Capstone research projects database
The Capstone research project is where students work on real-world issues.
See the Capstone projects TRP students have worked on over the years.
Removing Barriers To Wound Care: Applying Appreciative Inquiry To Improve The Management Of Wounds Within The Matawa First Nations
This study uses appreciative inquiry to co-design a culturally appropriate intervention to support remote wound care delivery in Matawa First Nations communities.
Background
The purpose of this research study is to better understand the problem space of remote wound care within the Matawa First Nations communities. Ultimately, we hope to use explorative research to collect data that will inform requirements for the design of a resource or intervention that can be useful to help the Matawa First Nations Health Care team (MHT). We hope the intervention will help bridge the service gap and access to wound care within the Matawa First Nation Communities in Northwest Ontario. Objectives To understand the cultural environment, patient and provider experience in a holistic manner in order to improve wound care competency within communities; To understand and frame the problem space in a way that reflects the providers and the resources they have. To maintain cultural appropriateness when speaking with members of the Matawa First Nations communities and when co-designing an intervention with the MHT. To improve wound care competency in the Matawa First Nations community settings to prevent complicated wounds leading to amputations. To engage various Matawa healthcare providers. To promote the clinical wound care capacity of the MHT. To co-create a resource that can work within communities and that will address remote wound care needs. Methods and Procedure:The specific methodology of appreciative inquiry will be employed in this research study, and it will focus on the strengths of providers and their ability to give care. The study aims to inquire, imagine, innovate and implement intervention using multiple rounds of interviews that will improve wound care within the Matawa First Nations communities. This study will aim to engage Matawa health care providers in informal interviews to help with this process. The first phase is to inquire, which will include interviews with MHT members. Questions relating to wound care processes will be asked. The second phase is to imagine an improved wound care process, which will include individual and team brainstorming sessions. Our research team will list the themes obtained from phase one of the data on a draw.io document. These will all be related to the wound care process. The team will work with experts to ideate and list solutions to help keep what works within communities. The third phase is to innovate and come up with an intervention or resource based on the ideas provided in phase 2. Following the organization of the ideas and their ranking based on feasibility, ease and resources our team has available, we will come up with an intervention. Once an initial prototype of the intervention is created, we will reach back out to the MHT and ask for their input on the prototype. The final implementation phase will be to carry out the intervention within the MHT setting. This will allow for input and feedback from partners and providers, in the form of one final feedback interview.
Project team
- Margarita S. Elloso
- Vida Maksimoska
TRP supervisors
Project advisory committee
- Heather Boon
- Jeremy Caul
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Reusable diapers
Looking at promoting cloth diapers for low-income families and educating them and the public about safe washing techniques
Project team
- Leslie Shai
Revitalizing Tenant Wellness: Piloting the Implementation of a Wellness Hub at 100 High Park Avenue for Greater Access to Long-Term Mental Health Services for Tenants
The Toronto Community Housing Corporation (TCH) provides affordable social housing to a community of residents. In these community housing buildings, residents face various challenges such as mental health, safety and security, addiction, and economic challenges.
In partnership with the West Toronto Ontario Health Team (WTOHT) and TCH, we aim to implement a Wellness Hub to increase access to key resources, namely mental Health Resources.
Background
Toronto Community Housing Corporation (TCHC) is a non-profit group and stands as the largest social housing provider in Canada (About Us | Toronto Community Housing, 2023). The organization plays a pivotal role in addressing housing needs, by providing subsidized or rent-geared-to-income shelter to over 43,000 people across 106 of Toronto’s 158 neighborhoods (About Us | Toronto Community Housing, 2023). The 89,000 residents under TCHC’s care are a diverse tapestry, representing a wide spectrum of backgrounds encompassing age, education, language, mental and physical abilities, religion, ethnicity, and race (About Us | Toronto Community Housing, 2023).
