The Care Bus – A winter warming space

What is the program?

The Care Bus is a mobile outreach and harm reduction program operated by NorWest Community Health Centres (NorWest CHC). The program provides a safe, lower barrier space for people to warm up, connect with trained outreach staff, access harm reduction supplies and travel to essential services across Thunder Bay. Its flexible model allows staff to respond to changing weather conditions, emerging community needs and rider requests in real time. See the program element on community pop-ups for information on how the Care Bus supports these events. 

NorWest CHC aims to deliver comprehensive, integrated primary healthcare and promote overall well-being among underserved and disenfranchised people and communities living in northwestern Ontario.

Why was the program developed?

The Care Bus began as an emergency response during the COVID-19 pandemic, when widespread service closures left many people without a safe place to warm up. In Thunder Bay, long distances between services and limited public transportation made this gap more acute. The advocacy group “Not One More Death” (N1MD) made a notable recommendation for the initiation of the bus as part of its proposal to City Council for a cold weather emergency response in February 2021. The Care Bus has since evolved into a key mobile outreach service, with local grassroots organizations contributing to its growth.

The program continues to respond to evolving community needs. For example, local shelters have reported increases in demand, even early in the winter season, underscoring the growing need for a mobile outreach and warming space that can provide transportation to shelter services during the winter months.

How does the program work?

The Care Bus operates as a flexible, lower barrier harm reduction service from late fall through to early spring. It functions as a mobile warming centre, an outreach hub and a transportation service that helps people access food, shelter, harm reduction education and supplies and other essential supports.

The bus operates seven days a week from 1:30 to 9:30 p.m., with extended hours offered (9:30 a.m. to 9:30 p.m.) during the coldest months, January and February. During extreme cold events (below –25°C), the bus becomes an emergency warming space where riders can stay for safety and warmth. Operating until 9:30 p.m. means that riders can remain on the bus until spaces at overnight shelters become available. Rides are free, there is no time limit and riders can stay on the bus for warmth, support and rest and to reach needed services. Harm reduction outreach workers offer health education, harm reduction supplies, basic wound care, crisis support and referrals to health and social services.

All riders are required to sit down while the bus is in motion and at stoplights. Riders can get up once the bus is pulled over at a safe place. Staff often walk along the aisle to check in with riders as they drive along. There are roughly 29 to 35 seats available, depending on the spaces needed to accommodate mobility devices (e.g., wheelchairs, walkers, carts) and extra belongings that need to be stored temporarily.

Care Bus staff use daily tracking forms to record the quantity and type of services accessed, but they do not collect personal or private information from riders. A confidential Care Bus notebook is used among staff to communicate important information and any follow-up messages for riders.

While on board, riders can access:

• snacks and water
• hot meals through daily stops at meal programs (e.g., Dew Drop Inn for lunch, Salvation Army soup truck for dinner)
• warm clothing and emergency winter gear (e.g., socks, hats, gloves, scarves, underwear, emergency blankets, hand warmers)
• harm reduction supplies (e.g., safer injection supplies, snorting and smoking kits, naloxone, safer sex kits including condoms and lube)
• basic wound care and wound care kits
• hygiene supplies and personal protective equipment (PPE)
• therapeutic listening and emotional support (e.g., staff spend time with riders, helping to reduce their sense of isolation and support their mental and emotional well-being)
• referrals and accompaniment (e.g., emergency departments, primary care, withdrawal management services, safer sobering beds, emergency shelters, other community supports)
• transportation

Flexible route

The Care Bus always starts at NorWest CHC to allow for supply restocking and team preparation and planning. While the Care Bus does not follow a strict schedule or route, it does travel to a core set of daily stops including warming centres, emergency shelters, meal programs, libraries, opioid agonist therapy (OAT) clinics, health services, food banks, malls and transit terminals. The route remains flexible to meet the real-time needs of riders. Riders can call the Care Bus cellphone for pickups and staff can adjust the route throughout the day to help riders reach urgent appointments, avoid unsafe situations and accommodate mobility limitations. In some locations, the Care Bus shares bus stops with the Thunder Bay public transit service. The bus can also support individuals who are temporarily restricted (e.g., banned) from riding city buses, serving as an alternative way to get around Thunder Bay. This flexibility and adaptability are essential in a city where services are widely distributed and helps maximize individuals’ safety while reducing transportation barriers.

