Rebuilding Primary Care with the St. Michael's Hospital Youth Advisory Council

Rebuilding Primary Care with the St. Michael's Hospital Youth Advisory Council

The St. Michael’s Hospital Youth Advisory Council: Incorporating the youth voice into service delivery.

Show Summary

For this special series HIROC is partnering with the Association of Family Health Teams of Ontario (AFHTO) to highlight the work of several amazing primary healthcare teams.

In this episode we speak with representatives from the Youth Advisory Council, part of the St. Michael’s Hospital Academic Family Health Team. Katie Sussman is a Social Worker on the Family Health Team; Muzammil Syed is a member of the Youth Council and a graduate student at the University of Toronto; and Ermias Nagatu is also a member of the Youth Council and a student in the Occupational Health and Safety Program at Ryerson University.

The St. Michael’s Academic Family Health Team has a focus on serving vulnerable and unattached patients – and youth are an important part of that population. The creation of the Youth Advisory Council came from a desire to have youth patients inform the Family Health Team about what youth services were needed and where improvements could be made.

It’s only been a year – and the council has smoothly transitioned to virtual collaboration. The students are having an impact on decision-making as planned, but the council has also transformed into a place where the youth are playing a true leadership role. 

Mentioned in this Episode


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Ellen Gardner: Welcome to Rebuilding Primary Care, a special series from HIROC. I'm Ellen Gardner with Philip De Souza. We're delighted to partner with the Association of Family Health Teams of Ontario, AFHTO, to highlight the work of several amazing primary health teams.

Ellen Gardner: Today, we're speaking with the representatives from the Youth Advisory Council, part of the Academic Family Health Team at St. Michael's Hospital in Toronto. Katie Sussman is a social worker, on the Family Health Team, Muzammil Syed is a member of the Youth Council and a graduate student at the University of Toronto, and Ermias Nagatu, is also a member of the Youth Council, and a student at Ryerson University in the Occupational Health and Safety Program.

Ellen Gardner: The St. Michael's Academic Family Health Team has a focus on serving vulnerable and unattached patients, and youth are an important part of that population. The creation of the Youth Advisory Council, came from a desire to have youth patients inform the Family Health Team about what youth services were needed and where improvements could be made.

It's only been a year and the council has smoothly transitioned to virtual collaboration. The students are having an impact on decision-making as planned, but the council has also transformed into a place where the youth are playing a true leadership role.

Ellen Gardner: What was behind the creation of the youth advisory council? Katie, do you want to start?

Katie: The truth is, is that patient voice within the St. Michael's hospital family practice is really truly emphasized. We really consider patients to have the most essential insights when it comes to healthcare development and delivery. So we always knew that it was a goal of ours to engage patients within the healthcare service designed to really have an overall improvement on patient care.

So the focus on youth came from the Family Health Team. We have an emphasis on serving vulnerable or unattached patients. And the youth is an example of this population. And we actually created a strategic plan, really focused on meeting the healthcare goals of youth. As you guys know, or can imagine, that the youth patient demographic is really characterized by unique needs and developmental milestones. So for example, even our survey that we conducted found that a primary issue to youth is grades or school and self-esteem.

It also really marks a transitional age within healthcare service providers marking a transition from possibly a pediatrician to a primary care provider or alternatively, it could be in a time when people start to focus on their health and then want to actually start accessing primary care. So knowing that this was a demographic of very unique needs, we really knew that we wanted to have the youth patients really inform us what healthcare service would look like for them and what they're hoping for in a healthcare provider, so that we don't miss any patients. And nobody falls through the cracks.

Ellen Gardner: I'm interested in how the council actually works in practice, Katie. And it seems like you have a couple of representatives here today, but what is the actual function of the council? What kind of issues do you look at?

