The Growth and Evolution of a CHC

Learn about the growth and evolution of Access Alliance, and the driving forces behind a resilient model of care

By Miranda Saroli, Knowledge Mobilization and Social Action Coordinator, Access Alliance
chalkboard with the writing "The Growth and Evolution of  a CHC" with a red heart next to the text and pills off to the side

This blog post contains excerpts from a manuscript submitted to the Alliance for Healthier Communities, which had multiple contributing authors: Akm Alamgir, PhD; Miranda Saroli, MES; Axelle Janczur, MBA; Sonja Nerad, MSW

Community health centres (CHCs), in the simplest terms, work to improve the lives of the people they serve. How they do it is not so simple. CHCs in Ontario are guided by the CHC model of care, a framework designed to eliminate systemic barriers to accessing healthcare (such as poverty, geographic location and language) experienced by many communities. Programs and services go further still to proactively address the range of social, economic, and environmental factors that influence health (e.g. education, income, race/ethnicity, immigration status, and so on), through health promotion, illness prevention, and advocacy. (Read more about the CHC model of care here)

When Access Alliance Multicultural Health & Community Services (Access Alliance) first opened its doors in 1989, this small, ethno- and cultural-focused CHC had room to grow. Driven by its mission, and guided by the CHC model, grow it did – to become the large multi-service organization it is known as today. When the COVID-19 pandemic hit in March of 2020, Access Alliance was well positioned to weather the storm, keep its doors open and continue offering services. Of course, getting to this mature, resilient state did not happen overnight. It took over three decades of continuous learning, unlearning, adapting and adjusting.

In the sections that follow, we will showcase how four driving forces promoted the evolution and strategic growth of Access Alliance, a community health organization that today is highly adaptable and responsive to change, while simultaneously driven to realize its vision.

Driving Force 1: Identifying Priority Populations

In the beginning, Access Alliance focused on serving clients from the four founding communities (Vietnamese, Portuguese, Spanish-speaking, and Korean). At this early time, ‘country of origin’ and ‘immigration status’ were the main indicators for defining the organization’s service eligibility. By the mid-1990s, newcomers beyond the founding groups were seeking access to health care. Access Alliance began to study sociodemographic and health status information, and found that those populations experiencing multiple and intersecting barriers to the determinants of health experienced the poorest health outcomes. This included groups that had not historically been identified as priority populations, such as newcomers from lesbian, gay, bisexual, transgender and queer (LGBTQ2+) communities, as well as second and third generation immigrant populations.

With this knowledge in hand, the organization made a strategic decision to evolve from its founding communities to focus on the most disadvantaged newcomer populations. 

Access Alliance continues to conduct research on the intersections of race, poverty, and health-implemented evidence-informed programming, and advocates for system-wide health inequities to be addressed.

Driving Force 2: Establishing Partnerships

Access Alliance has long embraced partnerships as a strategy to address the systemic barriers that influence the wellbeing of its priority populations.

The organization recognized “that it is part of a larger system of service providers and needs to work continuously to break down silos and build linkages in order to increase access to services” (source article: Nerad and Janczur, 2000, 227). 

As the organization grew, the leadership decided to deliver services outside the downtown core, in priority neighbourhoods which were characterized by a high number of newcomers and a serious lack of service infrastructure. Here, Access Alliance formed partnerships slowly, since building trust with community members and service providers was critical. This process was facilitated by bringing evidence, organizational capacity, and a willingness to mobilize collective resources in response to community needs.

Over time, the nature of Access Alliance partnerships with regards to function has diversified significantly. Many are based on collaboration, working together towards a common goal or vision and combining influence and power to effect change, such as with academic and community partners for research and advocacy. Other partnerships are based on coordination, where organizations in the same sector (e.g. health, settlement) come together to coordinate, streamline and share services. One such example is the formation of the Non-Insured Walk-in Clinic (NIWIC) – a partnership among seven West-Toronto Community Health Centres designed to address the health needs of non-insured or under-insured people. Lastly there are partnerships based on cooperation, those assisting each other on an ad hoc basis, such as in response to the Syrian refugee influx in 2015.

Access Alliance continues to embrace its commitment towards meaningful partnerships – those which are increasingly geographically and functionally diverse – to advance shared goals for community development.

Driving Force 3: Responding to Needs

In 2003, Access Alliance launched the Access Model, which defined a formal strategy for responding to the needs of the community, by extending services and deploying resources to neighbourhoods throughout the city.

Over time, the model evolved to be the ‘Access-through-Equity-Model’, reflecting a commitment to address systemic barriers caused by geography, language, poverty, racism and discrimination.

Today, Access Alliance conducts community-based research, planning, and evaluation. Such practices ensure that the gathered evidence is timely, reliable, and useful to the communities served. Client needs are identified through the annual Client Experience Survey, feedback/complaints processes, and through anecdotal evidence from staff, while broader community-level needs are identified through comprehensive Community Health Needs Assessments Programs. Services are then redesigned according to the feedback, insights, and expressed needs of our clients and their communities. For example, the Expressive Arts programming was developed to respond to the mental health needs of refugees, who are facing multiple intersecting barriers to health and wellbeing, by creating a space for them to express their life stressors, trauma and experiences of migration through creative mediums.

Driving Force 4: Building Community Capacity

Strengthening community knowledge and skills has been an organizational health promotion goal since the beginning (source article: Nerad and Janczur 2000). One way Access Alliance does this is by offering volunteers and students training programs on community-based research, civic engagement, planning, evaluation, anti-oppression, and the CHC model of care.

Its Peer Outreach Program has been a flagship initiative where newcomer women are trained to conduct outreach, link residents to services, and participate in local service provider networks to reduce service gaps and enhance service pathways.

Since 2003, the agency has trained and supported many newcomer women to improve access to services for community residents in priority neighbourhoods. The Peer Researcher program is an adaptation of this model for building the research capacity of peers so they can investigate challenges and make positive changes in their own communities as ‘change agents’. Increasingly, the research model at Access Alliance is evolving towards peer-led ‘co(operative)-design’, and several projects have been piloted in recent years which integrated these elements (such as this project around tackling TB stigma and this project around improving health and wellbeing of LGBTQ+ newcomer women).

A Vision for the Future

Although COVID has left many of us feeling immobilized, Access Alliance programming and service delivery has been steadfast throughout the pandemic. As we look towards a recovery, CHCs like Access Alliance have to work hard to make sure that the needs and challenges of the communities we work with, particularly those exacerbated by the pandemic, do not get swept away or overlooked.

Strong partnerships which offer clients a network of support, a relentless focus on access and equity, and bold investments in community empowerment, along with the other principles of the CHC model of care will be critical for pulling ourselves out of the COVID-19 pandemic. It will also guide us towards an equitable recovery that prioritizes those communities most hard hit and works toward rebuilding a fair future for all.