Inside Toronto Metropolitan University’s community of care

Collaborative Care

In their placements at an urban clinic, psychology students work with interdisciplinary professionals to provide holistic care

The university’s Psychology Training Clinic is designed to train students to both recognize cultural barriers and build on the strengths of communities when providing care. In a partnership between the university and the Academic Family Health Team at St. Michael’s Hospital, Unity Health Toronto, students provide assessment services and psychotherapy in an interdisciplinary primary care clinic setting. 

Through the program, eight graduate students provide psychological services for four to five patients each throughout the year. Many of these patients come from marginalized or lower income populations, says Dr. Michael Cheng, director of the Psychology Training Clinic at Toronto Metropolitan University. 

In 2017, the program received the Collaborative Mental Health Care Award from the College of Family Physicians of Canada.

Ahead of the placement , students’ coursework and role-play simulations prepare them to feel comfortable with structured clinical interviewing in a real- world setting. During the placement, their one-on-one interactions with patients are recorded, with the patients’ consent, so supervisors can watch the interactions and provide helpful feedback.

Reviewing interviews with a supervisor “helps us see our strengths and weaknesses, and see opportunities for helping patients that we might not have recognized in the moment,” says Shadini Dematogoda, a master’s student in clinical psychology who is currently completing her placement at the Psychology Training Centre.

Dematogoda also appreciates that the program lets her work with interdisciplinary providers to provide holistic care. Students can call or message the patient’s primary care provider if they think an underlying health issue might be contributing to psychological symptoms. Likewise, they can work with an allied health provider to connect patients to social services or access income, housing or other supports.

This sets the program apart from other programs’ in-house psychology clinic placements, which are often in standalone psychotherapy clinics, usually affiliated with a campus health program. 

“The students really appreciate the family health team setting. The physicians and nurse practitioners are supportive and collaborative. When our students have a question or a concern about the patient, the staff clinicians are welcoming and responsive,” says Cheng.

In some cases, depression or anxiety may primarily be “the result of the patient’s social situation, whether that involves housing or employment uncertainty,” says Cheng. By connecting patients with resources to address these social determinants of health, students can help patients “without pathologizing social problems,” he explains. “In other cases, biological factors may play the predominant role in mental health illness, requiring close collaboration with primary care providers or psychiatrists.” 

He hopes that students will advocate for collaborative care models in their careers, which recognize the diversity of patients’ problems. 

Dematogoda says she feels fortunate to have her first practicum at the clinic at the hospital. 

“We’ve been exposed to such a diverse community,” she says. “Our training has shown us that a patient’s symptoms and their current circumstances are an accumulation of their biology; their thoughts, emotions, and behaviour; and also their social determinants like environment, family circumstances and economic situation.”

One of the biggest lessons from the practical training is that psychotherapy doesn’t fit a set schedule.

Dematogoda adds that she has learned to provide patient-directed care and to help the patient address the issues they see as most pressing, rather than start with the problems the provider sees as paramount. 

“Building rapport and making sure patients feel their concerns are heard is something I don’t feel we could have gotten from a classroom.”

A Broader View of Health Care

Placements outside of hospitals offer nursing students insight into the diversity of community resources available to their clients

The third year of the university’s nursing program is dedicated to the social determinants of health, health promotion and advocacy. During this year, students pursue placements outside of hospital walls—at places like social services agencies, shelters, detention centres, and public health departments. 

Students conduct a needs assessment, including asking clients about how services could be improved, and work in partnership with their preceptors to find a solution, explains Barbara Chyzzy, who leads the third-year collaborative nursing degree program at the Daphne Cockwell School of Nursing.

Some students create and lead training sessions for young parents on topics like bonding with their child, nutrition, and mental health. Others have worked in partnership with safe consumption sites, visiting local businesses to educate stakeholders on their importance.  In one case, students working with a doula agency mapped out gender-affirming services.

“That’s something they had never even considered—what services are available for trans or non-binary pregnant people,” says Chyzzy. (In her own community health role, Chyzzy works with the Young Parents No Fixed Address network of over 30 agencies that support young parents in Toronto).

Each week, the students have small group conferences to talk about their placements and learn from each other. Chyzzy says the community placements, combined with the theory they learn in class, teach them about the needs and challenges of patients outside of hospital walls, and to think critically about a strictly biomedical approach to health.

For example, students recently attended a workshop led by a Toronto-based midwife. It was a revelation to learn how midwives prioritize the patient’s wants, in terms of birthing position and other preferences. 

“We can also change the way nurses work within hospitals.”

The overarching goal of the placements is to expose students to the wide diversity of community resources. This way, even if they aren’t working in the community, they will be able to connect their patients to these resources, and also advocate for their expansion.

"If I don’t have students having an ‘Aha moment’ in their third year, then I haven’t succeeded,” Chyzzy laughs. “Probably the biggest revelation is, ‘I had no idea that nurses work in all of these areas.’”

Chyzzy says third-year students are “climbing up a hill, getting to the top of the hill, looking out to the world. They see this world in a totally different way. And then even if they go back down the hill, they always remember what they learned in community health.”