Katie: Yes, absolutely. And I'm going to pass it off to either Muzammil or Ermias, but the real intention of the Patient Advisory Council again, was to gather information on patient needs and have patients actually inform our healthcare service and healthcare delivery and the healthcare development of services. So Muzammil and Ermias have actually been there since the nascent stages of development. So I'm going to pass it off to either one of you.

Muzammil: I've actually been involved at St. Michael's Hospital ever since I was 17 or 18, and I've been working there ever since. And I recently came across a posting back then on social media, about a call for an advisory committee for the Family Health Team at St. Michael's hospital. And this really intrigued me. So I put in a request, an application and thankfully I was accepted. One thing which I do want to point out is I was not actually a patient of the Family Health Team per se. So we actually have representatives of non-St. Michael's Family Health Team who are not patients coming in to the council. But as Katie said, the majority of the patients, majority of the youth council are people who are patients from the Family Health Team themselves.

So we have youth members, as well as some staff members – we have Juliana Tobon, a psychologist, we have a Katie Sussman, a social worker, we have Priyanka Chowdhury, a physician, we have a dietician, and Nassim Vahidi-Williams, Patient and Community Engagement Specialist. 

They are mostly there as adult advisors in a supportive role. But at its maturity, the youth council is organized and run by the youth members primarily themselves. And it was the youth themselves who are taking the initiative on trying to find out what services need to be improved on, where can improvements we made, what are other healthcare needs which are not being offered right now? Can we identify those? And that's when we started working a lot with some of the residents at St. Michael's hospital and conducting different surveys as some of the healthcare deliveries and access, which you need to coach are not happening right now.

Ermias: I joined as a patient and a caregiver for another family member at Sumac Creek Health Centre, when they first opened up in Regent Park. I have always had a background in supporting education and health promotion throughout my community. And when I found out about the council recruitment at the very early stages, through a community agency, Pathways to Education, I immediately wanted to engage and advocate for youth such as myself going through healthcare, whether it's in a transitionary phase and the experiences I had then, or trying to figure out other ways to support a youth.

Ellen Gardner: Did you discover interesting things as you started into it – some of the gaps in the treatment of youth became apparent, and those were the focus of the council? Ermias maybe you can tell us.

Ermias: Yeah, I think as part of our next steps and pre- work with the youth survey, looking at and highlighting, what are those specific issues and gaps, not only anecdotally, from us as council members, but analyzing and being involved in this research process. So there have been areas such as services not being accessed with psychologists and mental health counselling, understanding preferred health information delivery. They are all interesting points that will then guide and steer future development. And we plan to be a part of that process as well.

Katie: And just to add to that, to Ellen. So I think your question is so great because that was the initial intention of the youth council was to really focus on healthcare services. And as Ermias has mentioned, there was a lot of trends that we weren't necessarily aware of such as how they're going to access personal health information or how we're going to deliver/relay information about appointments, or even accessing appointments, access to mental health services.

So the initial ask was to help us inform what our healthcare service for youth can look like. Initially, we even had an idea of having a drop-in clinic if that was even possible. But what's really amazing about the youth council is that it's really transitioned and transformed into so much more than that. It's transformed into a place where youth really have a leadership role. It's really nice because it almost has become a touchpoint for where we can not only talk about healthcare services, but even other youth-related initiatives that are taking place within our St. Michael's hospital community.

Ellen Gardner: Does the council have a lot of interaction with the rest of the hospital or how do you function within the larger hospital? Are you really an entity in and of yourself?

Katie: I would say the way in which this really does coincides with the actual hospital or even the network is just the network's emphasis on the patient voice in informing healthcare services, really having a true partnership in collaboration with patients.

Ellen Gardner: The pandemic arrives and it does seem though that the council didn't really skip a beat, that the youth were able to keep it going. Was that the case?

Katie: Yeah I would say so. And I'm actually going to turn this to Ermias a little bit in a second, because it was Ermias from one of the beginning meetings that we had, who always talked about the importance of having Zoom, especially for youth to increase access to our meetings. At first we thought it's better to do an in-person. People can actually get to know each other again. That's staff making an assumption and we got the youth to actually inform us otherwise. It was actually the youth who helped us make that transition so smoothly.

