Who are we?

Casey House is a specialty hospital in Toronto providing ground breaking care to people living with and at risk of HIV.

What is the MRAT?

The Multipurpose Resilience Assessment Tool (MRAT) is the hospital’s standardized intake, follow up, program planning and evaluation tool.

Utilizing the principles of transformative evaluation, the MRAT was designed by an interprofessional working group as an integrated client engagement, assessment and follow up tool that also generates holistic health data.

The MRAT captures socio demographics and data about clients’ health needs as related to eleven domains based on the social & structural determinants of health. Such data is the foundation for generating the actionable insights necessary to actively dismantle barriers to care and safe living. In addition to client care and program planning, the tool helps Casey House use data to build on our legacy of advocacy and social justice.

What does the tool include?

1. Structured topics to address with client

  • Access to health care
  • Physical health
  • Mental health & well-being
  • Impacts of substance use
  • Housing & living conditions
  • Income & finances
  • Access to food & nutrition
  • Literacy, education, job skills
  • Impacts of legal concerns
  • Supportive social networks
  • Access to rest & recreation

2. Tracks Socio demographics

  • HIV status
  • Disabilities
  • Race/ethnicity
  • Preferred language
  • Citizenship status
  • Gender identity
  • Sexual orientation
  • History of stigma

3. Detailed criteria for each structured topic to determine a resilience rating for each of these health domains

4. Resilience scale

In crisis     Vulnerable     Stable     Self sufficient     Thriving

How does it all work?

MRAT - How does it all work

What’s unique about the MRAT?

The MRAT enables an integrated approach to care planning, follow up and evidence informed decision making unlike many health care settings where care planning, programming, evaluation and organizational decision making function in silos.

MRAT Uniqueness

Clinicians have an at a glance understanding of health concerns in the broader context of any client’s life. Helps clinicians to recognize holistic determinants impacting clients’ physical and/or mental health needs, identify additional clinical assessments/ interventions needed and use longitudinal assessment data to track improvements/ deterioration over time.

Population level trends based on holistic health needs and sub groups of clients at different social locations (e.g. racial, socio economic status) drive continual refinements in how we deliver care, including service design, delivery and staff capacity building.

 Insights from aggregate data about clients’ holistic health needs directly inform strategic decision-making across portfolios. The insights inform care models and clinical programming, evaluation and research, strategic partnerships, donor stewardship, and public policy and advocacy.

 Leveraging insights from the MRAT influences systemic policy change and inform decision-making across the health care and social service systems. 

Explore more

Structurally competent, culturally safe care

Casey House serves clients from communities who face systemic and structural barriers to safe living. Having access to data at the point of care, about how such barriers impact individual’s lives enables staff to support clients in ways they have not been able to previously. Listen to nurse practitioner Arv and nurse Samantha to learn more.

Responsive, equity driven program offerings

During the pandemic, clients who were already socio economically disadvantaged faced additional financial burdens. The MRAT data led us to see that such financial burdens were having significant impacts on clients’ ability to maintain their overall health. Listen to day health program clinical lead, Racquel to learn more.

Future forward thinking, organizational planning and public advocacy

Experience has taught us that the needs of our clients are changing rapidly in the context of vast systemic inequities. The health needs of people living with and at risk of HIV are influenced by the broader conditions in which people live, including access to health care, safe and affordable housing, systemic racism, stigma and discrimination, among other social & structural determinants of health. The MRAT allows for a real time pulse on how these needs are changing, providing insights about the intersectional factors that most exacerbate barriers to health and well being. Ultimately, these insights will improve our ability to be proactive and positively address these needs both within and beyond the hospital. Listen to chief nursing officer, Wendy and CEO, Joanne to learn more.


The Multipurpose Resilience Assessment Tool (MRAT) is made possible thanks to the generosity and braveness of our clients who wi llingly share their stories, histories and insights. This requires a high level of trust and collaboration, a high degree of open mindedness and receptivity on the par t of our staff. We thank them for their insight about clinical process and their enthusiasm in integrating the tool into the daily business of caring for our clients.

We also wish to acknowledge the CUPS agency in Calgary who generously shared their Resilience Matrix, upon which this tool is based.