Aba, a young, vibrant single mother with a history of chronic illness lost her job a few years ago. She made the difficult decision to temporarily give up her child to care and move in with a family member, after she could no longer afford accommodation and her bills. Her plan was to find a new job, get things back on track and be reunited with her child. Unfortunately, due to irreconcilable differences and several failed attempts to secure a job, she was evicted by her family member and ended up on the streets. Since then, things have spiraled and resulted in several run-ins with law enforcement. Her chronic illness has not been properly managed for years, and police have once again been called to a scene, where Aba appears disoriented and is causing a disturbance. Is she under the influence of alcohol and/or drugs, or is she experiencing a health episode?
This fictitious character, created based on the infographic “What Triggers Homelessness” (Avalon Housing, 2013), illustrates the complexity of the issues faced by people experiencing homelessness. These complexities must be taken into context as healthcare providers develop and implement strategies to improve the quality of care for this vulnerable population. This blog will discuss how the Partnering to hack homelessness (P2H2) (Employment and Social Development Canada [ESDC], 2019) and Coordinated Access (ESDC, 2020) strategies can be applied to interventions aimed at improving the quality of healthcare for people experiencing homelessness in Canada.
Interventions to Improve Primary Care Access
According to Health Quality Ontario (2016), interventions reported in literature to improve primary care access among people experiencing homelessness include “standard or intensive case-management strategies, assertive community treatment, integration of primary care clinics where other services for people who are homeless (mental health and social services) are provided, fixed or mobile outreach, orientation of primary care clinic services available, and housing and supportive services”. The success of these interventions, however, is highly dependent on collaboration and seamless coordination of services. The concepts of P2H2 and coordinated access can therefore be applied as a framework for implementing these interventions.
Developing Strategic Partnerships and Coordinated Access
P2H2 maps strategic partnerships between service providers, health and social sectors (e.g. child and youth services, paramedics, health/mental health organizations), public safety (e.g. police officers and justice services), municipalities (wards and community centers) and communities (local businesses, neighborhood organizations, building managers and landlords associations) (ESDC, 2019). To better serve individuals like, Aba, these robust partnerships must be in place, with a clear direction and orientation to roles, prior to Aba requiring services. With strong P2H2 partnerships in place, key stakeholders can then collaborate to establish a quality coordinated access system.
A coordinated access system is a process by which individuals and families experiencing or at-risk of homelessness are directed to community-level access points, for in-depth needs assessment and targeted interventions by trained workers (ESDC, 2020). Features of quality coordinated access systems include a centralized database that displays real-time information; clear access points of entry; common assessment tools; standardized protocols; and resources (ESDC, 2020). Establishment of these partnerships and a coordinated access system must however be followed by intensive education to promote an understanding and awareness of the system and available interventions.
Targeted/Personalized Interventions
How could people experiencing homelessness better be served to improve their quality of health care? Consider Aba’s situation above. First of all, with the establishment and wide-spread awareness of a coordinated access system, Aba could have initially been directed to a community-level access point, where her unique needs, including housing, employment and access to quality care for her chronic illness could be identified (using a common assessment tool) and addressed adequately by connecting her to the appropriate supports.
Access to an integrated primary care clinic with standard or intensive case-management strategies (Health Quality Ontario, 2016) would ensure that Aba’s chronic condition continues to be managed holistically, whilst she is connected to the appropriate mental health supports to deal with the trauma associated with giving up her child and the stress of her changed circumstances. If the integrated clinic happens to be her first point of access, she could be connected to the appropriate social supports based on the standardized assessment tool developed for the coordinated access system.
With a coordinated access system and robust P2H2 partnership in place, Aba’s first interaction with law enforcement could have been an intervention point to turn things around. She could have been directed to healthcare professionals and the appropriate social supports if the police understood the complexities of her circumstances, and the roles of the various P2H2 partners.
Finally, consider the question of whether Aba is under the influence or experiencing a health episode. Public safety officers do not have the expertise to diagnose a medical condition which mimics the actions of a person under the influence of alcohol and/or drugs. With a standardized assessment tool, clear protocols which include a health assessment by a P2H2 partner when taking a vulnerable person like Aba into custody, and a connected database, Aba’s health needs can be identified and addressed adequately by the right experts.
Conclusion
The issue of homelessness and quality health care is a complex issue which needs to be addressed at multiple levels, and within the context of the individual being served. There is not a single solution that works for everyone, however efforts to improve the quality of healthcare for people experiencing homelessness must include the development of strong partnerships, coordinated access systems and targeted interventions to address the unique needs of each client.
References
Avalon Housing - Homelessness triggers.jpg (754×721). (n.d.). Retrieved November 22,
2020, from https://homelesshub.ca/sites/default/files/Avalon Housing - Homelessness
triggers.jpg
Employment and Social Development Canada. (2019). Infographic: Partnering to hack
homelessness (P2H2) - The Homelessness Partnering Strategy - Partnership mapping -
Canada.ca. https://www.canada.ca/en/employment-social-
development/programs/homelessness/publications-bulletins/guide-community-
partnership/infographic.html
Employment and Social Development Canada. (2020). Reaching Home: Canada’s
Homelessness Strategy Directives. https://www.canada.ca/en/employment-social-
development/programs/homelessness/directives.html#h2.3-h3.4
Health Quality Ontario. (2016). Interventions to Improve Access to Primary Care for People
Who Are Homeless: A Systematic Review. Ontario Health Technology Assessment
Series, 16(9), 1-50. http://www.hqontario.ca/Evidence-to-Improve-Care/Journal-
Ontario-Health-Technology-Assessment-
Kommentare