The TCHC location of focus in this pilot project is 100 High Park Avenue in West Toronto. There are 619 residents residing in this building, 80% of which are older than 25 (Refer to Appendix A for additional demographic data). 100 High Park Avenue is a medical desert with inadequate access to primary healthcare services, substantially less for the population density compared to other locations across the city. Challenges include increased mental health issues, poverty, and other circumstances that render residents vulnerable. As a result, residents face a multitude of concerns, including personal drug abuse or overuse, feelings of unsafety within the community, and instances of intimidation and attacks directed towards elderly residents, among others. Accessible routine primary health care services such as psychosocial services, health promotion and disease prevention are crucial to the long-term well-being of tenants and the surrounding community.
The West Toronto Ontario Health Team (WTOHT), comprising 35 organizations in the West Toronto area, plays a vital role in coordinating care between hospitals, primary care, home and community care services, long-term care homes, congregate settings, and various other healthcare services (About Us | West Toronto Ontario Health Team, 2023). Their goal is to deliver an improved and seamless healthcare experience for those receiving care in West Toronto.
In a collaborative effort TCHC, WTOHT, and our capstone team seek to address the multifaceted challenges faced by 100 High Park Avenue residents. Our team will facilitate an ideation process to effectively engage key community stakeholders and co-create a wellness hub tailored to the unique needs of TCHC residents at 100 High Park Avenue. This endeavor will not only seek to provide immediate support but also ensure the sustainability of these interventions, making a positive, lasting impact on the communities we serve. By bringing together the resources and expertise of both organizations, we aim to create a model that fosters well-being and resilience among TCHC residents, ultimately enhancing their overall quality of life and community cohesion.
- Problem Statement: Tenants experiencing mental health challenges in the TCH 100 High Park Avenue location, a known medical desert, have inadequate access to necessary mental health services, further exacerbating residents’ substance use and safety concerns.
- Need Statement: The need is to increase the accessibility and long-term use of mental health care services through the community Wellness Hub for tenants residing in the TCH 100 High Park Avenue location.
- Research Question: How might we develop and integrate accessible mental health services through the wellness hubs for all tenants at 100 High Park Avenue to improve the long-term follow-through of their care, overall health and safety?
Project team
- Sumaya Bhatti
- Anabela Cotovio
- Julia Kulczyski
- Osaru Omoruna
TRP supervisors
Roadmap to Bridging: Developing a Unified Discharge Process
A quality improvement project at CAMH’s Bridging Clinic examines barriers to care coordination, addressing a growing backlog of post-discharge mental health clients, particularly worsened during COVID-19.
Background
According to the Survey on COVID-19 and Mental Health, one in four (25%) Canadian adults (18 and older) self-reported symptoms of a mental health disorder, an increase from the one in five (21%) reported in Fall 2020 (Government of Canada, 2021a). One in five individuals (18.1%) aged 12 and older reported the need for help for their mental health in the Fall of 2020; and (45.0%) felt that their needs were either unmet or only partially met (Government of Canada, 2021b). Out of those with unmet needs, 20.9% reported features of the health care system, such as accessibility, as a barrier to meet their care needs (Government of Canada, 2021). The lack of coordination and fragmentation of Ontario's mental health care system generates confusion, hinders clear navigation of the system, and results in unnecessary emergency visits (Roadmap to Wellness, 2020).
The World Health Organization (WHO) defines care coordination as “a proactive approach to bring together care professionals and providers to meet the needs of service users to ensure that they receive integrated, person-focused care across various settings” (World Health Organization, 2018). Coordination of care or continuity of care (COC) has also been described as “the degree to which a series of discrete health care events is experienced by people as coherent and interconnected over time and consistent with their health needs and preferences” (World Health Organization, 2018). The lack of coordinated and continuous care in the mental healthcare space remains a significant challenge that greatly impacts costs and the patient experience. It has been shown, that without effective and timely follow-up and COC post-discharge from inpatient psychiatric care, clients are vulnerable to relapse within 30 days of discharge and are found to be at greater risk for suicide within six months (Rudoler et al., 2017).
