Social Care Guidance in the COVID-19 Context

Last Updated: June 9, 2020

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During pandemics, historically marginalized and minoritized individuals suffer disproportionately. This guide is for health and social care providers supporting people exposed to social risks that impact health, caused or exacerbated by COVID-19. It is intended as guidance and should not replace clinical judgement.

These risks are in 5 key areas:

  • Paying for basic expenses
  • Paying for food
  • Paying for housing
  • Isolation
  • Violence

Click below to get started:

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Ask your patients/clients

Health and social care providers should consider these key social determinants of health as they support patients/clients during the COVID-19 pandemic. 

Suggested script

“COVID-19 is impacting some people more than others. We are checking in on many of our patients/clients about issues that are important for health and well-being, so we can help people get the assistance they need.“

Stack of papers. Will you or your household find it hard to pay for basic expenses in the next 4 weeks?

Families with children face specific challenges and have access to specific benefits during COVID-19.
Yes
The following are some resources and supports that may be helpful:
If the patient/client has stopped working because of COVID-19

Canada Emergency Response Benefit (CERB)

If the patient/client is on Ontario Disability Support Program/Ontario Works

Ontario Works and Ontario Disability Support Program (OW/ODSP) Extended Emergency Benefit (for those on social assistance)

  • Provides $100 a month for single individuals and $200 a month for families for COVID-related needs (e.g. food, cleaning supplies, transportation, clothing) for May-July. This is automatically granted to those who received the one-time Emergency Benefit in March/April.

Remind your patient/client to contact their OW/ODSP caseworker if they are not already receiving these funds.

If the patient/client hasn’t filled out and sent in their tax forms

Free tax clinics

  • Through the Community Volunteer Income Tax Program, community organizations host free tax clinics where volunteers file tax returns for eligible people.
  • Click here to learn more.
Financial support for those caring for children

Canada Child Benefit (CCB) and Ontario Child Benefit (OCB) 

  • Provide extra monthly funding for each child in your family, up to a monthly maximum of $553.25 for each child under 6 years of age or $466.83 for older children (CCB) and additional $120 for low – and moderate-income families (OCB).

Remind your patient/client to complete their tax returns.

Support For Families

  • The Ontario Government is providing a one-time supplement to help families with children age 0-12 ($200) or 0-21 with special needs ($250).
  • If you have already successfully applied to the Support for Parents program (income supplement for strike days) and received payment through direct deposit, you are automatically eligible for the Support for Families program and do not need to apply.
  • Click here for more information and application process.
Childcare options

Childcare Canada

Additional resources

Prosper Canada – Financial Relief Navigator

  • Provides up-to-date, personalized information about how one can raise their income or lower their expenses during COVID-19.
  • Click here to visit the website.

Financial Services

  • Programs that provide people in financial need with basic income support and temporary assistance for urgent and unexpected financial events, grouped by region.
  • Click here to visit CEP’s Local Services Resource > Financial Services.
No
Proceed to next question below.
Stack of papers. Is there a risk you or your household won’t have food or be able to pay for food in the next 4 weeks?
Yes
The following are some resources and supports that may be helpful:
Food resources

Food Banks and Meal Delivery Services

Ontario Community Services Association with Meals on Wheels

  • The Ontario Community Services Association is working with Meals on Wheels and other partners to help people with delivery of food and essential supplies.
  • Click here for more information.
No
Proceed to next question below.
Stack of papers. Are you currently homeless or at risk of losing your housing in the next 4 weeks?
Yes
The following are some resources and supports that may be helpful:
If the patient/client is homeless

Shelters

If the patient/client is at risk of losing their housing

Tribunals Ontario – Landlord and Tenant Board

  • The Landlord and Tenant Board has suspended “all hearings related to eviction applications” and “the issuance of eviction orders, unless the matter relates to an urgent issue such as an illegal act or serious impairment of safety.” Even if a landlord gives written notice, the tenant doesn’t have to move out. The landlord must first get an order to end the tenancy from the Landlord and Tenant Board Opens – this usually includes a hearing where the tenant can present concerns.
  • Click here for more information.

