2014, and we have to follow through the response rate and pattern over years for making any inference about the process for ensuring a safe environment to share self-identity. Planning implication: Training opportunity for Access Alliance staff for collecting data: Access Alliance can take on a lead role to provide its staff with training for collecting this sensitive information, and also to maintain data quality while processing for analysis. Inform clients how data on racial and ethnic group will be used: Data collectors can provide information to clients on the purpose of ethno-racial data collection so that clients are aware who has access to their information and how it will be used, e.g., providing culturally appropriate services. Annual Activity Report 2015 Page 10

15 Annual Activity Report September 30, Countries of Birth of Clients Access Alliance is committed to providing accessible services for culturally diverse communities. In the financial year, top countries of origin for our clients were Bangladesh, Afghanistan, Portugal, India, Iran, Pakistan, Mexico, Nigeria, Hungary, and Colombia (Figure 5). The countries of birth appear to be changing over the years. Top countries of origin for our clients included India, Nigeria and Hungary that were not on the list of Top 10 countries in Clients born in Bangladesh, Portugal, India, Nigeria, and Hungary appeared to increase in number from 2013 data. While clients born in Afghanistan, Iran, Mexico, Pakistan, and Columbia appeared to decrease in number compared to the corresponding numbers in Emerging Communities New top countries in include India, Nigeria and Hungary. Figure 5: Percent of Clients by Country of Birth Outside Canada (Top 10) (n=8,372) Evaluation observation: Anecdotally, many of the Hungarian clients would consider themselves Roma. Presently, the practice of immigration policy in Canada will not provide members from this community with refugee status, and a proportion of refugee claimants from Nigerians will be granted convention status. These emerging client populations are likely to be uninsured and have barriers in securing employment with stable income and benefits. Annual Activity Report 2015 Page 11

16 5.7 Neighbourhoods Table 4 shows the top 10 neighbourhoods where Access Alliance clients reside. Distribution of clients accessing to the programs and services of Access Alliance in the year across Toronto neighborhoods were identified through analysis of frequencies of client postal codes, aggregated by the first three digits. This analysis revealed the four most common neighbourhoods among all clients (Oakridge; Crescent Town, Rockcliffe-Symthe and Black Creek) remain the same as previous years. Although the individual rankings may have changed, the composition of the fourth to tenth neighbourhoods has remained the same as the previous year. Individually, the count in these neighbourhoods has increased suggesting continued growth of clientele among all Top 10 neighbourhoods despite differences in ranking. For example, Dovercourt ranked seventh among contributing neighbourhoods, two rankings lower than the previous year, although the clientele in this area has increased from 133 to 233. Table 4: Top 10 Neighbourhoods Where Clients of Access Alliance Live In Postal Code Active Clients (N=10,040) Neighbourhood % Number Postal Code New Clients (N=2,273) Neighbourhood % Number M1L Oakridge M4C Crescent Town M4C Crescent Town M1L Oakridge M6N Rockcliffe-Symthe M6N Rockcliffe-Symthe M3N Black Creek M3N Black Creek M6M Mount Denis M6E Caledonia-Fairbanks M6E Caledonia- Fairbanks M4B (Parkview Hill/ Woodbine Gardens) M6H Dovercourt M5A Regent Park M1E West Hill M6M Mount Denis M4H Thorncliffe Park M1K Kennedy Park/ Ionview/ East Birchmount Park M3C Flemingdon Park M9M Humberlea/ Emery) Nearly half (48.8%) of the new clients reside in the top 10 neighbourhoods. For , the first four most common neighbourhoods remained the same as 2013 (Crescent Town, Oakridge, Rockliffe-Symthe and Black Creek). Annual Activity Report 2015 Page 12