To better understand this problem space, the Capstone team met with different stakeholders of the mental health system, including people working at the Centre for Addiction and Mental Health (CAMH) and in government. One of these meetings uncovered an opportunity at CAMH's Bridging Clinic (BRDG) for a quality improvement project regarding the navigation of the system. Dr. Andrea Waddell was leading this initiative and after several meetings to discuss goals and the project, working together was a good fit due to our shared interest in quality improvement in mental health care. Established in 2017 in Toronto, Ontario, CAMH’s BRDG aims to provide low barrier and rapid access for acute care post-discharge from mental health and addiction services. The clinic is intended as a mechanism to provide continuity of care while clients are connected with longer-term solutions. This service is provided to individuals who identify as needing support as they transition from hospital to the community. Individuals can access the service for a maximum period of three months. BRDG staff is composed of a leadership team (clinical directors and managers), administrative team, clinicians (social workers and nurses) and the physician team (psychiatrists). BRDG plays a role on the continuum of care stemming from the following client sources: the CAMH Emergency Department (ED) triage; post-assessment or post-discharge by the ED; and post-discharge from the CAMH inpatient unit. Clients are unable to schedule appointments and access the clinic on a drop-in basis. The services included in BRDG are designed to ensure that clients a re bridged to other CAMH services, community or primary care providers and not lost to follow-up. When we analyzed the BRDG monthly reports, we learned that there is an increase in the total number of clients served yearly from 2017 to 2020 (Figure. 1, p < 0.05, except between 2020 and 2021; p >0.05). However, the difference between the number of new clients and total discharges has not followed the same upward trend as clients served each year (ANOVA p=0.04, but Tukey p>0.05 in all comparisons).
If we accept the increase of clients served yearly as a surrogate of the number of open episodes, the backlog in discharges was a natural outcome given the absence of a growth in discharge. During COVID, the backlog of clients worsened, further disrupting the flow of BRDG. The data, however, does not pinpoint the reason for the backlog. It should be clarified from Figure 1 that the discharge number for 2021 reflects a one-time focused effort put on discharge in the last three months of the year.
Project team
- Andres Kohan
- Dorottya Harangi
- Mona Irannejad
- Stephannie Jeanneret Manning
TRP supervisors
Project advisory committee
- Andrea Waddell
- Melissa Hiebert
- Olivier St-Cyr
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Rx:Capacity
This project aims to address a gap in mental health support for adults aged 25 - 45 in downtown Toronto. While community-based supports exist, individuals may face barriers related to navigation, affordability, accessibility, and reduced capacity to engage, particularly during periods of poor mental health. There is a need for a more person-centred approach that connects adults to meaningful community supports addressing social connection, purpose, physical activity, and other non-medical contributors to well-being.
Background
Over the past 12 years, mental health challenges have risen significantly across Canada, with 28% of Torontonians reporting symptoms that impact their daily functioning. In the aftermath of the COVID-19 pandemic and with the rising cost of living, many adults in downtown Toronto report difficulties finding community, stability, and a sense of purpose. While traditional mental health services such as therapy and medications may help manage low mood and everyday stressors, a person's mental health is often shaped by other factors. Access to mental, emotional, and social support plays an important role in improving the well-being of individuals experiencing mental health challenges. Mental health professionals increasingly recognize that comprehensive mental health care must extend beyond pharmacological or medical treatments alone. Social prescribing is an approach in which health care professionals connect individuals to non-medical, community-based supports (CBS) and resources, tailored to their needs and interests. This model has been used to promote mental health by strengthening community connections and encouraging participants to engage in meaningful social activities and CBS that address daily well-being.
Despite growing recognition of mental health as a public health priority, Canada's mental health system continues to face significant structural and accessibility barriers. The delivery of mental health care is mixed regarding public and private services, which can contribute to inequitable access, particularly for those without private insurance coverage. A more fundamental limitation is the continuous focus on treating symptoms rather than addressing the social determinants that contribute to well-being within the mental health care system. Long wait times for publicly funded care, limited provider availability, and uneven service distribution further restrict timely access to appropriate support. Consequently, many individuals rely on primary care or emergency departments, which are not intended to provide ongoing, comprehensive mental health support. This biomedical focus highlights the need for complementary approaches, such as social prescribing, that address the non-medical factors influencing mental health.
