Links2Wellbeing connects older adults with local Seniors Active Living Centre programs and social opportunities to support whole-person wellness. The intake and co-creation process helps the centre understand the client’s interests, needs, possible barriers, and preferred next steps.
The chapter follows the client journey from referral to participation:
The process moves from community relationships between SALCs and health care professionals to referral, participation, follow-up, and reporting back.
📄 Project Implementation Flow Chart
📄 Intake & Co-Creation of Participation Overview
📄 Appendix B: Client Referral Form
📄 Appendix E: Client Consent Form
📄 Appendix E: Client Consent Form with Suggested Script
📄 Appendix F: Client Information Form
📄 Appendix G: Leisure Interests Guiding Questions
📄 Interview Tip Sheet - Building Rapport & Generating Conversation
The L2W pathway begins before the client arrives at the centre. SALCs and health care professionals connect in their communities. A health care professional identifies a patient who may benefit from social participation and writes a referral to the local SALC. Once the referral is received, SALC staff reach out and connect with the older adult client. The client then has an initial visit and co-creates a participation plan. Barriers are identified and removed where possible. Later, staff revisit the participation plan with the client, review barriers, and may report back.
The referral-to-participation overview also includes initial contact, warm transfer between health care and community, intake, discussion of needs and interests, identification of barriers such as financial barriers, and then client participation.
Initial contact should happen within 3 days of receiving the referral. During the first contact, staff or volunteers should include:
A reminder of the referral and where it came from
What the centre offers
A basic overview of the Links2Wellbeing project
An invitation to visit the centre and learn more
It may take more than one call to reach the person or for them to be interested in talking. The L2W recommendation is 3 tries.
Before making contact, check:
Do I know who referred the client?
Do I know what centre/program information I can share?
Can I explain L2W simply?
Can I invite the client to visit or learn more?
Have I documented the contact attempt?
A short tour
A walk-through of the program guide
Time to chat and learn about the client
Completing the Consent Form
Completing the Client Information Form
Co-creating a participation plan
The goal is not just to complete forms. The goal is to help the client feel welcomed, respected, and involved in shaping their own next steps.
The Consent Form explains that Links2Wellbeing is a collaboration between health care providers and local seniors centres. Its purpose is to connect older adults to social activities and connections with the goal of whole-person wellness. The form also explains that OACAO is partnering on an evaluation of the program to understand how participation at the centre impacts health and wellbeing.
The form tells clients that their responses will be combined with responses from other people across the province. Group results will be included in annual reports to the anonymous funder and partner organizations.
The consent form also confirms that participation has no impact on the client’s membership at the centre or participation in the Links2Wellbeing program.
Consent should be completed or reviewed when doing the Client Information Form at intake and at follow-up.
The suggested intake script explains that before talking about program interests, the staff member or volunteer has a few questions to help get to know the client better. It also clearly says that answering questions is voluntary, clients can skip questions they do not want to answer, and answers are confidential and kept in a secure location.
For a 6 or 12-month follow-up, the script explains that the team is reviewing questions again to learn how participation has impacted the client’s health and well-being.
Fields:
Name of participant
Links2Wellbeing client code
Name of centre
Intake confirmed?
6-month confirmed?
12-month confirmed?
Name and signature of person obtaining consent
The form should be kept with the Client Tracking Form and reviewed/signed at each survey date.
The Client Information Form is meant to follow Links2Wellbeing clients through their first 6-12 months at the centre. Once the form is completed in full, or the client is discontinued, the data should be entered into SurveyMonkey using the link at the end of the form.
Intake date
Client name and client code
Phone number
Name of person completing the form
Confirmation that consent is complete
Background/demographic information
Social connection questions
Current social activity involvement
Barriers to participation
Supports to overcome barriers
Co-creation and program selection
Subsidy information
The social connection questions ask how often the client feels they lack companionship, feel left out, and feel isolated from others. The response options are Hardly ever, Some of the Time, Often.