Housing Referral and Support

No
Proceed to next question below.
Stack of papers. Are you alone, and do not have family/friends who can help you during this time?
Yes
The following are some resources and supports that may be helpful:
If the patient/client is an older adult

Helplines for Seniors

No
Proceed to next question below.
Stack of papers. Do you have concerns about your (or your children’s) physical safety?

Caution if asking in an environment where an abuser could overhear.
Yes
The following are some resources and supports that may be helpful:
If the patient/client is in immediate danger

911

  • If patient/client is in immediate danger, call 911 or advise them to go to the nearest emergency room.
If the patient/client is a woman experiencing violence or safety issues

Assaulted Women’s Helpline

  • Provides 24/7 support to access Violence Against Women (VAW) shelters, counseling, and other resources for women, non-binary, and trans individuals.
  • Click here to visit their website for more information or call 416-863-0511 or text #SAFE (#7233) (support in over 200 languages by phone).

Talk4Healing

Barbra Schlifer Commemorative Clinic

  • Specialized clinic for women experiencing violence,  which offers legal help, counselling and information. They offer language interpretation and video remote interpreting through a Deaf interpreter.
  • Click here to visit their website for more information or call 416-323-9149 x 234.
If the patient/client is a senior experiencing violence or safety issues

Seniors Safety Line (SSL)

  • Provides counseling and safety planning support for older adults who are abused or at-risk of abuse.
  • Family members and service providers can also call for information about community services.
  • Click here to visit their website for more information or call 1-866-299-1011.
If the patient/client is a man, non-binary or trans person experiencing violence or safety issues

1 in 6 Men’s Helpline Chat

  • Provides 24/7 support to men, non-binary, and trans individuals experiencing sexual abuse or assault.
  • Use the online chat to access counselling, support, and other resources.
  • Click here to visit their website.
No
Proceed to Goal-setting and follow-ups below.
Additional resources for vulnerable populations

CEP Local Services Resource

Thehealthline is a province-wide compilation of local health and community services, providing easy access to reliable data and empowering patients and healthcare providers to find the services they need close to home. In order to ensure patients and healthcare providers have access to the most up-to-date information about service availability and service changes during the COVID-19 public health emergency, the CEP and thehealthline have worked together to update this information for select priority services, by region.  Priority health and community services include assistance for isolated people, financial services, mental health services, pharmacies, diagnostic centres, laboratories and more. 

ConnexOntario

Provides free and confidential health services information for people experiencing problems with alcohol and drugs, mental illness and/or gambling. Also provides connections to local services/supports. Visit www.connexontario.ca or call 1-866-531-2600 (support in over 170 languages by phone).

Upstream Lab COVID-19 Social Resource Connector

See Upstream Lab for a list of resources and a tool to choose the right resource for your patient/client.

Community Legal Clinics (Legal Aid Ontario)

Provide free legal advice for a variety of concerns (e.g. housing, family law, immigrant and refugee cases).

Steps to Justice

Provides reliable and practical information online for common legal problems.

A social history tool using the IF-IT-HELPS mnemonic

This tool is designed as a reference, teaching and practice tool to assist in performing a social history in the context of healthcare provision. It is intended as a guide for assessment and intervention, as opposed to a checklist.

CEP Poverty Tool

This tool directs providers to use key questions to assess their patients’ living situations and current benefits and includes links to key government and community resources to support positive interventions.

Goal-setting and follow-up plan New

Goal setting

Work with your patient/client to develop realistic treatment goals.  Daily achievable SMART goals are:

Specific (simple, sensible, significant)
Measurable (meaningful, motivating)
Achievable (agreed, attainable)
Relevant (reasonable, realistic and resourced, results-based)
Time bound (time-based, time limited, time/cost limited, timely, time-sensitive)

Follow-up plan

Developing a clear follow-up plan with the patient/clients has been shown to dramatically increase the likelihood of connecting to a social resource.