17 5.8 Length of Stay in Canada An increasing proportion of Access Alliance clients have been settled in Canada for over 5 years. In , over half (56%) of clients had been in Canada for over 5 years (Figure 6), while the number was 36 % in 2013, and 31% in This is related to the healthy immigrant effect of the newcomers. Figure 6: Length of Stay in Canada for Clients % 24% 41% 27% 31% 36% 17% 15% 18% 11% 13% 11% Less than one year 1-3 Years 4-5 Years Over 5 years Evaluation observation: This increased proportion of settled clients may be due to targeted recruitment activities for programs, and the continued reliance of clients on Access Alliance services over the years. Considering the context of healthy immigrant effect, clients staying in Canada for longer time start suffering from health related issues similar to native Canadians if proper intervention is not planned (Health Canada, 2013). Access Alliance can play the lead role in this perspective with a combination of health promotion interventions to maintain the healthy immigrant effect. Annual Activity Report 2015 Page 13

18 5.9 Status of Current Immigration and Health Insurance Figure 7 shows the current immigration status of all clients in the FY Out of 10,040 clients, 6,491 responded the question, among whom 10.3% were citizens (n= 1,030), and 33.4% (n=2,510) were permanent residents. Refugee clients including refugee claimants comprised 19.9% (n=1,995), and non-status 1.9% (n=186) of clients. Figure 7: Immigration Status of Clients in (N=10,040) PNA/ DNK 0.2% Others 7.5% Blank 35.3% Refugee 19.9% Permanent Resident 25% Citizen 10.3% Non-status 1.9% Figure 8: Health Insurance Status of Clients (Percentage) (n=5,496; N=10,040) OHIP, 65.6% No-insurance, 24.5% IFH, 7.7% Others, 0.8% 3-month waitng for OHIP, 1.4% Over 24% of our clients were not insured, 1.4% were on a 3-month waiting period for OHIP, and 65.6% of clients had health insurance coverage through the Ontario Health Insurance Program (OHIP). Nearly 8% of the clients were covered by the Interim Federal Health program (IFH) coverage (Figure 8). Evaluation Observation: Low response rates to questions around immigration and health insurance status were common throughout the years. For this reason interpretations of the data should be taken with caution. Planning Implication: Data quality issue requires to be taken as a critical performance indicator. Relevant staffs will be trained so that they will collect and enter complete data into NOD. Annual Activity Report 2015 Page 14

19 5.10 Level of Education and Annual Family Income Nearly one-third of the clients of years of age group had completed postsecondary education (Table 5) in comparison to 64.1% of Canadian residents of the same age group (NHS 2011). Over half of the clients (Table 5) had annual family income less than $15,000. Clients were asked, during their registration with Access Alliance for any program or services, about the number of people supported by their income. In total 66.4% (n=6,666) out of 10,040 clients filled this question, and the average number of households supported by their family income was 6.03±16.3. Low income cut-offs for a family of 6 living in Toronto is $49,389 per year as set by statistics Canada (LICOs 1 ). Using this measure, more than 75% of Access Alliance clients are below the LICO. Table 5: Distribution of Clients by Education and Annual Family Income (N=10,040) Active Clients (n= 8,954) Annual Family Income (n=7,455) Education Number % Income Range Number % Post-secondary 2, $0-$14,999 3, Secondary (Grade9-12) 2, $15,000-$19, Primary (Grade 1-8) 1, $20,000-$24, No formal education Other $25,000-$29, , $30,000-$34, Do not know $35,000-$39, Prefer not to answer $40,000-$59, $60,000 and above Do not know 1, Prefer not to answer LICO is an income threshold below which a family will likely devote a larger share of its income on the necessities of food, shelter and clothing than the average family. Annual Activity Report 2015 Page 15

20 5.11 Disability Out of 3,970 clients during the year , 119 provided a response (3% response rate) when asked to select different forms of disability. Among the respondents, 62% indicated that they had no disability, while 12.6% indicated chronic illness, 4.2% physical or sensory disability, 3.4% mental illness, 2.5% developmental disability, 1.7% drug or alcohol dependence, and 0.8% learning disability, and 8.4% other. Evaluation Observation: This question was too sensitive to collect response from clients. Also the set responses are not mutually exclusive. This is a TC LHIN recommended question, hence requires sector intervention to decide on. Annual Activity Report 2015 Page 16

