We are all closely watching the number of COVID cases as they spike across the province and we imagine that many of you are wondering what that means for CHIRS - our staff and our clients.  

Our Senior Management team and the COVID Implementation Committee continue to monitor the situation daily.  If only there was a magic formula that would tell us that, if the numbers are above or below a certain point, we should respond a certain way.  But there isn't. So for now we have to base our decisions on what our health experts are recommending.  This week the Medical Officer of Heath told everyone to once again limit our risk factors.  Based on that and other recommendations and on the rising numbers over the weekend, we have made the decision to scale back on some supports and practices and hold steady on others where we feel we can continue to do so safely.

Here are the key decisions based on our discussions today:

For Residential Services

• Visiting protocols are changing.  Visits will once again be limited to outdoors only, close to the residence, employing all the safety protocols that we have been following (socially distanced, outside, with masks).  That means no more visits to family homes or community outings to restaurants, patios, or indoor public venues with families or friends.  Under very specific circumstances there may be some exceptions to these restrictions. 

• Client community outings will be re-evaluated to assess whether they are safe and necessary.  We are NOT restricting all community outings because clients cannot be expected to stay in their residences indefinitely.  But we are asking that the frequency of outings be limited and, in some cases, reduced and that the location and type of outing be carefully considered for risk, always seeking the safest options available. 

• Client outings to restaurants and patios and indoor public venues will be discontinued for the time being.  There is a higher inherent risk in these settings and there are safer alternatives. We recognize this puts additional pressure on staff to keep clients engaged in meaningful activity so we will continue to investigate opportunities to assist with this (e.g., additional recreational social activity opportunities and perhaps having small cohorted supports at Head Office for some clients). 

For Community Outreach Services

• All in-person supports must be re-evaluated at this time.  We are NOT restricting all in-person supports but we need to constantly be evaluating the risk and the need and looking for the safest options.  If the risk is high and the need is low, the support should be discontinued for now.  On the other hand, supports can likely continue where the risk is low and the need is there.  Staff are being asked to work with clients and families to make a plan and help them prepare for the possibility of another lockdown. 

• Again, client outings to restaurants and patios and indoor public venues will be discontinued for the time being.  

• While the weather stays good, supports will happen outdoors as much as possible.  We live in Canada and we know that winter is coming, but for now we'll take advantage of the pleasant fall weather, put on a sweater, and keep supports outside.  As for what happens when it gets cold - for now we don't have an answer. It's hard to predict where will be next week, let alone in December.   

• CHIRS vehicles can still be used to take clients to medical and other important appointments, maintaining all the safety protocols we have already put in place.  However, we will be driving clients in CHIRS' vehicles only when there is a client NEED to get somewhere and when staff driving them is the safest option, as we know being with someone in a car is a higher risk activity. 

For Neuropsychological Testing

• The clinic will remain open for now because we believe that this can be done safely.  However, we will NOT be proceeding with plans to increase the number of testing days nor reduce the restrictions that are currently in place.

What about Head Office?

• If staff can effectively complete their work from home, they will continue to do so.

• Staff can come in to Head Office when necessary and we will continue with all the safety precautions that are currently in place.  This includes restricting the number of people on site on any given day. 

Keep well and keep safe.  We will get through this!

We are so encouraged to see the progress that Ontario and Toronto have been making in recent weeks in response to the COVID-19 pandemic.  There was 1 case reported in Toronto the other day, just 1!  That is such a relief to all of us who have been watching those counts on a daily basis.  We thought this might be a good time to give you a bit of an update about what has been going on here at CHIRS - at a time when we are feeling some optimism.

We have had a few more clients return to their homes at Aldebrain, St. Georges, and Finch Residence and the staff have done an amazing job of helping clients settle into the new reality.  Things don't look quite the way that they did back in March, when these clients left to stay with family members.  There are new rules, different programming, and even some new staff.  For some clients it's been a bit of an adjustment, but we are working through it with them.  The Behaviour Therapists and the teams are also conducting intensive community safety assessments as we start to support clients getting back to community activities such as going to the bank or the grocery store or even considering getting a haircut. 

