Since 2006, the Upper Grand Family Health Team has taken a team-based approach to patient care and well-being. We provide a broad range of health-care services that focuses on health promotion, disease prevention and chronic disease management.
Through our programs and services we aim to help decrease utilization of local hospital emergency departments and increase our patients’ abilities to improve their health within their own communities. Our clinical team is comprised of 24 allied professionals who practice in the areas of mental health, pharmacy, health promotion, dietetics, occupational therapy, palliative care and nursing specialties.
We have established strong relationships with our community partners including the Waterloo Wellington Local Health Integration Network, Wellington-Dufferin-Guelph Public Health, Groves Memorial Community Hospital, and various other local, regional and provincial groups to improve access and integration of care for our patients.
Our ultimate goal is for patients to feel empowered and encouraged to play a central role in their health care and recovery. We are dedicated to achieving excellence in patient care and we foster the development of future healthcare professionals through offering student internship and educational opportunities with our organization and our physician partners.
“Our ultimate goal is for patients to feel empowered and encouraged to play a central role in their health care and recovery.”
Interested In Becoming A Family Health Team Client?
The majority of our services require referrals from a collaborating family physician of the Upper Grand Family Health Organization. To see one of our Mental Health Counselors, Dietitians, Nurse Specialists, Pharmacist, Outreach Worker, Occupational Therapist, or Health Promoter please make an appointment with your Family Physician to be referred or call the Family Health Team at (519)843-3947 for more information.
There are TWO ways you can become a Family Health Team Client:
Vision and Principles
You may view our organization’s 2017-2020 strategic plan here.
Our vision is to empower the people in Centre Wellington and surrounding areas to enhance their health through equitable access to a range of the highest quality primary health care services.
The core principles of our organization are as follows:
We recognize that through collaboration and integration all parties work together to enhance the current level of primary health care available to the community and strategically evolve their existing capabilities and services roles.
We recognize the roles, competencies, diversity, worth and contributions of all practitioners and staff who form our organization. We strive to engage in honest, courteous and non-judgmental communication and acknowledge the needs of others to be involved in decisions that could affect their interests and roles in the organization.
Continuous Quality Improvement
We recognize that the quest for excellence is a continuous journey. By adopting the Model for Improvement approach to continuous quality improvement; the Upper Grand Family Health Team demonstrates a commitment to strive for improvement and to spread successful and sustainable change across the organization.
View our 2017-18 Quality Improvement Plan.
We are committed to acting upon and contributing to the latest advances in medical technology and best practices. Accordingly, we continuously develop appropriate policies, procedures and mechanisms aimed at fostering mutual understanding and a working environment that encourages individual initiative, creativity and problem solving, and that enables professional development through continuous learning and recognizes the rewards high performance and team excellence.
We act responsibly in accordance with professional and clinical service standards, use resources wisely and efficiently, share information appropriately and measure and report on performance to key stakeholders.
Patient / Community Engagement
We believe that the participation of patients and their families in the design and delivery of services is essential to achieve optimal care. Our definition of high quality services will include description and measurement from the patient and family perspective.
We are located in Centre Wellington and provide support and services to approximately 30,000 residents within Centre Wellington, North Wellington and direct surrounding areas. The Upper Grand Family Health Team works in collaboration with the Physicians and Medical Practices within the Centre and North Wellington area including those who are a part of the following practices:
- Riverview Medical Group – Upper Level
- Riverview Medical Group – Lower Level
- Grand River Family Physicians
- Geddes Medical Group
- Family Practice Associates of Elora
- Elora Medical Group
- Dalby Family Practice
- Arthur Family Health Centre
Patient Rights and Responsibilities
We are committed to providing the best primary health care in our community. We believe that our patients and families are partners in the delivery of quality healthcare. Therefore we make the following commitments to you:
When you visit our offices or contact us you have the right to:
- Be treated in a kind and respectful way
- Be given information in a way that you will understand and is meaningful to you
- Expect that your health care team will share relevant information with each other within the circle of care, unless otherwise restricted by you.