Project team
- Jessie Schnarr
- Amanda Sunderdas
TRP supervisors
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SAFER-FARM (Strategies for Avian Flu Exposure Reduction through Farm worker Awareness and Risk Management)
SAFER-FARM seeks to characterize perceptions, attitudes, and behavioral practices regarding H5N1 prevention measures among occupationally exposed populations, primarily poultry farmers. We are working to identify barriers and facilitators to prevention measures, including the adoption of Personal Protective Equipment (PPE) and the uptake of pre-pandemic vaccination. We will design evidence-based, targeted interventions to enhance H5N1 transmission prevention measures. We will validate intervention designs with poultry farm owners and operators to pre-establish the feasibility and acceptability of recommendations among influential agricultural community members.
Background
The H5N1 avian influenza virus has demonstrated an unprecedented capacity for cross-species transmission, with documented outbreaks spanning wild birds, domestic poultry, dairy cattle, and a growing range of mammals. Between January 1 and August 4, 2025, 26 human infections were confirmed globally, with 11 resulting in death, for a case fatality rate of 42.3%. The risk of viral reassortment to a human-transmissible strain represents a credible pathway to a global pandemic with potentially serious consequences for human health and the global economy.
Since late 2024, H5N1 outbreaks in Ontario have required full flock depopulations under Canadian Food Inspection Agency (CFIA) protocols, with direct consequences for farm operators, supply chains, food prices, and food security. Health Canada has acquired over 870,000 vaccine doses but fewer than approximately 500 have been administered, with eligibility restricted to laboratory technicians and those involved in culling infected poultry or wildlife. Agricultural farm workers, facing among the highest occupational exposure risks, remain excluded from eligibility and face significant barriers to PPE adoption and health communication.
SAFER-FARM asks the following question: What barriers and facilitators exist for adoption of H5N1 avian influenza prevention measures on livestock farms, and how can these insights guide intervention design?
Project team
- Dan Ambrochi
- Dylan Chiu
- Frank Shannon
- Kasthuri Theivendirarajah
TRP supervisors
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Scaling Ultra Low-Field Portable Brain MRI in Rural and Remote Canada Using an Implementation Science Approach to Improve Diagnostic Access
Advanced neuroimaging in Canada is concentrated in urban centres, leaving rural, remote, and Indigenous communities with limited access. While ultralow field portable MRI has shown early technical promise, widespread adoption is hindered by implementation gaps, not technology alone. This project addresses barriers related to workforce training, workflow integration, governance, and community trust by engaging diverse stakeholders to co-design a practical implementation toolkit. Using a mixed-methods, implementation science approach grounded in CFIR, we aim to generate evidence-informed guidance to support equitable, sustainable scaling of portable MRI in underserved Canadian health systems.
Background
Conventional MRI systems require specialized infrastructure, shielding, and on-site expertise that make them unsuitable for geographically isolated or resource limited settings. This structural reality contributes to diagnostic delays, unnecessary patient transfers, and inequitable access for rural, remote, and Indigenous communities across Canada.
Recent advances in ultralow field portable MRI have demonstrated technical feasibility and early clinical utility in non traditional environments, including pilot implementations in remote Canadian hospitals. However, the evidence base for how to implement these technologies sustainably, accounting for governance, staffing, cultural safety, and community trust, remains limited.
This capstone applies implementation science frameworks, specifically the Consolidated Framework for Implementation Research (CFIR), to address this gap. The study follows a four-phase, mixed-methods design:
- Exploratory interviews (12–15 participants) with radiologists, MRI technologists, administrators, policy stakeholders, and Indigenous advisors to identify barriers, enablers, and readiness factors.
