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RFP--Trans Health Expansion Development of an Evaluation Framework, Sherbourne Health Centre

Toronto, Ontario
Deadline January 18, 2017


On behalf of the partners in the Trans Health Expansion initiative, (Sherbourne Health Centre, including Rainbow Health Ontario, Women’s College Hospital, and CAMH) Sherbourne Health Centre is requesting proposals to develop an evaluation framework for the Trans Health Expansion initiative.

Closing Date and Time: January 18. 2016 at 9:00 a.m.

About the Trans Health Expansion:

Legislative Change
In an effort to reduce wait times and improve healthcare access and services for trans people, the Ontario Ministry of Health and Long-Term Care changed the Ontario Health Insurance Plan (OHIP) funding criteria for transition-related surgeries to allow “qualified providers” throughout the province to refer clients for surgery. Prior to this March 2016 regulation change,
trans people hoping to undergo transition related surgeries could only access referral through Toronto's Centre for Addiction and Mental Health (CAMH). This limited access, combined with consistent increases in the number of people in Ontario seeking services, resulted in a significant wait list for surgical referral in Ontario.

Proposal to improve access to surgery
In April 2016, the government announced new funding in the provincial budget to improve care for trans Ontarians and directed Sherbourne Health Centre/Rainbow Health Ontario, CAMH and Women’s College Hospital to work together with community partners to realize a proposal for expanded and sustainable health services to support trans and gender diverse individuals and communities across the province. Key focus areas proposed include:

Primary care access & consultation:

  • Increasing access to experienced and culturally aware health care providers that are motivated to work with trans individuals;
  • Increasing primary and community care comfort, knowledge, and ability to provide transition support and referrals for specialized care (e.g. transition related surgeries); reducing wait list for surgical referral in Ontario.

Health care provider education:

  • Increasing the ability and skills of health care providers in providing care to trans and gender diverse individuals.
  • Transition-related (aka gender-affirming) surgery:
  • Providing options for transition-related surgeries and support closer to home;
  • Increasing access to publicly funded surgery readiness assessments;
  • Understanding surgical service experience and needs of the population, and
  • Increasing information about procedures, process, and wait times.

The Proposal to Improve Health Care Services for Trans People in Ontario

A proposal to improve health care services was submitted to the Ministry of Health. The proposal outlined the following three phases of work.

Phase 1 (0-12 months):

  • Conduct wait list evaluation and develop a plan to reduce the wait list at CAMH;
  • Develop assessment and referral training module for primary and community providers;
  • Continue training primary care providers across the province;
  • Provide education and support to clients on the OHIP regulatory changes and health navigation support to enable people to most efficiently and effectively access the health services and wellness supports they may need;
  • Provide specialized mental health support for trans people and consultation to their providers across the province as needed.

Phase 2 (12-24 months):

  • Conduct assessment of community needs;
  • Train qualified healthcare providers to offer referrals for transition related surgeries;
  • Evaluate access to and capacity for OHIP funded transition related surgeries;
  • Understand surgical volumes/need;
  • Create capacity for publically-funded outpatient surgical services;
  • Develop a plan to expand access to OHIP-funded transition related surgeries in- province;
  • Create improved recovery facilities for trans people who live in precarious housing or have more complex health needs to receive medical care and support in the post- operative period;
  • Understand and communicate impacts of OHIP regulations on transition related surgeries;
  • Establish an evaluation framework.

Phase 3 (24-36 months):
Phase 3 envisions a multi-year effort to engage trans community and health care providers in the development of coordinated and comprehensive trans health services and supports across the province, bringing care closer to home wherever possible. A subsequent proposal will be developed for this work.

The primary partners in the Trans Health Expansion are Sherbourne Health Centre - including Rainbow Health Ontario, Sherbourne’s program that has a provincial mandate ; Women’s College Hospital; and the Centre for Addiction and Mental Health. This partnership has been established to support the delivery of accessible health care and advance surgical planning, for trans and gender-diverse people across Ontario.

Input from partners and stakeholders – trans and gender diverse individuals and communities, healthcare and community organizations, and funding bodies – are critical to the development of a comprehensive provincial network of services. The implementation work is being carried out through a series of committees which include members of trans communities.

Additional information
The partners in the Trans Health Expansion will be contracting with SARAVYC at UBC to conduct an analysis of the Ontario respondents to a national survey about trans people’s experiences with assessment and referral.   See  canadians-experiences-with-gender-affirming-surgery/ for more information.


  • A detailed workplan outlining methodologies, key activities and timeframe for the development of the evaluation framework
  • Hard and Electronic copies of an evaluation framework for the Trans Health Expansion that:
    • attends to both process and outcomes
    • aligns with the Institute for Health Improvement (IHI) Triple Aim framework,
    • includes data collection methods
  • A proposed 3 year workplan (fiscal 2017-18 to fiscal 2019/20) to support the implementation of the evaluation framework
  • Proposed budget and resource implications to support the implementation of the evaluation framework
  • Presentation of the evaluation framework and associated materials to stakeholders in the Trans Health Expansion initiative (to be defined)

Content of Proposal:

In responding to the RFP, we request the following information:

  1. Detail of your - or your consultant group’s - experience developing evaluation frameworks in the non profit and health care sector.
  2. Proposed methodologies to be used to conduct the project, including where applicable, roles and required time for staff/stakeholder involvement.
  3. Timeline and proposed workplan. NB: All work must be completed by March 31st, 2017
  4. References from clients with whom the consultant has completed similar work.
  5. Estimated fee.
  6. Resources required from partner agencies (Sherbourne Health Centre, Women’s College Hospital and the Centre for Addiction and Mental Health) to support the work.
  7. A brief description of how you would ensure the framework aligns with the Institute for Health Improvement (IHI) Triple Aim Quality Improvement framework.
  8. Demonstrate your understanding of the history of trans people’s relationship to health care services in the province of Ontario and a brief description of how this would inform the development of an evaluation framework.
  9. A brief description of any background or experience you have in working with populations that are disenfranchised from the health care system.

Evaluation of Proposal:

Our team of partners will evaluate the proposals with consideration for the following factors:

  • An understanding of the scope and objectives of the Study.
  • An overview of the experience of the consultant / consultant team in related projects.
  • A demonstrated understanding of how the Triple Aim approach to quality improvement will inform the evaluation framework.
  • The specific consultant(s) proposed and their experience relative to the role for which they are proposed.
  • Demonstrated understanding of the sensitives and needs of trans communities and how this would inform the development of an evaluation framework.
  • Feasibility of proposal and demonstrated ability to complete project by March 31st.
  • The daily rate, the total days and associated cost for this study.
  • An indication of the degree of flexibility in the consulting days proposed.
  • References

Sherbourne intends to use a high degree of discretion in its selection decision, guided by the above factors. Sherbourne may, in its sole discretion, request further information, including an interview, with consultants as part of its decision making.


Proponents should submit their proposals electronically to:

Devon MacFarlane, Director, Rainbow Health Ontario Cc: Gael Hinnighan:

Submissions will be accepted until January 18th at 9:00 a.m.