Certain groups require more frequent follow-up:

  • At imminent risk of losing housing.
  • Newly homeless.
  • Newly unemployed without income support or savings.
  • Experiencing domestic violence.
  • Experiencing any of the above with dependent children in the household.
  • Unable to leave the home easily due to physical disability or frailty.
  • Unable to access the internet and/or telephone.

Consider the following potential barriers as you co-develop a plan with your patient/client:

  • Access to phone, internet, etc.
  • Comfort with using technology, websites.
  • Literacy, English proficiency and language needs.
  • Ability to leave home if needed.

Framework and approach New

Consider using the following best practices of crisis management, anti-oppressive/anti-racism principles, motivational interviewing, strength-based approaches and trauma-informed care for engaging in conversations with your patients/clients. The following principles for engaging in conversation with patients/clients are grounded in empathy and non-judgmental care and can help ensure your interaction is as client-centred as possible.

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  • Crisis management
    • Provide reassurance and develop rapport through validation of the problem and active listening.
    • Evaluate the severity of the crisis and assess the patient’s/client’s mental, psychiatric and medical statuses.
    • Ensure the safety of the patient/client and others.
    • Try to stabilize the patient’s/client’s emotional status and create an action plan.
    • Try to prevent the patient’s/client’s use of inappropriate coping mechanisms.
    • Help the patient/client focus on their strengths and how these and other coping mechanisms were used successfully in the past.
    • Follow up with the patient/client to provide ongoing support.


    See: A Practical Guide to Crisis Management (AAFP).

  • Motivational interviewing
    • Express empathy through reflective listening.
    • Explore the discrepancy between patient’s/client’s goals or values and their current behaviour.
    • Avoid arguments and direct confrontation.
    • Adjust to patient/client resistance rather than opposing it directly.
    • Support self-efficacy and optimism.

    See: Centers for Disease Control and Prevention Module 3: Communicating with Patients.

  • Anti-oppression/anti-racism practices

    When treating patients/clients:

    • Provide non-judgemental, culturally safe care.
    • Respect your patient’s/client’s views and ways of knowing.
    • Ensure that your patient/client knows and is a partner in their healthcare decision-making process.
    • Ensure that your patient/client determines whether or not the care received is right for them.


    Note: Anti-Anti-oppression/anti-racism practices cannot be taught quickly, but require proper training and time to learn.

    See: Health and Health Care Implications of Systemic Racism on Indigenous Peoples in Canada: Fact sheet (widely applicable).
    See: Practicing Anti-Oppression in Medicine (ppt).

  • Strength-based problem solving
    • Start with what is important to the patient/client and focus on strengths.
    • Seek to understand the crucial variables contributing to individual resilience and well-functioning families/communities.
    • Provide a common language and preventative philosophy.
    • See resiliency as a goal that provides a conceptual map to guide prevention and evaluation efforts.
    • Employ client-driven and relationship-focused intervention strategies.
    • Engage distressed people with respect and compassion.
    • Perceive capacity building as a dynamic process that evolves over a lifetime.


    See: Hammond, W. (2010). Principles of Strength-based Practice. Calgary, Alberta: Resiliency Initiatives.

  • Trauma-informed care

    Principles of trauma-informed care:

    • Safety: ensure your patient/client feels physically and psychologically safe.
    • Trustworthiness and transparency: build and maintain trust with the patient/client.
    • Peer support: is a key vehicle for establishing safety and hope, enhancing collaboration, and utilizing stories and lived experience to promote recovery and healing.
    • Collaboration and mutuality: working collaboratively with others.
    • Empowerment and choice: patient’s/client’s strengths and experiences are recognized and built upon.
    • Cultural, historical and gender issues: provide care that is respectful to the racial, ethnic and cultural needs of the patient/client, and recognize and address historical trauma.


    See: SAMHSA’s Concept of Trauma and Guidance for a Trauma-Informed Approach.