- Participate in making decisions about your care
- Receive culturally-sensitive care
- Know the names and roles of people involved in your care
- Express your concerns and get answers to your questions
- Be told of the fees not covered by OHIP and that you or your family will have to pay
We pride ourselves on maintaining a safe and collaborative environment for everyone who visits or works in our offices. Therefore we kindly ask for the support of our patients to help us achieve this goal by:
- Being polite and respecting other patients, visitors and members of the health care team
- Recognizing that the needs of other patients and families may sometimes be more urgent than your own
- Giving accurate information to your health care team to help them plan your care
- Giving your health care team the name of the person who will represent you if you cannot make decisions by yourself
- Following the plan of care the best way you can
- Accepting responsibility for the decisions you make about your treatment
- Taking responsibility for your personal belongings
- Respecting clinic property and acting in a safe and responsible way at all times
- Understanding and taking responsibility for all expenses not covered by OHIP
- Notifying your health care provider if you cannot keep an appointment
Our Staff – Integrated Health Care Professionals
Nicole Arthurs, RD, CDE
Nicole is a Registered Dietitian and Certified Diabetes Educator who has been with the UGFHT since 2010. She completed her BASc in Applied Human Nutrition at the University of Guelph and her dietetic internship with Hamilton Health Sciences. She enjoys being a member of a collaborative team and sharing her love of food and nutrition with the community. She has experience counseling clients in all aspects of nutrition, but has particular interests in the areas of Diabetes and Gastrointestinal Disease. When she’s not working she enjoys baking, trying new recipes, and spending quality time with her husband, daughter, and cat.
Terri Ney, RD
Terri grew up in Erin and completed her undergrad at Ryerson in Toronto. She eventually found her way to Fergus where she found her dream job working as a dietitian with the Upper Grand Family Health Team in 2007. After becoming a mom and raising children locally she became aware of areas to improve care for families using nutrition. Since then Terri has spearheaded the launch of the Breastfeeding Café and a series of Pediatric Nutrition workshops. Terri has been sought out to share her unique programs with other FHTs and is considered a leader by her dietitian peers.
Amy Waugh, RD, CDE
Amy is a Dietitian and Certified Diabetes Educator who has been working at the UGFHT since 2007. She grew up in rural Ontario and while she has lived and worked in various cities across the province is very happy to have settled in Centre Wellington. She is passionate about primary care and the role of nutrition in preventing and managing chronic health conditions across the lifespan.
Jena Docking, R. Kin
Jena has worked in the fitness industry for over 15 years. She quickly found her calling for Fitness and Health promotion after working at a ladies gym in her hometown of Mount Forest. She received her diploma as a Certified Personal Training through the Canadian Society of Exercise Physiology in Niagara. After graduating she began personal training clients ranging from the general public to Triple A hockey players, which sparked her interest in injury rehabilitation. Jena eventually took a position at a physiotherapy clinic which led her back to school where she pursued her undergraduate degree in Kinesiology.
Jena has been with the UGFHT since 2013 and is actively involved in walking programs, pulmonary rehabilitation, chronic disease management, falls prevention, managing menopause, smoking cessation, exercise prescription, fitness and health education, fitness assessment, program design, chronic pain workshop, Healthy You classes and much more.
Mental Health Counselors
Mental Health Counselors play an integral part in assisting in the improvement of patient mental health and social well-being. The FHT Counselors will help you to cope with issues in your life that cause you emotional distress or to help you to monitor and self-manage a mental health issue.
Catherine Barlow, MSW
Catherine Barlow has been a Mental Health Therapist with the UGFHT since 2012. She is also an Assistant Clinical Professor at the Michael DeGroote School of Medicine, dividing her working time between her private counseling practice in Guelph, teaching medical students and working part-time for the Family Health Team. In her spare time, she enjoys long walks in the forest with her dog and spending as much time as possible in nature. She also enjoys creative pursuits such as oil and pastel painting, photography and knitting.
Linda Borys, MSW
Linda is one of the Mental Health Therapists at the UGFHT and has been working here since 2012, enjoying helping people find ways to have happier and more satisfying lives. Linda refers to herself as a “cat lady” but she considers all pets as “people!” Making good soup gives her joy, and sleeping in on weekends is her guilty pleasure.
