Working Collaboratively with Local Partners to Provide Integrated Care Across East Toronto


At South Riverdale Community Health Centre (SRCHC), a strategic priority for the organization is to “lead systems transformation through building and nurturing partnerships that support an inter-sectoral approach to addressing the social determinants of health.” SRCHC is involved in multiple partnership projects with agencies and community that focus on improving the well-being of clients and community members. We work with communities and research partners to build knowledge and evidence that inform practice, leadership and transformative change. 

SRCHC works closely with partner agencies with in the East Toronto Health Partners Ontario Health Team (OHT) and the Downtown East OHT to plan and coordinate services. East Toronto Health Partners (ETHP), the OHT serving East Toronto, is a collaborative initiative that brings together more than 100 health, social and community service providers and organizations who work together to improve the ways in which community members find and receive care in East Toronto. 

SRCHC is an anchor partner within the ETHP and represents one of five community health centres (CHCs) in East Toronto including Access Alliance, East End Community Health Centre, Flemingdon Community Health Centre and Vibrant Healthcare Alliance. CHCs in East Toronto have a long history of working together in an integrated and collaborative manner. SRCHC has worked with local CHCs on a range of healthcare initiatives with a focus on health equity, health promotion, community governance and team-based care for socially vulnerable and medically complex residents. By working as one coordinated team, rather than separately, we aim to make finding and receiving care more connected across the spectrum of care and easier to navigate. This approach helps to improve access to services, as well as reduces delays, mitigates duplication in care and addresses gaps in service delivery. 

SRCHC staff support a number of projects within the ETHP OHT, including:

  • Working with OHTs in our community to redesign integrated care pathways for chronic obstructive pulmonary disease, congestive heart failure and diabetic foot care.   
  • Working with ETHP on a year-long consultation that will help to advance the OHT’s work across equity and anti-racism. This work will inform how we work together to co-design a more inclusive health system that delivers high-quality care with equitable health outcomes for everyone.   
  • ETHP has partnered with the Registered Nurses' Association of Ontario (RNAO) to embark on a four-year journey to optimize patient outcomes through evidence-based practice and robust staff engagement across multiple ETHP member organizations. This partnership has been informed by the implementation of Best Practice Guidelines, which provide evidence-based recommendations and implementation tips pertaining to infrastructure, knowledge exchange, capacity building, dissemination, evaluation and reporting. SRCHC is currently working with our OHT partners in East Toronto on a falls prevention toolkit to help inform organizational fall prevention programs across our OHT partner organizations. The toolkit also contains a series of image and text-based handouts to help people prevent and respond to falls at home.  

SRCHC’s partnerships are paramount to achieving the organizational vision to create empowered, healthy and thriving communities where everyone belongs. It is through collective efforts with ETHP that we strive to amplify the work being done at the Centre and expand our impact throughout East Toronto by enhancing integrated care for its community members.