The form also asks whether the client is currently involved in social activities, such as hobbies, visiting with friends, or other recreational activities.
The form should be completed in conversation with the client. The intake is not just paperwork; it is a guided conversation about social connection, interests, barriers, and support.
The Client Information Form specifically reminds staff and volunteers to advise the client that the plan is being co-created together with them. It is important to empower the client and let them know that their interests guide the next steps.
The co-created participation plans are programs and activities chosen according to the client’s interests, goals, and gifts. Co-creation empowers clients to improve their own health and well-being by developing new skills, participating in meaningful activities, and becoming connected to the community.
If the client is not ready to choose a program, staff or volunteers may provide information about available programs and activities.
The Leisure Interests guide is meant to help staff and volunteers explore a client’s interests. The goal is to move beyond the referral and discover what brings the client joy and purpose. The guide does not need to be followed in full or in order. It is meant to support strong interview skills, especially when clients may have difficulty expressing or recognizing their interests.
The suggested opening frames the conversation warmly: the centre has many activities, but the goal is to find things that actually fit the client’s life and interests.
Appendix G: Leisure Interests Guiding Questions
The Interview Tip Sheet gives practical strategies for building rapport. One key strategy is the “Tell Me More” rule: when a client gives a one-word answer, do not immediately move to the next question. Instead, invite them to share more. For example, if they say they like knitting, you might ask what they are most proud of making.
Another strategy is to normalize not knowing. Some older adults may feel pressured to already have hobbies. A supportive response is to acknowledge that some people come with a full calendar, while others are looking for a fresh start.
What did you used to do for fun?
What keeps you busy these days?
What is one thing you would like to look forward to next month?
Interview Tip Sheet - Building Rapport & Generating Conversation
Appendix G: Leisure Interests Guiding Questions
The Client Information Form asks staff or volunteers to identify barriers that might affect participation. Listed barriers include:
Language
Transportation
Caregiving or family responsibilities
Cost or fees
Physical accessibility
Hearing and/or vision impairments
Declining or poor health
Hesitancy to participate
Cultural practices
Other barriers
None of the above
The form also includes an “Overcoming barriers” section. This is an opportunity to ask additional questions, describe centre supports, and brainstorm solutions. For example, if a client is hesitant to participate, a companion might attend a program with them for support.
Financial: cost of participation or program supplies
Structural: transportation, physical accessibility, program scheduling
Social: cultural or language barriers, lack of peers, pressure from family or friends
Attitudinal: “This is not for me,” or negative views of a seniors centre
Appendix F: Client Information Form: Barriers & Overcoming Barriers
It is recommended to offer flexibility with intake, such as allowing trial programs first. You could use Motivational Interviewing techniques to explore hesitations and motivations for participating.
Despite best efforts, some referrals may not be ready to participate. Staff and volunteers should respect the client’s dignity of risk and autonomy to choose.
If the client is discontinued or staff are unable to contact them, no consent review is needed. In that case, move directly to Section C of the Client Information Form.
Date of discontinuation
Closest possible date if the exact date is unknown
Reason for discontinuation, if known
When the form is completed in full or the client is discontinued, the data should be entered into SurveyMonkey.
Record date of discontinuation
Add closest possible date if exact date is unknown
Add reason, if known
Enter data into SurveyMonkey
Contact OACAO if assistance is needed
Volunteer Link Ambassador
Volunteer Peer Mentor
There are other possible volunteer supports, including data entry for SurveyMonkey, compiling and delivering outreach packages, and retraining existing volunteers to support part of the L2W program.
Introduce client to instructor and other members
Remind client of centre layout, such as washrooms and water
Check in with client throughout the activity
Update staff on important information
Create a positive environment for the client
Maintain confidentiality
Book the next program date
These scenarios are here to help you practice applying the intake and co-creation process. There are no grades and no wrong attempts - just read the situation, think about what you might do, then open the suggested approach to compare your response.