- Stakeholder survey (40–60 participants) to assess perceived feasibility, acceptability, and priorities for toolkit components
- Toolkit development to synethsize interview and survey findings into a practical, transferable implementation resource
- Validation (5–8 participants) to assess usability and real-world applicability of the draft toolkit
The study is conducted virtually via Zoom/Teams and is classified as minimal risk by the University of Toronto Health Sciences REB. It involves no patient data, no clinical interventions, and no health records. Indigenous perspectives on trust, cultural safety, and governance are incorporated through advisory input in partnership with the Weeneebayko Area Health Authority (WAHA).
The final deliverable is a co-designed implementation toolkit intended to support health systems planning for portable MRI adoption across diverse rural, remote, and Indigenous-serving contexts in Canada.
Project team
- Kareem Draz
- Karina Pacholczyk
- Pardaman Setia
TRP supervisors
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SPOT Concussion:Systems to Prevent Overlooking Teen Concussion
This study identifies barriers and facilitators to the use of paediatric concussion clinical practice guidelines among primary care providers in Toronto.
Background
Background: Evidence-based Clinical Practice Guidelines (CPGs) help improve the quality and consistency of care provided by healthcare professionals. However, despite the existence of multiple concussion-related CPGs, published studies suggest that CPG awareness and adherence is low for the management of paediatric concussion. Not using CPGs could contribute to missed diagnoses or the mismanagement of children at risk for persisting post-concussion symptoms (PPCS), such as anxiety and learning disabilities, which can last for years following injury. There is a need to increase the utilization of paediatric concussion CPGs by primary care providers (PCPs).
Objective: We aimed to improve the use of CPG guidelines among community-based PCPs in Toronto by first identifying the facilitators and barriers to the uptake of CPGs.
Methods: A qualitative descriptive study design was used. Family physicians, paediatricians, and nurse practitioners were recruited via purposive and snowball sampling. Semi-structured interviews were conducted online. A combination of deductive and inductive coding was used, and a reflexive thematic analysis process followed for data analysis.
Results: Eight participants met our eligibility criteria and were interviewed. Four overarching themes were identified:
- Diverse conceptualizations of concussion CPGs and their relevance
- Limited opportunities to learn about paediatric concussion
- The important role of intermediaries
- End-user needs remain unmet
Conclusion: Participants shared their perspectives, insights into their decision-making process, and helped identify the barriers and facilitators to the use of concussion CPGs. With this knowledge, custom strategies for community-based PCPs in Toronto could be created to improve concussion CPG uptake.
Project team
- Amelia Di Meo
- Bethany Tong
- Maryam Fereig
- Sarah Diaz
TRP supervisors
Project advisory committee
- Heather Boon
- Gabrielle Freire
- Charlene Welsh
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STAMPS: Strategies to Access Mental-health Perinatal Services
The STAMPS study explores the mental health care pathways of birthing parents and providers in Toronto, identifying structural, process, and contextual barriers to support for perinatal depression and anxiety using the Donabedian framework.
Background
The STAMPS study investigated the mental health care experiences of birthing parents and healthcare providers within Toronto, with a specific focus on perinatal depression and anxiety. We aimed to understand the barriers and facilitators to mental health support and uncover the resources available for birthing parents who are experiencing perinatal depression or anxiety.
Perinatal mood and anxiety disorders are a spectrum of mental health conditions affecting individuals during the perinatal period, spanning the entire pregnancy and up to one year after childbirth. Perinatal depression, one of these conditions, is the most common complication of childbirth. In addition, perinatal anxiety is another common condition and is a strong predictor of postpartum depression.
In Canada, perinatal depression and anxiety symptoms are estimated to affect around 23% of women, yet not everyone who experiences these conditions talks to someone about their mental health. In fact, only around 50% of those who do reach out for help talk to a professional!
Even with the high number of people affected, there are no formal screening guidelines for perinatal depression or anxiety in Canada. However, as other countries have shown, the problem may not be with screening but with referral networks, available resources, or follow-up.