Ermias: Hey, it's Ermias, I definitely can. So the brief hiatus we had with the pandemic, we fortunately were prepared for virtual engagement through Zoom. As Katie had mentioned, I pushed for increasing the access on a digital platform to allow youth that were sometimes travelling after school, or just really wanting to save money and have a meeting from home. And so we transitioned from meeting at the Bond Street Family Health Team location to fully virtual on Zoom and attendance actually increased and engagement increased from there. We were able to continue to move forward with our next steps and that being recruitment of more youth members. And so far it's been great. There are other areas online that we've been able to collaborate and really work together on focusing on youth engagement.

Muzammil: Absolutely. I concur a hundred per cent with Ermias and Katie. We've seen increased rates of engagement and attendance. In fact, our productivity has gone up as well. We've been a lot more productive knowing that we moved all of our work virtually to one platform called Slack as well. And that's made our project management a lot simpler, a lot easier, a lot more efficient, and it just makes us work really well as a team. And as a result, I think we've been very productive throughout the pandemic.

Katie: And I have to say when Muzammil first mentioned Slack, I have never in my life heard of such a platform. So they’ve really taught us a lot!

Ellen Gardner: At the AFHTO conference, you talked about a youth survey that was completed by 285 youth across your clinics. What were the results and how are you going to use them?

Muzammil: We were fortunate to work with a few medical residents. As a result we asked them questions, pertaining to a few different things. I wanted to inquire how aware were the youth of the services offered by the Family Health Team. Then we also wanted to ask, what's the preferred method of receiving health information, and are they receiving enough health information? And lastly, what's the preferred method of contact? And amongst these three things, the first one being awareness to access to service – the vast majority of them were actually not aware of the services offered with The Family Health Team. And that kind of served as a target that you could potentially work at.

Muzammil: How can we make youth more aware of the many services offered by the Family Health Team? On top of that, then we asked once we dove in a little deeper, what services were not being accessed currently, and which they thought were most important. And amongst those, it was a psychologist or counselling, which the youth said they needed the most, but they weren't currently accessing. So that provided us with a target that, that's something that we could improve on – how to make them more aware of the different services that are offered and how they can access it.

Muzammil: When you go to the second thing, which pertains to health information, the youth were pretty happy on the health information they were getting. The preferred method of health information delivery was via posters. So they deemed having a poster, for instance, at different clinics at different sites really helps makes them more aware of what's going on. After posters it was TVs. So if you have a TV playing in the clinic, youth are more likely to focus on that and learn about different health information and delivery.

Lastly, when we ask the youth what their preferred method of contact was, the vast majority of them overwhelmingly preferred email. Email communication allows you to more readily contact the health providers and vice versa.

Ellen Gardner: That's interesting. Some of those are quite low-tech methods – posters. You wouldn't imagine would be a preferred thing for youth, but that's great to hear.

Katie: And what was so interesting about that, Ellen, is that at St. Michael’s, we’re very lucky because we're so well resourced with mental health services. A lot of the social workers provide brief mental health counselling. We're fortunate to have Juliana who helps supports us as well with the mental health counselling work on more complex cases. We even have a partnership with Ryerson where psychology interns are able to provide counselling. So to hear that a lot of our youth patients were not informed or aware of the breadth of our mental health services, it was, it was actually quite surprising.

Ellen Gardner: You've created a great model of how a Youth Advisory Council can provide value to a Family Health Team at this stage. And I know you're still in early times and you've just come through the year of creation and you're still working things out, but do you have any advice that you would give other Family Health Teams who might be thinking of setting up their own youth council?

