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Integrating Comprehensive Health
Services into Social Housing Initiatives
in Vancouver's DTES
• Primary Outreach Services:
• Paul Bangah, RN BScN,
• Valerie Edelman, BSW
Primary Outreach Services
Clinical Housing Team
Clinical Tenant Support Team
Clinical Outreach Team
Overview
• Serve clients who live in the Downtown
Core and the Downtown Eastside
• Serve clients who are housed in
supportive low threshold housing or are chronically homeless and need clinical
interventions
• Teams support over 1205 individual units
across 17 sites, plus 6 shelters
• Teams support improved integration of
services
Primary Outreach Services
Jeffrey Ross Tamura Haven Dominion
Princess Rooms The Lux Anchor Gastown
Sakura So Sereena’s Crosswalk Hazelwood
Stanley First United London Carl Rooms
Sunrise Arco Triage Beacon
Vivian New Fountain Beacon Washington
Primary Outreach Teams
• Multidisciplinary Teams:
Physicians
Nurse Practitioners
Nurses
Case Managers and Social Workers
Health Care Workers
Counselors
Psychiatrist
Services
• Primary Care
• Mental Health
• Addictions
• Social Work
• Relationship building and Advocacy
Harm-reduction approach
• Relationships
• Education
Sexual Health
Safer drug use
• Alcohol and Methadone Maintenance Programs
Population served
• A population at the centre of a serious health and social
system crisis:
Living in poverty
Significantly under and untreated mental health, addiction and medical problems
The Clients
• Survivors of Trauma: people living with complex, developmental, and intergenerational trauma
• History of negative experiences with health care
systems
• Labeled as “hard to engage”, “resistant” and
“chronic” with “behavioural problems”
Delivering Health Care
• Knowing clients on a level other than “care-provider”
• Striving to be collaborative, client-centered, and culturally competent
• Creating positive experiences with the healthcare system
• Bridging client to community health clinics by removing
barriers
Barriers
• Addictions
• Mental Health
• Other priorities
• Stigma
• Wait times
• Fear
Why Primary Outreach Services?
• Increasing contact with health care providers
• Decrease use of Emergency dept
• Provide lowest barrier care on outreach basis to client
homes
How do we find our clients?
• Site specific
• Cold-calls
• Engagement and relationship-building
• Crisis intervention
• Staff referral
• Health Fairs
Single Room Occupancy Hotels
Living Conditions
SROs - 10x10
• Sink
• Communal bathrooms and
kitchens
• Poor air quality
• Mold, bug infestations, rodents…
Other rooms
Approx 400sq ft
Self-contained bachelor suites
Balcony with garden (promoting
healthy diet)
Windows to outside, good air
circulation
Very few rooms available
Living Conditions
Shelters
•Some shelters maintain single rooms, others can have 2 - 40 people
sharing a room with minimal space between beds
•Circulation can often be a concern
•Common for clients to share needles, pipes, cigarettes
Partnering with Non-profits
• Staffing
• Services
• Collaboration
Clinical Housing Team (CHT) Initial
Evaluation Findings (2008) • CHT able to connect with 74% of clients living in initial 8 sites
• 41% of CHT clients had not accessed any VCH health services in 12 months prior to CHT contact
• 30% of clients seen 6 or more times by CHT were referred to other VCH health services
• 40% of clients referred for primary care or Adult/Older Adult Services, 50% referred for addiction services, 10% referred for mental health services
• In clients seen by CHT 6 or more times the ER reduction was 30%
• CHT interventions reduced semi/non-urgent ER visits by 55% for previously high usage clients
Evaluation of Primary Outreach
Services (CHT, CTST, COT 2010)
In the 120-day period after initiation of POS
treatment, clients had 20% fewer ED visits than
prior to POS.
The greatest reduction was with the most
frequent users of the ED with 58% fewer ED visits.
Urgent visits declined by 22% overall (6% CHT)
while less urgent visits declined by 15% (21%
CHT).
Connecting with Community Resources
• Community Health Clinics
• BC Centre for Disease Control (BCCDC)
• Street Nurses
• Providence Health COPD Outreach Team
• Mental Health Teams
• Outpatient clinics at VGH and SPH
• Outreach respiratory therapy services
• DTES TB Outreach Program (Direct Observed Therapy)
Collaboration with TB Nurses Jerry Cyr and
Lynn Goodman
• Screening in Buildings
• In 2011: 212 people screened in 7 sites
• Follow up care
Keeping Numbers of TB Down
• Testing
• Treating TB
• Treating HIV
0
5
10
15
20
25
2006 2007 2008 2009 2010 2011 2012
Active TB
Diagnosed by TB Program
Comorbidity with HIV
Comorbidity with Addictions
Moving Forward
• More regular screenings
• More buildings
• Planning ahead
Thank you
Questions?