Andrea Hall, MSW, BSW, MSc
Andrea is a member of the supportive and palliative care team providing counseling and social work to individuals and families coping with a life-threatening illness. In her role as grief counselor she assists bereaved individuals who are struggling to cope with their grief and facilitates bereavement and caregiver support groups. Her qualifications include a MSW, BSW, MSc, and post-graduate certification in Grief and Bereavement.
Nadia Landry, MSW
Nadia is a Master’s level Social Worker (MSW) who has been with the UGFHT since 2007. She currently splits her time as a Mental Health Therapist with the Dalby Family Practice and as the FHT’s Geriatric Social Worker. Nadia is passionate about helping clients to feel empowered to live their best life. To help achieve this she is committed to ongoing education and has recently completed Wilfred Laurier University’s Cognitive Behavioral Therapy certificate program and Narrative Therapy training through the Hincks-Dellcrest Centre in Toronto. In her spare time, Nadia enjoys quality time with her family and pets, reading, nature walks, and traveling “back home” to Canada’s east coast to spend time by the ocean.
Melody Mann, MSW, RSW
Melody has over 10 years’ experience in the counselling field. She uses a strength based approach and incorporates mindfulness, narrative therapy and cognitive behavioural therapy into her practice. Melody sees it as a privilege to hear people’s stories and to be a part of navigating mental health challenges, life transitions and personal growth. In her spare time she enjoys spending time in nature, with family, and in creative pursuits.
Marilyn Vaccaro, MSW, RSW
Marilyn has been with the UGFHT from the very beginning, in 2007, working as a Mental Health Therapist. She attended the University of Montreal initially and spent time travelling before moving to Waterloo to complete my Master’s Degree as a Clinical Social Worker. Keeping current professionally is very important to Marilyn, as she loves learning about the best ways to help people help themselves. During her time at the FHT she has pursued professional development in Equine Assisted Therapy, mindfulness, and the neuroscience behind trauma. In her spare time Marilyn enjoys restoring by the sea, and being creative.
Joannie Bruyn-de Oliveira, RPN – Telemedicine Nurse
“The Ontario Telemedicine Network (OTN) is one of the largest telemedicine networks in the world, helping to deliver clinical care and distance education among health care professionals and patients using live, two-way videoconferencing systems and related diagnostic equipment. In addition to its capacity to bring health care to virtually any patient, anywhere, at any time. The Ontario Telemedicine Network also enhances opportunities for professional development for physicians, allied health care providers, and students. More than 3,000 health care professionals in more than 1175 sites across the province use OTN to deliver care to their patients. This year, alone, OTN will deliver more than 135,000 patient visits.” Ontario Telemedicine Network 2017.
For more information on Telemedicine services visit www.otnhub.ca.
Janis Moriarity, RN- Geriatric Specialist
Janis is a Registered Nurse who started with the UGFHT in November 2017. She completed her Bachelor of Science in Nursing through McMaster University/Conestoga College in 2006. In her early career Janis worked in Acute Care Hospital specializing in the areas of cardiac care and vascular access nursing. She has also worked in the community in programs focused on chronic health conditions. Janis’ passion is working with seniors. In her role as Geriatric Nurse Specialist Janis’ goal is to use health promotion and disease prevention strategies to help seniors stay in their homes and in optimum health. She works in collaboration with Family Physicians and Geriatric Specialists for those who require further assessment and care. When she is at home Janis enjoys hiking, entertaining family, and the traditional arts: sewing, knitting, painting and telling stories.
Shelley Lillie, RN, BScN, SHPCN(C) – Palliative Specialist
Shelley is the supportive and palliative care nurse who helps people in our community with life threatening illnesses. She provides pain and symptom management, navigation through hospital-community transitions, and end of life planning for the individual and families. Her qualifications include RN, BScN, and a specialized certification in palliative care, CHPCN(C).
Lisa Melburn, RN, BScN – Cardiac Specialist
Lisa has been nursing for over 28 years, with over 12 years in Fergus. She looks forward to meeting with people to discuss how to control and monitor symptoms of lung disease (COPD) and heart disease (Congestive Heart Failure). One of the ways to manage contributors to chronic illness is to stop smoking cigarettes, if you are interested in quitting or reducing Lisa can help you develop a “Quit Plan” and review the options that are available. You can often find Lisa at the Centre Wellington Sportsplex exercising with clients, or teaching at the Pulmonary Rehabilitation course at Groves Hospital. Be sure to say hello if you see her walking her dog on some of the local trails or share your favorite healthy recipe.
