1door.ca
Waypoint Centre for Mental Health Care
Waypoint, in partnership with the Central Ontario Specialized Health Network, led the development of 1door.ca bringing Simcoe County/Muskoka one step closer to a coordinated access mechanism for mental health and addictions (MHA). The driving factor of this work was to simplify and streamline system users’ access to counselling and therapeutic services as a result in […]
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Adolescent and young adult cancer program
The Ottawa hospital
The Adolescent and Young Adult (AYA) Program at The Ottawa Hospital is an integrated, patient-centred navigation model designed to connect young people with cancer to the right care, at the right time, and as close to home as possible. It works alongside existing care teams to identify individual needs early and streamline access to specialized […]
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Caregiver-Centered Care Education for the Health, Social, and Community Care Workforce
Department of Family Medicine, University of Alberta
The Caregiver-Centered Care Education Initiative aims to strengthen staff capacity to partner effectively with family caregivers as valued members of the care team. The goal is to enhance communication, empathy, and collaborative care practices that recognize caregivers’ knowledge, roles, and well-being. Through practical strategies and real-world examples, the education supports staff to involve caregivers in […]
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Connecting People and Community for Living Well – Bonnyville, Alberta Community Group
Assisted Living Alberta
Our work incorporates wellbeing at its foundation, honoring the multiple factors that contribute to living well, and building on the strengths of communities in responding to the evolving needs of their local population. In later 2025, Bonnyville, Alberta in Canada became a new Community Group out of 16 rural Alberta Community Groups we support under […]
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Enhancing Integrated Care
Horizon Family Practice
Our organization is currently experiencing significant challenges related to fall risk and frailty, particularly among older adults and individuals with multiple chronic conditions. Falls are one of the leading causes of injury and hospitalization in our patient population, often resulting in loss of independence, decreased mobility, and extended recovery times. Many of our clients exhibit […]
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Evaluating Expanded Clinical Roles in Primary Care: Evidence from NB Health Link
Centre for Research in Integrated Care
The purpose of this research study is to explore the impact of expanded clinical roles (registered nurses, licensed practical nurses, and physician assistants) within NB Health Link on patient experiences and healthcare utilization. More specifically, this research will: (1) examine changes in ED utilization among NB Health Link patients following implementation of expanded roles and […]
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First Episode Rapid Early Intervention for Eating Disorders Canada (FREEDcan)
Children’s Hospital of Eastern Ontario (CHEO)
FREEDcan is an early intervention model for eating disorders (EDs) for young people aged 8-25 years, co-adapted for Canada from the United Kingdom’s evidence-based FREED model. It is an integrated systems care model, bringing youth-serving community treatment settings (e.g., mental health and addictions, family health teams, campus health, integrated youth services, primary care, etc.) together […]
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MyDAWN: Depression & Anxiety Wellness Navigation tool
Waypoint Centre for Mental Health
MyDAWN (Depression & Anxiety Wellness Navigation) is an early intervention stepped care pathway that supports primary care physicians (PCPs) in the management of anxiety and depression in children and youth. Using evidence-based assessment tools (e.g. RCADS) embedded within the PCP electronic medical record, MyDAWN recommends best-practice treatment and management. The result is a sustainable, scalable […]
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Neighbourhood Care Team
Baycrest Hospital
The Neighbourhood Care Team (NCT) is a scalable outreach-based, integrated geriatric model that brings together cross-sector community partners to operate as one team in support of community dwelling seniors. Originating within the North Toronto Ontario Health Team the model currently serves over 1,500 community members across nine buildings. NCT aims to improve access to health, […]
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NYTHP CDM Hub
Flemingdon Health Centre (FHC)
The NYTHP Chronic Disease Management (CDM) Hub is a community co-designed, team-based service that improves access and continuity of care for people living with CHF and COPD in North York. Its goal is to stabilize patients, reduce avoidable ED visits and hospital readmissions, and support self-management through culturally and linguistically appropriate care. Referred patients receive […]