21 6.0 ISSUES ADDRESSED BY SERVICE PROVIDERS In the FY , Access Alliance service providers addressed 61,718 encounters for clients (Table 6). Service Provider Primary Health Care Team Table 6: Number of Encounters by Service Provider Primary Care Team 21,504 Diseases 10,777 Practices and 8,818 procedures Number of Encounters 53,704 Risk factors 682 Symptoms 611 Social problems 356 Other issues 260 Dietitian Team 26,994 Social Work Team 5,206 Settlement Team 5,848 Peer Outreach Workers 2,166 Total 61, Primary Care Team Primary care team (physician, nurse practitioner and nurse) addressed a total of 21,504 issues in the FY Approximately half (50.1%; n=10,777) of those issues were systemic diseases/ conditions compatible to the Canadian version of the 10 th International Classification of Disease (ICD-10 CA) database (Figure 9). Rest of the issues (49.9%; n= 10,727) related to clinical practices and procedures, risk factors for chronic diseases, and symptoms have been shown in Figure 10. Psychiatric and mental health related conditions were the most common (17.2%; n=1,858) medical issues addressed by the primary care team. As an agency, Access Alliance identified mental health as a priority medical issue. However, Musculoskeletal (11.6%; n =1,248), respiratory (10.2%; n=1,104), genito-urinary (10.2%; n=1,101), gastro-intestinal (9.5%; n= 1,027), and endocrine (9.4%; n=1,014) conditions composed comparable proportions that require significant consideration as well. Issues composing 2% or less of total medical issues were grouped in the Others category, which includes Eye and Adnexa, Infection and Parasitic, Ear, and Mastoid processes, and Neoplasm/cancer. Annual Activity Report 2015 Page 17

22 Figure 9: Diseases Addressed by Primary Care Team (n=10,777) Figure 10: Percent Distribution of Other Issues Addressed by Primary Care Team (n=10,727) Blood related 413, 4% Pregnancy, Childbirth, and puerperium 441, 4% Circulatory 679, 6% Skin and subcutaneous 850, 7% Neurological 408, 3% Others, 1941, 16% Endocrine/ Nutrition/ Metabolic 1014, 8% Psych 1858, 17% Gastrointestinal 1027, 9% Musculoskele tal and connective tissue 1248, 11.6% Respiratory 1104, 10.2% Genito- Urinary 1101, 10.2% Clinical practices & procedures, 41 Symptoms, 2.8 Social problem, 1.7 Others, 1.2 Risk factors, Risk Factors for Chronic Diseases Data on common risk factors have been extracted from NOD database. The list included dyslipidaemia (alteration of the ratio between helpful and harmful lipids in the blood), obesity & overweight, physical inactivity, smoking, impaired glucose tolerance, and elevated blood pressure. According to Figure 11, prevalence of elevated blood pressure increased. Risk factors that declined include impaired glucose tolerance, physical inactivity and smoking. Prevalence of dyslipidaemia, and obesity & overweight remained similar since Figure 11: Risk Factors as a Percentage of Issues Addressed by the PC Team (n=21,504) Dyslipidaemia Obesity & Overweight Physical Inactivity Smoking Impaired Glucose Tolerance Elevated Blood Pressure Annual Activity Report 2015 Page 18