Holly Stokman, RN, BScN, CDE – Metabolic Syndrome Specialist
Holly Stokman is a Registered Nurse Specialist in diabetes and smoking cessation. She works with physicians at each of the medical practices within the UGFHT to provide care at diabetes clinics, and can meet one on one for ongoing diabetes management or smoking cessation counseling. In addition to her current role she has nursing experience in community and institutional settings. Holly is passionate about helping people to live well in spite of chronic conditions, to break free from addictions, and to heal their bodies and minds.
A Nurse Practitioner (NP) is a nurse with advanced university education who works both independently and in collaboration with other health professionals to provide individuals of all ages with quality health care services. NP’s take care of the physical, emotional, mental and social aspects of their patients’ health needs. They have additional education and advanced decision-making skills in the assessment and diagnosis of acute illnesses and injuries and in the management of chronic illnesses such as diabetes and hypertension. They have the knowledge and authority to prescribe certain medications are are authorized to order laboratory tests, x-rays and other diagnostic tests, as well as refer patients to other healthcare professionals.
Andrea was born and raised in Kirkland Lake where she enjoyed winters downhill skiing and summers at her family cottage in Quebec. Andrea eventually left the great white north to complete a BScN degree at Queen’s University in Kingston. She was subsequently employed with Toronto Public Health in the Sexual Health department followed by the Family Health department where she worked as a French language Public Health Nurse for the Healthy Babies Healthy Children program. She worked mainly with French speaking immigrants and refugees for a number of years before leaving to travel the world with her husband. The two traveled extensively through Southeast Asia, Australia, New Zealand, and numerous central and eastern European countries before returning home to refocus on their careers. Andrea feels that she gained tremendous cultural knowledge and understanding through both her personal travel and work experience.
After much debate, Andrea left Public Health in 2005 and decided to return to a more clinical focus. She completed her Primary Health Care Nurse Practitioner Master’s Degree in 2008 and has since been employed with the UGFHT where she hopes to remain until her estimated date of retirement in 2037! Andrea and her family are happy to call the communities of Elora and Fergus “home”. Andrea looks forward to collaboratively supporting you and your family for years to come!
Julia graduated with a Bachelor of Science in Nursing from McMaster University in 2006. She then worked as an RN in the Emergency Department at Mount Sinai Hospital in Toronto, before travelling to Australia to work for a year. There she worked in various hospital and primary care settings in the Sydney area with her now-husband, who grew up there. She completed her Primary Health Care Nurse Practitioner and Masters of Science in Nursing Program at York University in Toronto in 2011. Upon graduation, she worked as a Primary Care NP with the Guelph Family Health Team before joining the UGFHT in 2014. Her experiences have developed her passion for a holistic approach to preventative health care, women’s and children’s health, and chronic disease management, as well as caring for all patients throughout their lifespan. Outside of her work she loves hiking, cooking, travelling and spending time with her husband and two beautiful young daughters.
Kristin is a Primary Health Care Nurse Practitioner who has been with the UGFHT since 2008. She has a long history in Public Health with sexual health, women’s health and health promotion. Kristin’s passion for herself and others is a healthy lifestyle to obtain optimal health and prevention of illnesses. She especially enjoys all outdoor activities, especially sailing, kayaking and paddle boarding. Walking in the woods and doing yoga is also a strong interest for the meditative benefits. Kristin and her husband have three sons in their twenties who are mostly in the West pursuing more rigorous outdoor pursuits.
Colleen Loree is a Primary Health Care Nurse Practitioner who has been with the Family Health Team since 2015 and serves patients of the Grand River Family Physicians clinic in Fergus. She has a nursing background in the Intensive Care Unit and Cardiac Surgery/Coronary Care Unit in Kitchener, as well as the Emergency Department at Groves Memorial Community Hospital. She also has shared her knowledge by teaching nursing students at Conestoga College. She has a passion for comprehensive, evidence-based mental health, sexual health, and chronic pain management. Colleen delights in the knowledge that the Nurse Practitioner role allows her to spend more time with her patients in order to understand their health challenges (and assets) so she can be a resource for their pursuit of health goals. In her leisure time Colleen enjoys competitive, synchronized skating, playing with her daughter, running, camp nursing, and planning family travel adventures.