Our Outreach teams have also started to resume in-person supports to clients living in the community.  We have taken a methodical approach to evaluating a client's need for in-person support, the potential risks for our staff and clients, and opportunities to mitigate the risks.  In some ways, it has been like starting over with service planning.  Often the way we provide support or even the type of support being requested have changed dramatically.  But we are very happy to be re-engaging face-to-face with our clients (even if it is only the eyes we can see).  In addition to changing the way support is provided, you will notice that staff will be arriving with masks and they will be conducting Point of Care Assessments before every visit.  A Point of Care Assessment is a tool that staff will use each time they visit to assess the risk of exposure, the type of support needed, and what precautions are needed to protect themselves and the client. 

We continue to offer more than 30 ADS programs through Zoom every week and this has allowed us to stay connected to our clients and to reach new clients who weren't able to travel to Head Office for programs.  Probably the number one question we are asked is "when will the Club re-open?"   

We do not yet have a confirmed date but our plan is to hold steady until at least the end of September.  This will allow Toronto to, hopefully, have a successful transition into Stage 3 and will allow us to see the impact of schools re-opening in September.  Even then programs and services will not operate like they did before the pandemic.  We will, however, start trialing certain in-person activities when it is safe to do so and where physical distancing can be readily incorporated.

Staff continue to self-screen before entering a CHIRS site and have been instructed not come to work if experiencing any of the known symptoms of COVID-19. Site users must wear surgical masks while in client units and common areas of a CHIRS site; the mask can be removed only when an individual is in an enclosed office, by themselves. Signage has been posted limiting the number of people using common spaces at any one time. Congregate spaces like the kitchens will be the last to open up.  At the Head Office, we have instituted a building schedule and are permitting a maximum number of staff at any one time on each level, with social distancing protocols still in place.

Senior Management has developed a plan for a staged return based on priority need for being on site, the premise of which is start small and increase our bubbles as we go.  Each team will provide a proposed plan for who needs to be on site and when.  Senior Management will review these and make decisions based on a safe density.  As the province opens, we will look at what is reasonable with respect to finding the right balance between working on site and from home.

CHIRS Residential Settings

We have started the slow process of bringing residential clients back to their CHIRS homes.  We are prioritizing returns based on client need and family need.  We are carefully considering the support needs of the clients returning and evaluating any potential risks of bringing them back into the congregate setting. 

A number of our residential staff are on leaves based on personal medical concerns or on the provincial emergency order to limit staff to one employer; we therefore have to consider our capacity to support each client safely.  

We are asking clients and families about any potential exposure risks they may have had while living in the community and are requiring that clients be tested for COVID-19 and receive a negative result within 24 hours of returning to the residence.

In addition, we are working to support residential clients as they start to re-access community services.  We have developed assessment and education protocols to support some clients to return to important community outings, such as banking and elective or non-urgent medical procedures.

Community Services

The Community Facilitators have been continuing to provide support to their clients throughout the pandemic.  Wherever possible that has been remote support over the phone or through Zoom, but many have also been providing direct, face-to-face essential support based on the needs of their clients.

We are starting to ramp up in-person support.  For some clients, needs may have changed and we may feel that the in-person support is now essential for some of those clients. But we are also starting to look at returning to those supports that are important but may not have met the threshold of essential.  Staff are feeling more confident that the protocols are in place in the community to ensure their safety as they resume those services.  Staff are very eager to get back to providing the support their clients need.

We have developed a needs assessment to help prioritize resumption of service and a Point-of- Care assessment that staff will use to evaluate and mitigate potential risks. 

Clinical groups are continuing through Zoom.  We are offering Positive Psychology, SUBI (Substance Use and Brain Injury), DBT (Dialectal Behaviour Therapy) and Mindfulness groups.  We have also launched a new Women's Group.

The STOP Clinic will be resuming smoking cessation intervention this week.  Appointments will be provided through Zoom and Nicotine Replacement Therapy products will be delivered to client's homes. 