Staffing

The bus is typically staffed by three harm reduction outreach workers and one bus driver contracted through a local transportation company. A Care Bus coordinator provides additional support on the bus on a regular basis. Most shifts are limited to four hours in length, recognizing that the work on the Care Bus can be physically and mentally challenging. The staffing roster includes 10 to 15 casual workers, some of whom are previous bus riders and who bring their own living and lived experience to the work. Staff with living and lived experience offer meaningful peer-informed support, bring valuable insights, strengthen rapport with riders and help foster a welcoming, non-judgmental environment. The staffing model also provides an accessible entry point for people interested in exploring harm reduction and outreach work. 

Training

All staff are required to complete training in overdose prevention and response (including mock overdose response drills), all policies and procedures outlined in the internal Care Bus operations manual, education on and distribution of harm reduction equipment, and de-escalation techniques (e.g., to address potentially violent situations). It is highly recommended that staff participate in additional trainings such as general first aid and CPR, basic wound care and infection prevention techniques, and cold-weather first aid (e.g., frostbite, hypothermia). When available, staff are also encouraged to participate in trainings on Indigenous cultural safety, self-care for outreach workers (e.g., burnout prevention) and trauma-informed approaches. The Care Bus coordinator prioritizes ongoing debriefing with staff, which is particularly helpful for newer staff and staff with living and lived experience.

Bus operations emphasize safety and consistency. Staff conduct supply stock checks, safety walkthroughs and route planning at the NorWest CHC base site location each day before starting their shift. A detailed internal Care Bus operations manual outlines all policies, safety procedures, shift checklists, supply lists and rider eligibility criteria (e.g., no substance use in the bus, no violence).

Collaborative partnerships

The Care Bus is operated by NorWest CHC in close partnership with other community organizations, including the Thunder Bay Indigenous Friendship Centre and the Mindimooyenh Health Clinic, run by the Ontario Native Women’s Association. These partnerships strengthen Indigenous-focused outreach, and the partner organizations can provide occasional additional staff during ride-alongs — including systems navigators, mental health workers, nurses, after-care coordinators and grief specialists.

In partnership with other community organizations, the Care Bus facilitates access to many services in the community (e.g., withdrawal management, walk-in health clinics, community events). This often begins with a Care Bus harm reduction outreach worker having a conversation on the bus with a rider about what they need and about their options. The worker then calls the relevant organization (e.g., withdrawal management) to see if they are open and if they have capacity for a walk-in visit. If they have space to accommodate the rider, the Care Bus will bring them to the service, and the harm reduction outreach worker will accompany them inside to ensure they are connected to the appropriate service. Community partnerships include city transit, emergency departments and health and social service agencies (Thunder Bay Indigenous Friendship Centre [TBIFC], withdrawal management and safer sobering sites [St. Joseph’s Care Group], Salvation Army, Elevate North Western Ontario [NWO], Grace Place, People Advocating for Change through Empowerment [PACE], Lutheran Community Care, Thunder Bay Regional Health Sciences Centre, Urban Abbey Shelter, Shelter House, St. Andrew’s Dew Drop Inn meal service, Ontario Native Women’s Association, among others). These partnerships facilitate referrals and coordinated responses, and they assist people banned from public transit or who are experiencing crises in the community.

Transformative Change Awards 2025 -- Care Bus. (NorWest CHCs) (Video credit: AllianceON)

Required resources

• Transport bus with seating, accessibility spaces and storage spaces
• Contracted bus driver through an accredited transportation provider
• Team of trained harm reduction outreach workers, plus a full-time frontline coordinator and part-time program coordinator (e.g., planning, reporting)
• Staff training sessions (e.g., overdose response, basic wound care, general first aid and cold-weather first aid, de-escalation of potentially violent situations, harm reduction supplies and CPR)
• Care Bus operations manual (e.g., policies, safety procedures, supply lists, shift checklists, tracking sheets)
• Harm reduction and sexual health supplies (e.g., naloxone, safer drug use kits, safer sex kits)
• Wound care materials, basic medical supplies and PPE for staff and riders, first aid kit, spill kit and basic cleaning supplies
• Food, snacks, water and hot meal coordination with partners
• Winter gear and emergency cold-weather supplies (e.g., hats, gloves, socks, jackets, underwear, blankets, hand warmers)
• Hygiene and self-care supplies (e.g., period products, basic toiletries)
• Cellphone dedicated to sharing information on the Care Bus and receiving pickup requests
• Partnerships with health and social service organizations for referrals and ride-along support
• Base site for storage and supply restocking
• Communication and promotional materials (e.g., social media sites, website, rack cards, business cards and posters)