23 6.1.2 Mental Health Issues Addressed by Primary Care and Social Worker Teams Mental health issues were addressed by both the primary care and social worker teams. These two teams attended 3,967 mental health issues in the FY (Figure 12). Depression was the top mental health issue (n=848; 21.3% out of 3,967) addressed by the service providers. Other important issues were anxiety 12.9 % (n=511), schizophrenia 5.21 %( n=207), behaviour problems 2.6 %( n=105), and substance abuse and addiction 6.6% (n=260). Figure 12: Important Mental Health Issues Addressed by the PC and Social Worker Teams (n=3,967) Others (n= 2036, 51%) Depression (848, 21%) Anxiety (n=511; 13%) Substance abuse and addiction (n=260, 7%) Schizophrenia (n=207, 5%) Behaviour problems, (n=105, 3%) 6.2 Social Workers Team In total 5,206 individual issues were addressed by the social workers in the FY Figure 13 shows that therapeutic counselling/ listening was the most frequent issue (7%; n=366 out of 5,206) addressed by the social workers, followed by post- traumatic stress disorder (5.3%, n=277), coping with life s problems (4.8%, n=251), anxiety (4.7%, n=247, social isolation (4.6%, n=239), depression (4.5%, n=235), post-immigration stress (3.0%, n=158), language barrier (2.7%, n=141), feeling depressed (2.2%, n=116), and administrative procedures/forms (2.2%, n=116). The facet of depression (4.5%) encompasses minor depression, mild major depression, moderate major depression, severe major depression, and reactive depression. Subsequently, the facet of post-traumatic stress disorder (PTSD) encompasses complex PTSD and while PTSD is traditionally classified as an anxiety disorder in Diagnostic and Statistical Manual IV, its notable prevalence among our client base warranted a unique category. Annual Activity Report 2015 Page 19

24 Figure 13: Distribution of Clients Top Issues Addressed by Social Workers (n=5,206) Language Barrier (141) 2.7 % Post- Immigration Stress (158) 3.0% Feeling Depressed (116) 2.2% Request for Administrative Procedure/ Form (116) 2.2% Visit for Therapeutic Counselling/ Listening (366) 7.0% PTSD (277) 5.3% Depression (235) 4.51% Social Isolation (239) 4.6% Anxiety (247) 4.7% Coping with Life's Problems (251) 4.8% 6.3 Settlement Workers Team Settlement workers addressed 5,848 issues in the FY Nearly one third of these issues (27.9%; n=1,629) were for administrative procedures. Figure 14 displays the top ten issues that were addressed by the settlement workers. Following administrative procedures, the most common issues were related to immigration (15.0%; n=877), financial problems (9.3%; n=546), housing problems (6.9%; n=402), issues related to the healthcare system (6.5%; n=382), discrimination based on sexual orientation (4.9%; n=286), language barriers (4.9%; n=285), advice on community resources (4.7%; n=273), requests for referrals (4.3%; n=253), and issues with obtaining citizenship (1.6%; n=95). Annual Activity Report 2015 Page 20

25 Figure 14: Distribution of Clients Top Issues Addressed by Settlement Workers (n=5,848) Visit for Advice on Community Resources (273) 4.7% Request for Language Referral(s) Barrier (285) (253) 4.3% 4.9% Problem with Obtaining Citizenship (95) 1.6% Housing Problem (402) 6.9% Discrimination based on Sexual Orientation (286) 4.9% Problem with Health Care System / Access / Availability (382) 6.5% Financial Problem (546) 9.3% Request for Administrative Procedure / Form (1629) 27.9% Immigration Issues (877) 15.0% 6.4 Peer Outreach Workers (POW) Team Five Peer Outreach Workers (POWs) worked for a total of 56 POW-months in the FY (each of the four POWs worked for a 12 month period, and one POW worked for eight months). POWs reached out 2,166 unique and total 9,380 encounters (Table 7). Table 7: Activities of the Peer Outreach Workers Type of Encounter Number (No. of Clients per (No. Hours per Total hours during POW) per month POW) per month year/ POW Total Encounters 9, ,704 Unique Encounters 2, ,120 Total Outreach 3, , EMPLOYEES, VOLUNTEERS AND STUDENTS 7.1 Employees A total of 24 clinicians and 11 administrative staff work in the Primary Health Care Team. Most of them are working as full-time and permanent staffs (14 of 24 clinicians; 9 of 11 administrative staff); the detail is shown in Table 8. The majority of the staffs of community programs (18 of 35) are employed full-time permanent. Annual Activity Report 2015 Page 21