Adult Day Services continues to provide multiple Zoom programs (over 35 per week) and are adding new programs and connecting with other agencies to pool resources.   The Club and in-person social recreation groups will be the last to re-open; we have not yet made any concrete plans for those services to resume.

Head Office Operations

We are working on a quote to upgrade our phone system to a VOIP system so that our phone system can more effectively handle our mobile workforce needs.

Obtaining PPE remains a priority; fortunately, our PPE situation is stable at this point and we have months of supplies for most items. We have also been successful in obtaining face shields from the Ministry supply when we could not source our own at a reasonable price. We are in discussions with Ontario Health trying to arrange mobile COVID-19 testing for our staff and clients.

CHIRS has been focusing its resources on client and staff safety. To date, we have had no confirmed cases of COVID-19 at CHIRS. As the COVID-19 situation evolves, we modify our safeguards based on often daily directives from the Ministry of Health in order to stem the transmission of COVID-19. We monitor our Personal Protective Equipment (PPE) supplies, update signage and active screening of clients and staff, and implement isolation and infection prevention protocols. Here are some highlights...

In general...

• Although our sites are closed to the public, phone calls coming into the main CHIRS number continue to be answered remotely by our Reception person; we have developed new processes for connecting callers to the appropriate staff and these processes seem to be working very well.

• Many CHIRS staff have been enabled to work from home, reducing their possible exposure to COVID-19 as well as the exposure to their co-workers and clients.

• We keep our staff informed of changes in health directives. For staff that must come to a CHIRS site, we continue to emphasize the necessity for social distancing, screening, and good hand hygiene.

• We have instituted active surveillance at all 3 of our sites. When anyone arrives at any of our 3 sites, they complete a COVID-19 screening, which includes answering questions to assess symptoms and to assess potential COVID-19 exposure; staff also take their temperature.

• We have increased the level of disinfection of commonly used surfaces at CHIRS sites.

• To help deal with the effects of stress, our clinical team has made online and in person resources available to help staff maintain their mental health and eligible staff continue to have access to resources through the CHIRS benefits provider.

In our residential settings...

• Some of our residential clients are staying with family. With fewer clients on site, we need fewer staff on site... and when we reduce the number of people on site we limit client and staff exposure. 

• Staff are actively screened every day.

• Clients are monitored and screened twice per day for symptoms of COVID-19.

• As a precaution, staff are wearing surgical masks throughout their shifts, in conjunction with frequent hand washing and the use of gloves, gowns, and goggles when needed.

• PPE is available at all of our sites. We have a good supply and monitor our inventory daily.

• Staff have been very creative and resourceful in helping clients to understand what is going on and to cope with new routines. Their creativity has also helped clients be meaningfully occupied during isolation.

Our day service and community activities...

• Our community-based staff have been providing case management services via telephone and the internet; this has been a great way to help clients stay connected while limiting their exposure to the virus.

• Our clinical staff have been meeting with clients through virtual means, including convening virtual groups.

• Our day services staff have been safely producing and delivering boxed meals and food hampers to clients in need. When available, other needed supplies are added to these hampers - things like cleaning supplies, toilet paper, and recreational materials.

• Staff have developed creative virtual programming, some of which is so successful and appreciated that we plan to continue it after the pandemic has abated.

• The employee Wellness Committee continues to be active in collecting and sharing resources that support staff to stay physically, mentally, emotionally, and spiritually well.

Our senior management staff and Board of Directors...

• The CHIRS COVID-19 Implementation Team are in contact with each other daily, responding quickly to new developments and directives.

• Human Resources personnel continues to be in regular contact with staff who are self-isolating; many of them have already returned to work after obeying directives for those who returned from travel outside the country or for those who were not feeling well.

• The Senior Management team distributes a daily update to staff and the CHIRS Board of Directors, summarizing the day's key events and information, as well as resources to support CHIRS staff and their work.

• The daily updates keep staff informed and connected, but they don't allow for interaction. The response? A CHIRS Town Hall via the ZOOM meeting platform. We hosted 2 pilots and were so pleased with the staff involvement that we are planning additional sessions.