Evaluation

Care Bus staff use daily tracking forms to record the quantity and type of services accessed. These forms capture the number of riders, the number and types of supplies distributed, services provided on the bus, route locations and stops, referrals and accompaniment provided, health education delivered, staff observations and rider testimonials.

During the 2024–2025 operating season (early December 2024 to mid-April 2025), the Care Bus had 10,824 interactions (averaging approximately 80 people per day). A total of 8,693 riders used the Care Bus for transportation and 2,131 people accessed services at the door of the Care Bus at various locations throughout the city.

Services provided included:

• 245 one-on-one education sessions focused on a variety of topics (e.g., information about local services and resources, harm reduction education, overdose prevention, basic healthcare, wound care)
• 411 successful referrals and connections to local services (e.g., 100 connections to the hospital, 185 connections to emergency shelters, 73 connections to withdrawal management services, 26 connections to health services)
• 2,487 connections to hot meals (e.g., Dew Drop Inn for lunch, Salvation Army soup van for dinner)
• 1,585 therapeutic listening sessions
• 76 basic wound care supports and 28 first aid responses
• 166 safer space monitoring for people after they had used substances in the community
• 10 overdose responses and lives saved by Care Bus staff in the community

Supplies distributed included:

• 10,148 snack bags and 916 meals
• 5,090 winter clothing accessories (e.g., hats, gloves, socks, scarves) and 212 winter clothing items (e.g., jackets, thermals, sweaters)
• 301 naloxone kits and 98 drug testing kits
• 281 safer injection supply kits, 981 safer smoking supply kits and 306 safer methamphetamine kits
• 57 safer sex kits
• 201 wound care kits

Testimonials from bus riders and harm reduction outreach workers also helped capture the impact of the Care Bus.

Challenges

• Limited privacy on the bus makes it difficult to provide some forms of healthcare and emotional support.
• Follow-up with people can be challenging because of the casual, anonymous and lower barrier nature of the service and the lack of personal data collection.
• The seasonal nature of the Care Bus requires starting up and winding down the entire program each year, routinely creating challenges with service continuity, staffing, partnerships and funding.
• High demand during extreme weather events and during hours when other services are closed (e.g., evenings, weekends, holidays) strains staffing and resources, often meaning that drop-offs must be prioritized before new riders can be picked up.
• There is sometimes a risk of violence toward staff and unpredictable behaviour from riders. There is a constant balance between keeping staff and riders safe and ensuring that services remain as low barrier as possible. Riders are banned from the service only as a last resort.
• Many riders face bans from public city transit, which increases reliance on the Care Bus.
• Occasional emergency situations require staff to balance support with safety, sometimes involving collaboration with emergency services or community partners.

Lessons learned

• Having staff with living and lived experience on the team strengthens rapport and creates supportive opportunities for peer employment and a pathway into harm reduction work.
• Route flexibility is essential to meeting community needs in real time.
• Trauma-informed, person-centred approaches allow staff to build trust and meaningful relationships.
• Partnerships with Indigenous organizations expand the cultural relevance and accessibility of care.
• Providing multiple services in one mobile location (e.g., warming space, transportation, harm reduction supplies, referrals) increases engagement and reduces barriers.
• Consistent staff training, a clear operations manual and ongoing staff debriefing and check-ins support safety and quality across the team.
• Daily staff feedback and simple evaluation tools help the program adapt each season.

Program materials

• Program web page: The Care Bus
• Mayor’s Community Safety Awards: Outstanding Community Project 2021 (9:50)

Contact information

NorWest Community Health Centres
525 Simpson Street
Thunder Bay, Ontario
P7C 3J6
807-626-8487
info@norwestchc.org