Team-Based Care

As a patient of the Niagara Falls Community Health Centre, you will have a team of health professionals, known as your Care Team, working to provide you with the appropriate care to help you achieve your health care goals.
(Please note, we are not a walk-in clinic)

What does it mean to have a care team?
You are not assigned only one single health professional, but rather a specific team of health professionals working together to provide your care. This will allow you to be seen more quickly when you need an appointment and gives you the right care, at the right time, by the right person.

How we work together:
Your Team will work with you to create a treatment plan and help you achieve your health care goals. They will communicate with each other, and you, to provide the most appropriate care. 
The benefits to this model of care include:
  • more accessible appointments
  • not having to retell your story
  • provide you with the right care, at the right time, by the right person
Professionals on your care team:
Your team will consist of:
  • Nurse Practitioners
  • Doctors
  • Nurses
  • Counsellors
  • Outreach Workers
  • Registered Dietitian
  • Kinesiologist
  • Occupational Therapist
  • LGBTQ2+ Support Coordinator
  • Dental Health Community Worker
How you'll be supported:
Primary-Care Providers (Nurse Practitioners & Doctors): 
  • Comprehensive primary health care for rostered clients of all ages, genders, or diseases

  • Promote prevention, health education, acute and chronic disease management

  • Providing services such as: 

    • Bloodwork on site

    • Well baby/child care and immunizations

    • Preventative screening

    • IUD/IUS insertions and removals

    • Minor procedures

    • PrEP counselling and treatment

    • Trans care

    • Medical terminations

  • Full service lab (urine testing, strep testing, phlebotomy, etc.)

  • Injections and immunizations

  • STI treatments

  • TB testing

  • Naloxone health teaching and dispensing

  • School, public health and employee forms

  • Mental health follow-ups and check-ins

  • Telephone triaging

  • Individual goal oriented, short-term counselling

  • Various topics facilitated in group settings

  • Single-session counselling

Outreach Workers: 
  • Supporting clients

  • Connections to programs & services that will assist them in accomplishing goals

  • Advocating for clients needs and well-being

  • Assistance with form and application completion

  • Supporting life skills building through programs

  • Some examples of support provided include:

    • Transportation

    • Assistance with ODSP & Ontario Works

    • Food Access

    • Housing/Rent Smart

    • Birth Certificates

    • & Referrals to community programs such as:

      • Parenting support

      • Addiction services

      • Counselling

      • Life skills programming

Registered Dietitians: 
  • Education on nutritional guidelines for infants, youth, and adults (including prenatal support)

  • Address food allergies & intolerance

  • Support strategies to create meal plans on a budget

  • Facilitates group cooking classes with a focus on healthy eating on a budget

  • Separate nutrition fact from nutrition fiction

  • Nutrition counselling for chronic disease management

  • Using the latest research to treat & prevent injury and disease

  • Improve movement and function

  • Injury assessment and treatment

  • Strategies for managing joint health including arthritis

  • Education and exercise support for chronic disease (diabetes, heart and lung disease etc.)

  • Chronic pain management

Occupational Therapist: 
  • Focus on how physical, mental or cognitive function affects the ability to do the things that you need to or want to. Working with your team, OTs will assist with:

    • Promoting health

    • Maintaining function and participation in daily occupations

    • Restore independence

    • Prevent disability. 

  • Assessments and interventions may include activities of daily living, memory, walking and mobility, fall risk, home safety, sleep, etc.

LGBTQ2+ Support Coordinator: 
  • Support for sexual & gender diverse individuals and their families

  • Advocating & assisting with barriers and tough conversations

  • Connecting individuals with community resources and access to health care

  • Assisting with legal name and sex designation changes

  • Facilitate group programs and family education sessions

Dental Health Community Worker: 
  • Dental navigation based on needs and available resources

  • Assisting with accessing available dental community programs and services, such as:

    • Ontario Seniors Dental Care program

    • Green Door Project for emergency services

Team Care Circle2.png