• The CHIRS Board of Directors are in regular and close contact with the Executive Director regarding Ministry directives and other important material; in additional ways they support the safe and effective functioning of the organization.

Finally, gratitude...

• We are so encouraged by how well our clients have observed the "stay at home" protocol; their efforts not only keep them safe, but contribute to the safety of the wider community.

• We thank our families for their patience and understanding in not visiting the residence; we know how difficult that is and how much restraint must be employed.

• We also thank the families that were able to take their CHIRS client/family member home; we know that having them there can be a comfort and it helps our efforts to manage the situation.

• We have received many donations of food supplies for our hampers being distributed to clients in need and recreation materials for clients isolating at home, often without access to the Internet. We have also received monetary donations to support our work. We thank all of those individuals and businesses; your donations have helped to make a difficult situation more manageable.

• We have received so many well wishes and positive feedback from families and friends of our clients...

CHIRS has been magnificent and I'm so very grateful. The phone calls are great, and the food basket is eagerly anticipated and enjoyed thoroughly. Also a great chance to see the deliverer in person!

My son is responding well to the blitz of support that he is receiving from you and the other staff. So: THANK YOU!!

CHIRS has been effective in quickly enabling staff to work remotely with the necessary tools to be productive... What is amazing is how in such a short period the staff has adapted to the new world.  Not only are staff helping clients adjust and cope while they are dealing with their own anxiety and facing the real potential of compromising their own health... CHIRS has been proactive at recognizing that limiting contact is critical... So many staff are long time employees and really do know the clients so understand what will work for each.  A priority has been limiting TV and the negative news loop which raises anxiety... clients are now doing a daily stretch and relaxation session.  For our family, staff are supporting daily FaceTime calls so that we can include our pets to entertain our family member...  On these calls I can see he is happy and relaxed and for a guy who doesn't like to be locked down this is very comforting.  We know this has everything to do with his being in a supportive and understanding environment.

We thank them all for those encouraging words. We are so very proud of our staff and know that they are doing a remarkable job...and when we hear those same compliments from others, it feels very good.

Below is a link to what the Ontario government is doing to stem the transmission of COVID-19. You can check there any time for the most up-to-date information...

https://www.ontario.ca/page/stopping-spread-covid-19

• The CHIRS Clubhouse is closed until further notice
• All community programs are cancelled until further notice
• Outreach clients can connect with staff by phone instead of in person. If you need medically necessary or essential outreach support, please contact your primary worker to discuss options.
• No new admissions to any CHIRS service
• Residential outings are cancelled, unless medically necessary
• Visits to CHIRS Residences should be avoided. If you need to visit a CHIRS Residence for any reason please contact a Service Coordinator or Manager before doing so
• The Neuropsychology Clinic will be closed until further notice. If you have an Assessment scheduled with the clinic or an appointment scheduled with Dr. Lemsky, Dr. Busse, or Dr. Bolshin someone will be in touch to make a plan.

Over the last few weeks we have been closely monitoring and responding to the situation surrounding COVID-19 and we felt, at this time, it was necessary to enact the next stage of our pandemic plan. We always take Infection and Prevention and hand hygiene very seriously because we want to help keep everyone as healthy as possible. It is apparent that this new virus is spreading quickly and we want to do our part to keep our clients and those in our community healthy and to help slow down the spread of the illness. Our staff are still available to help you. Please feel free to contact your worker or any CHIRS staff by phone if you need to speak with someone. This was a difficult decision to make as we did not want to disrupt services to our clients and families but everyone's health and safety is our primary concern and we wanted to act with the utmost precaution. Thank you for your understanding.

If you would like any additional information please see Public Health Agency of Canada's report "Community-based measures to mitigate the spread of coronavirus disease (COVID-19) in Canada". https://www.canada.ca/en/public-health/services/diseases/2019-novel-coronavirus-infection/health-professionals/public-health-measures-mitigate-covid-19.html