26 Table 8: Staff Count by Department and Employment Status Permanent Permanent Contract Contract Department Total Full-time Part-time Full-time Part-time PHC Clinicians PHC Admin Community Programs Language Services Research and Evaluation Central Administration and Finance (including ED) Others (Seasonal Students, Project Staff) Consultants 0 Total Volunteers and Students Numbers and hours of both the volunteers and students increased in the FY from the previous year (Table 9). The average number of hours contributed by each volunteer has increased substantially over the years (110% since 2013; 117% since 2012; and 80% since 2011), and average number of hours contributed by each student have also increased 38.3% over the past year. Table 9: Volunteers and Students Volunteer/ Student Active volunteers Volunteer hours contributed 4,721 4,002 2,797 7,155 Average number of hours per volunteer Student placement Student hours contributed N/A 6,998 6,532 12,037.5 Average number of hours per Student N/A Annual Activity Report 2015 Page 22

27 8.0 CONCLUSION Analysis of the collected data identified that the number of clients has been increasing over years. Demographic distribution of the clients showed silent shift of demographic paradigm of the clients, e.g. clients from Hungary and Nigeria showed an increasing trend over the recent past years, more than four out of ten of our clients are staying in Canada over 5 years. We serve vulnerable population, e.g., over one-third of our clients are from the refugee stream and non-status, and increased number of clients from the LGBTQ+ community. Mental health was found to be the most prevalent issue to visit our service providers. Access Alliance is a complex care organization with higher number of encounters per clients, a proxy indicator for complexity, and requires well-designed integrated care practices. Major concern for this report is for data quality, specially referring to the health equity measuring questions. Considering the preferred languages by clients and the requests for interpretation for language services, priority languages of the agency (after English and French) will be- Spanish, Farsi, Portuguese, Bengali, Arabic, Hungarian, and Sgaw. Planning Implications: 1. Take data quality into the accountability framework, and organize appropriate needbased training for the relevant staff (PDSA can be a useful strategy to improve data quality) by the management and quality improvement committee teams in October- November 2015, and follow-ups in April Design more efficient integrated care practice plan by the teams, and monitor the effectiveness through using the balanced score card- by the Health with Dignity portfolio by December Leverage existing agency partnerships to support Language Services in initiatives to meet the language support needs for emerging and rare languages- by the Language Services and the senior management as an on-going process. 9.0 WORKS CITED Health Canada. (2013). Migration Health in Science and Research. Accessed July 30 th 2015 at Low-Income Children 0-5 Years. (2015). The Toronto Report Card on Children. Toronto: Accessed on July 30 th 2015 at: Statistics Canada. (2014). NHS Profile, Toronto: Accessed on July 30 th at Annual Activity Report 2015 Page 23

28 10. GLOSSARY OF FREQUENTLY USED TERMS Chart ID: Unique identification number for each client assigned during the on-boarding process coded according to the primary service location, e.g., E stands for East location (APOD). Encounter: Refers to the frequency of interaction of the clients with the service provider(s). One client will have one chart ID, but may have multiple encounters in a year. During each encounter, the client may have multiple issues to be addressed. Number of issues addressed by the service provider also contributes to understanding the complexity of care. NOD: Nightingale-On-Demand is the data repository system software for Electronic Medical Records (EMR) and other records for clients. Encode-FM: Codes used in the NOD for encounters, reasons for visits, and issues addressed by the service providers. Reason for visit: Unprocessed statements of clients (according to Encode-FM) to describe their problem as a reason for visiting their service providers. Issue: Assessment categories for the client (aligned to Encode-FM) that the service provider put into the NOD. Active Clients: Refer to the clients whose information is available in the EMR system. Typically client data remains in the system for a period of three years. Clients Seen: They are a sub-set of the active clients who visited service provider(s) during any specified time period (typically a year). New Client: They are a sub-set of clients newly on-boarded into the agency during that particular period of time (typically one year). Preferred Language: This refers to the preferred language selected by clients at the time of onboarding. Sometimes this indicator may not reflect the first language for some clients who feel comfortable in speaking English for communication with service providers. Country of Origin: This is a proxy indicator derived from the data on country of birth. Annual Activity Report 2015 Page 24