Katie: The one thing that I would say is that it involves a lot of commitment. Again, part of the reason why the St Michael's academic Family Health Team, the reason why we were so persistent on a Youth Advisory Council is that it's so deeply ingrained. Again, having the patient voice as a partnership to collaborate and to inform healthcare services. We truly look at them as the experts. So that is so deeply ingrained within our culture and even developing the youth council. It wasn't like we woke up one day and just decided to have a committee.

Katie: It actually started because we already had a patient advisory committee that was created in 2018. We then wanted to extend to the youth patients, because we didn't want to miss out on such a high needs and important patient population or patient demographic. So I think one of the things that's really important when you have any patient advisory committee is really recognizing the importance of power-sharing and recognizing that we aren't actually the experts here. The healthcare practitioners aren't the experts, it's actually the patients that are, and how can we work alongside each other to really achieve certain goals?

How can we work alongside each other, collaborate to really develop what those goals will look like?

Ellen Gardner: For Ermias and Muzammil, I'm interested in what the experience has been like for you. What's surprised you, and maybe what you hope is going to happen with the Council going forward? Ermias, maybe we can start with you.

Ermias: The first meeting I attended, I was not surprised, but very grateful to see that the support for this committee was there. From the beginning, I was offered food, a place to have the meeting and to cover my transportation costs. So I knew right away that my barriers to come to the next meeting would be reduced. I recognized someone from the community and that was Muzammil.

Ermias: And, I did feel a sense of comfort and connectedness already, and that's part of why I stayed on and we had a lot of effective ways of communicating. And from there, it led to opportunities to be involved and develop skills and capacities in presentations at the conference.

I think our team's openness and flexibility with new ideas is going to allow us to reach our next steps. And I hope that will include a larger, broader representation of our St. Michael's Family Health Team, youth projects that are informed by our survey. So that would be, as Muzammil mentioned, very focused on delivering youth-focused services and being online and also having a larger social media presence. And I think down the line from there, I hope that would also lead to funding for additional councils, focused on youth and projects related to youth engagement to really empower youth patients.

Muzammil: One thing which has been great again, and I'm just echoing what Ermias said here is that they totally removed any barriers to being involved in the youth council, be it funding, be it involvement. And that's one thing which we’re trying to maintain for future years as well. So when we were recruiting for this year's upcoming council, we made sure that we try to maintain health equity and remove any barriers that might exist. I think that's one thing which is great.

The other thing, which I think is great is there's really a diversity within the team, which is continuing, and there's a strong emphasis on that. There's a diversity of people, diversity of people with different backgrounds with different life experiences, and diversity of thought as well, but that's important.

Another thing which I think was important that I liked was they really made it official. And I think that's really important. That's something which I would tell other Family Health Teams to consider when creating such a team, is to make it official. Work with the youth to co-create a terms of reference, its purpose, a meeting schedule. By making it official, it puts everyone on track. It allows you to get more involved, they know there's something to be done here. I think that allows the whole process to be a lot more streamlined, a lot more effective and a lot more successful.

Muzammil: And lastly, one thing which I think was surprising to me was initially, because we were all new. We didn't know each other. We were all kind of at a ‘What do we do?’ Cause we were still in the planning stage. However, what I've realized is that there's a recognition that there needs to be time. You need to give youth time. Youth provide energy, they provide new ideas, they provide lots of momentum and a fresh new perspective, but it often requires time. They need time to get to know each other. They need time to figure the different problems where they could help. So initially things are a little slow that's okay. Give time to the youth, they'll surprise you.

Ellen Gardner: That's well said. Katie, any thoughts from you on things that have surprised you and what do you look forward to with the Council?

Katie: I think the level of excitement and engagement to be quite honest was so surprising. Juliana, myself, a lot of the initial members of the staff youth engagement committee, which didn't include any patients, had that same momentum, had that same passion, and had that same desire to really come up with supports and youth specific services. And to really make sure we met the needs of youth. So having youth members who share that same passion and that same momentum was so validating and so rewarding and so exciting.

