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?