Barb Wagg is a Primary Care Nurse Practitioner who works with patients out of the Arthur Family Health Center; she is also a member of the memory clinic team in Fergus. She enjoys educating patients on health promotion and prevention. Before becoming a Nurse Practitioner in 2009 she worked for nine years as a registered nurse in the Emergency Room at the Guelph General Hospital. She lives on a horse farm outside of Damascus with her husband, son, and two daughters. In her spare time enjoys reading, skiing, and riding horses with her family.
Amanda Froese, OT
Amanda Froese is a registered Occupational Therapist who earned her Bachelor of Science in Health Studies, with a minor in Gerontology from the University of Waterloo, before pursuing her Masters in Occupational Therapy at McMaster University.
At the UGFHT Amanda has a broad scope of practice. She works with clients of all ages and a variety of conditions to help them participate in occupations that are important to them. “Occupations” are more than just jobs and include all the day-to-day activities someone wants or needs to be able to do. From children struggling with their morning routine to older adults looking to live safely at home, Amanda enjoys working together with clients of all ages to help them overcome obstacles interfering with their daily activities. She is also involved with the FHT’s Chronic Pain and Memory Clinic programs. Outside of work Amanda enjoys hiking, travelling, and playing Ultimate Frisbee
Nikki has been with the UGFHT since June 2015 and is an Outreach Worker with the Rural Wellington Community Team (RWCT). The Rural Wellington Community Team understands that it’s hard to reach out and find the resources you need, when you need them. They work in the community and with each rural health team to connect you to community agencies, help you to navigate social programs, and support you when family or friends can’t help. The RWCT knows that there are many factors in your life that can affect your health.
Gillian Haigh, RPh, PharmD
Gillian graduated from the Doctor of Pharmacy program at the University of Toronto Leslie Dan Faculty of Pharmacy in 2017, during which time she gained experience working in both community and institutional pharmacy settings. Gillian was born and raised in Guelph, Ontario, and has come back to the Center Wellington area to continue her pharmacy practice close to home. At the Family Health Team, Gillian provides medication reviews, Chronic Pain assessments, patient education, and drug information, as well as being an active member of the Quality Improvement Committee. In her spare time, Gillian enjoys swimming and staying active at the gym, cooking new recipes, and working on home design projects. “
Physician Assistants (PA) are healthcare professionals who practice medicine as members of a team with their supervising physicians. As part of their comprehensive responsibilities, The UGFHT PA conducts physical exams, diagnoses and treats illnesses, orders and interprets tests, counsels on preventive health care, and prescribes medications.
Cathy Verity, BSc., MSc., BHsc.PA
Cathy completed her Bachelor of Sciences and Master of Sciences at the University of Guelph. She was in the second class to graduate from McMaster’s Physician Assistant Program. Cathy joined the UGFHT in 2011 and primarily works with the Geddes Medical Group in Elora. She, also, enjoys working with the Memory Clinic Team in Fergus monthly. Cathy is the proud mom of three children, of whom she loves camping, getting outdoors and listening and playing music with! Cathy is an advocate in her role as a Physician Assistant and is happy to answer any questions you may have about the profession!
Lucy De Finis – Receptionist
Lucy moved to Fergus nineteen years ago with her husband and three young children. Nine years after moving to Fergus her family added a new member to the family, a Bichon Frisée Poodle named Tiffany. She returned to the work force after sixteen years of staying at home. Lucy has been the Receptionist with the UGFHT since 2009 and couldn’t have asked for a better place to work. Her focus is to make clients feel welcomed when they enter our office, as well as answer any questions or concerns our clients may have.
Outside of working hours, Lucy’s passion is to prepare authentic Italian and gourmet meals for family and friends. In addition to her passion for cooking, she also looks forward to every spring when she plants her vegetable garden. It’s a very small garden but it’s enough to put her gardening skills to the test… evidently, to the benefit of the FHT staff, she always plants too many tomatoes!