Katie: Juliana and I always say after each of the meetings that we attend that we're so lucky to have youth patients who are so engaged, so motivated, have such a desire and want to create, to change, to do. It also teaches us, which is really important. So I think that's what I'm really excited about for this upcoming year is that we can now start to really capitalize on. We've spent so much time planning and preparing that we now can start to really capitalize on all of the amazing strengths of our youth council members, and really start to create some change.

Ellen Gardner: Just want to close by asking what the experience of presenting at the AFHTO conference was like. Ermias, were you there at that conference? Did you present?

Ermias: I was there presenting with the rest of the group and it was pre-recorded online. So that was another area we learned and creatively shared our pieces and sections, which we then brought together into one presentation video. And that was, that was very fun. And it was a great learning experience. I've never been part of a group on my presentation before, and I hope to continue doing more with the team.

Muzammil: I was really privileged to be part of AFHTO, it was a great learning experience for me. Ermias commented on us working together remotely and make a presentation, which was a huge learning opportunity for us. And now I think we have a very good idea on what to do going forward and different software that we can use.

But I think more than that, I think for me, I learned a lot from listening to the other speakers, the other presentations of the guest speakers. For instance, having the Deputy Premier, the Minister of Health, the honourable Christine Elliott, her remarks were absolutely amazing. Dr. Jane Philpott, I actually know her son when I went to McMaster, it was nice to have her speak. So it was more to the other conversations that I listened to and was fortunate enough to learn from and pick from. And I think there were a lot of ideas that we can actually take from them and implement within this upcoming year.

Philip De Souza: The one thing that I really like what Katie said also is about power-sharing it's so true. People often feel like, "Oh, the health services are not listening to me, or my voice isn't heard."

Philip De Souza: And the fact that have and the health team and you know what we're going to share that power, we want to hear your voice. And then on top of that, you want to take that knowledge-sharing, that Katie also mentioned about knowledge-sharing. If there's something that was maybe negative that came back from feedback, that's important to share with those in the Family Health Team or just in the healthcare community in general, they can say, ‘Oh, you know what? We didn't see that perspective. Let's change that. Or let's talk about how we can change that.’ I really like that. And then the last thing I wrote down was just about how Muzammil talked about the conference and how he appreciates learning from others. And I think that's something that we have to tie back to us.

Philip De Souza: We're so happy to work with you all. We can take what you guys have done and scale that across our network. So people can say, ‘Oh, you know what, maybe we should have, you know, we only have one committee, we should have another committee for the youth and other committee, for whatever different patient populations.’ And I think that's fantastic, and it really drives home the message of like we're all in this together. It’s all about the voices of those who serve. And of course that they have a safe environment.

Katie: The one final thought that I really did want to add is that I think what's most exciting about this is learning from our youth or our patients' experiences. I always say, we don't know what we don't know. And I feel so fortunate to be able to sit at a table with so many amazing youth representatives and really learn from their own experiences. It really is a council that consists of such diversity and such passion. And I really look forward to what the future has in store for all of us.

Muzammil: Thank you so much for having us thank you.

Katie: Thank you so, so much.

Ermias: Thank you very much.

Ellen Gardner: You've been listening to rebuilding primary care especial series about Family Health Teams produced by hero and the association of Family Health Teams of Ontario. Today. Our guests were Katie Sussman, a social worker on the Family Health Team at St. Michael's Hospital, Muzammil Syed, a graduate student at the University of Toronto and a member of the St. Mike's Youth Advisory Council. And Ermias Nagatu, also a member of the Youth Council and student at Ryerson University in the Occupational Health and Safety Program. Thank you for listening.

Thank you for listening. You can hear more episodes of Healthcare Change Makers on our website and on your favourite podcasting apps. If you like what you hear, please rate us or post a review. Healthcare Change Makers is recorded by HIROC's Communications and Marketing team and produced by Podfly Productions. Follow us on Twitter at @hirocgroup or email us at We'd love to hear from you.