29 Appendix Planning Template Strategic Directions Performance Measures Key Activities Timelines Owner Needle on Quality Completeness of data for eight TC LHIN demographic questions, and OHIP numbers Low No Show rate Take data quality into the accountability framework, and organize appropriate needbased training for the relevant staff through 1. PDSA 2. Objective chart audit pathway October- December 2015, follow-up in April 2016 ED (PO), 1. Manager QIC (PM), Manager, IT/IM, and Manager Clin admin 2. Senior Res Scientist and Manager QIC Improve Access Integrated care pathways for all clients of Access Alliance Integrated care pathways for residents who step into Access Alliance Design more efficient integrated care practice plan by the teams, and monitor the effectiveness through using the balanced score card Mar 2016 Director PHC (PO), Health with Dignity team (PM), HP team, Child & Family (Support) Equity Ratio between filled and unfilled request for translations and interpretation Leverage existing agency partnerships to support Language Services in initiatives to meet the language support needs for emerging and rare languages March 2016, Follow up in March 2017 Director CHW (PO), Language Services (PM) Annual Activity Report 2015 Page 25

30 Program Logic Model for the Annual Activity Report 2015 Important objectives for preparing this report are: I. Updating our evidence about clients attributes demographics and services needed. II. Sharing relevant information with the stakeholders e.g. teams, clients, funders & partners. III. Designing evidence-informed program and service planning to meet clients actual needs. IV. Interpolating the information into quality improvement framework for future action plans. Input Output Target Database(s) Outcome Deliverables and KTE Project Manager: Akm (Manager, Quality and Accountability Systems MQAS) Research Assistant Volunteers to support one international medical graduate student as volunteer (to analyze critical assessment data), one U of T student to support her and RA with the software, and one MPH graduate from University of Western Ontario to support editing One placement student of Clinical Research Associate program to analyze mental health data, and to correlate with the clinical data One U of T student to create GIS map with data 1. Pulling of data by My from NOD by April Data organization, cleaning, and exporting SPSS for analysis with support from team in May-Jun 3. Collecting data from other coordinators/ managers from dashboards/individual databases May-Jun 4. Preparing report by Carol (RA) by July Sharing the initial report with the respective teams for their feedback by Jul- Aug Review and revise the report by MQAS and sending the revamped report to the team again 7. Preparing and submitting the final version of the report to the Executive Director for review and critical appraisal 1. NOD 2. Language Services database 3. Volunteer Services database 4. Peer Outreach Worker s database 5. HR staff database 1. Compatible SPSS and Excel dataset prepared 2. Other databases compiled and aligned to the NOD data 3. Initial, reviewed, and team informed report prepared by Sep Two levels of evidence will be prepared descriptive and inferential 5. Descriptive analysis for updating the information, accountability and learning; while the inferential analysis will be for moving the needle of quality, action items to be designed, and comparing the trends over time and place 6. Develop evaluation observation very clearly guiding towards planning implications 7. Record the team feedback into planning matrix 8. An inclusive evidence-informed report 1. Communication to teams after initial compilation of the report by Aug Report to the ED or designate by third week of Sep PPT to Sep Management Team meeting 4. Report to the Board 5. PPT presentation to the Board in Oct PPT to All Staff Meeting in November 7. PPT presentation to the community members at each of the locations planning with the management teams 8. Report to publish at the website for public Evaluation Tool: Realist evaluation framework for summative (including process evaluation) and formative evaluation. Annual Activity Report 2015 Page 26

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