Continuing Care Project

What is the system challenge?

Continuing care services and supports are extremely important for helping people to reach their long-term substance use recovery goals. By “continuing care” we mean any kind of support that comes after a period of substance use treatment (whether inpatient, residential, or intensive outpatient treatment) where the goal is to help the person to continue and maintain their recovery over the long-term.

Continuing care can be offered in a number of ways, including:

  • group counselling;
  • individual therapy;
  • telephone counselling;
  • brief check-ups;
  • self-help meetings; and
  • recreational programming.

In Toronto, adequate continuing care services and supports do not currently exist in a coordinated, structured, or intentional way. Service providers and people with lived experience tell us that the lack of continuing care is a major gap in Toronto’s mental health and addictions system.

What are we doing about it?

We are supporting project stakeholders to work towards identifying, narrowing down, and then implementing workable solutions. PSSP will assist in the development of a shared vision and strategy, build momentum to address identified challenges, connect with other initiatives working to strengthen continuing care, establish shared measurement practices for project stakeholders, and highlight policy barriers that limit the effectiveness of continuing care.

Who is involved?

Who is involved?

The Continuing Care Project is being led by a steering committee of community representatives from a range of service sectors, organizational roles, and lived experiences of accessing treatments and supports for substance use issues. The steering committee members are:

  • Melissa Pennman, Community Support Worker, LOFT Community Services – ASH Program
  • Dennis Long, Executive Director, Breakaway Addiction Services
  • Adam Benn, Manager of LGBTQ Community Programs, Sherbourne Health Center
  • Kelly Lawless, The Jean Tweed Centre
  • Stacey Bowen, Peer Facilitator, Shelter Relief Worker Fred Victor; Women’s Own Detox
  • John O’Mara, Executive Director, Salvation Army: Toronto Harbor Light Ministries; Homestead Addictions Services
  • Robin Griller, Executive Director, St. Michael’s Homes
  • Aklilu Wendaferew, Assistant Executive Director, Good Shepherd Ministries
  • John Bushell, Addictions Counsellor, Renascent
  • Jessica Slotnick, Community Health Nurse, Street Health
  • Lori Steer, Director of Housing and Homeless Services, St. Stephens Community House
  • Julia Bloomfield, Clinical Director, The Jean Tweed Centre

39 organizations or networks have participated in community meetings and consultations related to the Continuing Care Project:

  • Addiction Service Provider Working Group
  • Addiction Services at St. Joseph's Health Center Toronto
  • Alpha House
  • Barbra Schlifer Commemorative Clinic
  • Boréal College
  • Breakaway Addiction Services
  • CAMH
  • CAMH, Aboriginal Service
  • Central Toronto Youth Services
  • Elizabeth Fry Society of Toronto
  • Entité 4
  • Fred Victor
  • Good Shepherd Non Profit Homes
  • Inner City Family Health Team
  • LOFT Community Services -
  • Mainstay Housing
  • Michael Garron Hospital Withdrawal Management Services
  • Native Child and Family Services
  • Ontario Aboriginal HIV/AIDS Strategy
  • Reconnect Community Health Services
  • Regeneration Community Services
  • Renascent
  • Saint Michael's Homes
  • Sherbourne Health Center
  • Sistering
  • Sound Times Support Services
  • St. Michael's Hospital
  • St. Stephen's Community House
  • Street Haven at the Cross Roads (Addiction Services)
  • Street Health
  • The Access Point
  • The Jean Tweed Centre
  • The Salvation Army
  • The Works/Toronto Public Health
  • Toronto Western Hospital Transition House
  • True North Medical Services
  • Women's Own Withdrawal Management
  • YMCA of Greater Toronto
?What's this?

Full Implementation

The project has not yet reached this implementation stage.

Next Steps

Working with project stakeholders to develop a practical way of addressing the issues raised through consultations, community meetings, and literature review.


Charting the path: Findings and opportunities from the Continuing Care Project

The Community Connect Pilot Project Final Evaluation Report and Executive Summary present findings from the evaluation of the Community Connect pilot project, including key themes and recommendations for future offerings of the model.

The Community Connect Implementation Guide is intended to support community-based substance use and WMS service providers plan for and implement the Community Connect program model. It outlines the essential components of the model and explains what happens during each step of the service, describes observable behaviours for each component that can be used as benchmarks for practice and oversight, and provides resources to guide the development of an evaluation strategy for implementation of the model.