Before creating solutions to improve perinatal mental health in Toronto, we need to understand the mental health care pathways of birthing parents who experience perinatal depression or anxiety and of healthcare providers who offer perinatal services. This is the gap we aimed to fill. Birthing parents in Toronto are currently experiencing the burdens of untreated perinatal depression and anxiety.
Our objective was to discover the mental health care pathways of birthing parents and the current perinatal mental healthcare support systems in Toronto. By understanding the mental health care journey of birthing parents, we aimed to identify gaps in perinatal mental health care in Toronto. To ensure inclusivity of sex and gender diversity, this study was open to any individual who had given birth or was pregnant, and who self-identified as a woman or mother, including those who identify as transgender, transsexual, two-spirited, androgynous, agender, intersex, bigender, gender questioning, gender fluid, non-binary, genderqueer, or gender-non-conforming.
In terms of healthcare providers, we included professions that are part of the perinatal circle of care, including nurses, psychiatrists, family doctors, neonatologists, midwives, obstetricians, social workers, and doulas. The study relied on one-on-one semi-structured interviews with birthing parents and healthcare providers to gather their lived experiences with perinatal mental health care. We collected information about symptom awareness and diagnosis, as well as how they found support services for perinatal mental health, what services they found, the treatments or services offered for perinatal mental health, and whether these services were beneficial for the treatment of their mood disorders.
Common themes between care pathways were highlighted and analyzed. Given the complexity of the Canadian healthcare system, we needed a conceptual framework to categorize our exploration including barriers and facilitators to perinatal mental health service and care delivery.
We decided to use the Donabedian Model, which we combined with context of care to organize these themes into the following main categories:
- Structure - represents the attributes of the settings in which care occurs like resource access and wait times
- Process - denotes the exchange between patients and providers, such as perinatal mood disorder diagnosis and care management https://sydneytaylor58.wixsite.com/stamps
- Outcome - represents the effects of care on the health status of patients, such as mental health awareness and patient satisfaction
- Context of care - individual influences on perinatal mental health care, such as social determinants of health and mental health stigma
Project team
- Dr. Nancy Mingo
- Dr. Ayeshah Mohiuddin
- Sydney Taylor
- Susan Elizabeth Zelko
TRP supervisors
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The 1 in 5 Perinatal Mental Health Project; Understanding Clinician awareness in Ontario (Kanadario) of a Treatment Pathway devised to assist patients and clients suffering from Perinatal or Postpartum Mood and Anxiety Disorders (PMAD)
This mixed-methods study evaluates Ontario clinicians’ awareness and uptake of the PCMCH Care Pathway to improve treatment of perinatal mood and anxiety disorders.
Background
Mental health resources and clinicians available to provide timely and cost-effective treatment have diminished as the number of individuals requiring care has steadfastly risen in the province of Ontario. (1,) Individuals in the perinatal period, which spans from conception to the first year following childbirth, are no exception. In 2019 the Maternal Mental Health Survey conducted by Statistics Canada showed 23% of respondents, or circa 1 in 5, reported symptoms in line with the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) definition of mood disorders depression and anxiety (1, 2) Research from all provinces and territories across Canada is definitive that perinatal mood and anxiety disorders (PMAD) are neither uncommon nor insignificant and that the repercussions that follow are far-reaching and profound to both birthing person and their infant.(3,4,5,6,7)
The 1 in 5 Perinatal Mental Health Project is a mixed-method cross-sectional study in survey format which aims to evaluate clinician awareness and uptake of the Provincial Council for Maternal and Child Health (PCMCH) Care Pathway for the Management of Perinatal Mental Health published in July 2021(8). The 1in 5 Perinatal Mental Health Project assumes an iterative process analyzing the PCMCH treatment pathway usage and how this may influence perinatal care providers in Ontario and impact their patient’s health and well-being. Data collected can be used to inform further development of treatment options that are accessible, timely and beneficial to clinicians and birthing persons suffering from PMAD.
Project team
- Suzan Lorenz
TRP supervisors
Project advisory committee
- Sabrina Kolker
- Rohan D'Souza
- Kristin Horsley
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