Dr. Amanda Kamminga – Medical Director
The primary responsibility of the Medical Director role is to provide leadership within the FHT related to quality of care, access to care and efficiency of care delivery. In this role Dr. Kamminga collaborates with the Executive Director and all members of the inter-disciplinary team to provide leadership regarding Access of Care, Clinical Coverage and Support, Quality and Risk Management, as well as representing the organization at various local and regional tables.
Dr. Kamminga is also currently a practicing physician at the Riverview Medical Group – Lower Level.
Cora Van Zutphen RPh – Acting Executive Director
Ensuring service excellence is of utmost importance to Cora.
As an integral member of the team, the Executive Director reports to the organization’s Board of Directors to advise on matters of policy and risk, quality monitoring, evaluation and human resources. Cora also supports service planning and delivery by actively developing team-based, patient-centered programs that meet the highest standards of care. She works with the Board of Directors to develop and execute the organization’s strategic plans and acts as a liaison with community partners and the Ontario Ministry of Health and Long-Term Care.
Outside of working hours, Cora enjoys spending time with her family and loved ones, running with her high energy canine companions, and attempting Pinterest DIY projects.
Louise Poole – Administrative Assistant
The Administrative Assistant provides a wide variety of administrative support to the Executive Director, members of Board, Medical Director and staff to ensure that the day-to-day office functions run smoothly. Louise’s main focus is to ensure that staff are fully supported so that they can focus on assisting their clients and completing their daily duties. Louise joined the Upper Grand Family Health Team in 2017 and previously worked in various administrative supporting roles within the aerospace industry.
Commitment to Quality
The Upper Grand Family Health Team is committed to ensuring that our programs and services meet the highest levels of quality and that principles of ongoing improvement are incorporated into our daily patient care and organizational planning activities. We collaborate with our partners at the local, regional and provincial levels to ensure that our healthcare system meets the goals outlined in Health Quality Ontario’s (HQO’s) 2015 Quality Matters: Realizing Excellent Care for All report.
Our Quality Committee consists of interdisciplinary staff and physicians who work collaboratively to develop annual Quality Improvement Plans, which are public commitments to meeting quality improvement targets that positively impact patient care. This plan is submitted to HQO and the committee meets regularly to discuss our progress and performance on the indicators that are selected as priorities.
Our 2017-18 UGFHT Quality Improvement Plan outlines the following goals:
- Improving rates of follow-up within 7 days by Family Health Team providers among patients discharged from acute care
- Improving rates of cervical cancer screening
- Improving rates of colorectal cancer screening
- Developing a revised method for collecting patient satisfaction data
- Improving the proportion of patients with medication reconciliation within the past year
Current membership of the Upper Grand Family Health Team Quality Committee is as follows:
Dr. Fil Incitti
Dr. Amanda Kamminga
Kristin Kathiravelu, Executive Director
Colleen Loree, Nurse Practitioner (co-chair)
Melody Mann, Mental Health Therapist
Lisa Melburn, Cardiac Nurse Specialist
Dr. Julie Ray
Dr. Nancy Rose-Janes
Cora Van Zutphen, Pharmacist (co-chair)
Amy Waugh, Dietitian
If you have questions or would like more information please contact the UGFHT Executive Director, Kristin Kathiravelu at email@example.com.
The Upper Grand Family Health Team is administered by a Board of Directors composed of members of the Upper Grand Family Health Organization and community stakeholders. The Board’s role is to set strategic directions, develop high level policies, allocate financial resources, and set and evaluate program goals.
The Executive Director and the Family Health Team Medical Director report to the Board, while the allied health professionals report to the Executive Director.
Current Board of Directors:
Dr. Alison Williams – Board Chair
(Vacant) – Vice-Chair
Andrew Goldie – Treasurer
Dr. Mark Sugamori – FHO Lead Physician
Cora Van Zutphen – Acting Secretary
Join Our Team
The Upper Grand Family Health Team is committed to being a great place to work. We offer comprehensive retirement and health and dental benefits, a safe and supportive work environment, many career development opportunities and the satisfaction of contributing to a healthy future for the residents of Centre Wellington.
There are currently no vacancies on our team.