HEALTH SERVICES & HOMELESSNESS€¦ · Web viewHEALTH SERVICES & HOMELESSNESS FINAL SUMMARY REPORT (V1) Executive Summary "Individually, we are one drop. Together, we are an ocean."-SatoroRyunosuke

HEALTH SERVICES & HOMELESSNESS

QUESTIONNAIRESEPTEMBER 28, 2011 – NOVEMBER 11, 2011

Submitted by Jane Parkinson, FacilitatorDecember 2011


HEALTH SERVICES & HOMELESSNESSF I N A L S U M M A R Y R E P O R T ( V 1 )

EXECUTIVE SUMMARY

Ryunosuke Satoro’s statement aptly reflects the underlying premise of the Health Service and Homelessness Project. Key London leaders formed a partnership with health service providers as well as individuals who have experienced homelessness. They began with the belief that a collaborative effort is an imperative for successful change. To address the magnitude of the issues associated with creating a system to meet the core health service needs of individuals and families experiencing homelessness in London, Ontario requires the engagement and effort of many. The commitment to collaborate was what inspired the formation of an ad hoc working group of five partners gratefully supported by London Community Foundation and Ashley Leanne Powell Fund.

The Health Services and Homelessness Project involved bringing together health and other service providers dedicated to working with individuals and families experiencing homelessness. It was agreed from the beginning that, before applying solutions, it was important to engage people who have directly experienced homelessness and to build a deep understanding of the issues they experience in accessing core health services. Further there was overwhelming consensus to better understand the current state of care and services from the providers’ perspective; building on their successes and minimizing barriers would serve as the basis for future improvement in the health services provided to those experiencing homelessness.

This summary provides a collation of the important ideas generated from two well-orchestrated sessions (held on September 28, 2011 and November 11, 2011), and forms the basis for the collaborative work that lies ahead. This summary includes data collected from participants during these two sessions. The data is largely unedited so as to preserve the integrity of the commentary. It is expected that a working group will be established with the leadership of Dr. Abe Oudshoorn to review this information. This report, combined with other existing research and planning documents, will lead to

APPENDIX B: 1

"Individually, we are one drop.

Together, we are an ocean."


the identification of solutions and a plan to apply them system-wide. Again, those involved in the future will take a collaborative approach to health service system improvements, in the planning, implementation and evaluation phases to address the needs of people experiencing homelessness.

APPENDIX B: 2


PARTNERS AND PURPOSEThis collaborative project was intended to be the initial step in a long-term process of improving health services for individuals and families experiencing homelessness. Strong commitment to the effort was demonstrated and the process evolved as partners clarified the purpose and outcomes. PARTNERS PROJECT PURPOSE

Arthur Labatt Family School of Nursing, Faculty of Health Sciences, University of Western Ontario (Abe Oudshoorn)

To provide an opportunity for input and engagement in a process intended to increase understanding of health services currently provided to individuals and families experiencing homelessness.City of London Community Services, London

CAReS(Jan Richardson)London InterCommunity Health Centre(Pam Murray)

OUTCOME

Middlesex London Health Unit, Communicable Diseases(Cathie Walker & Rhonda Brittan )

A snapshot of the “as is” state. To capture what is happening now; to understand the strengths, challenges and opportunities before implementing solutions.Regional HIV/AIDS Connection(Sheila Coad)

PROJECT SCOPE AND DEFINITIONS What do we mean by health? While recognizing the importance of all the determinants of health, such as food, clothing, transportation, education and shelter, the scope of this effort was focused on what might be best described as direct health services. This component of the project was intended to increase understanding of the health services which are sometimes considered to be more related to the “medical” side of health and encompass primary care, mental health, and acute care. This specific focus was not intended to negate the importance of all determinants of health, but rather to refine and deepen understanding of the current state of these services and the unique experiences of those at greatest risk.

What do we mean by homelessness?

APPENDIX B: 3


Homelessness is a broad concept and often includes individuals and families who experience homelessness once in a lifetime as well as those who are under-housed and at risk of homelessness, in addition to those who have no fixed address or are commonly referred to as “couch surfing”. The focus of this project was limited to understanding the health services needs of those who are at high risk and experiencing what may be referred to as ”absolute homelessness”. This project was seeking to understand the health service needs of individuals and families who are most street involved, sleeping “rough” and residing in shelters.

PROCESS The Health Services and Homelessness Project started by gathering information using a questionnaire which was completed by 100 individuals who have lived experiences of homelessness (See Appendix A). The responses to the questionnaire were useful in organizing two main events designed to encourage maximum engagement and information exchange. The first event, a half-day interactive session was held on September 28, 2011 and was attended by over 60 health care and service providers (See Appendix B), and included all of the organizations identified in the questionnaire plus several others subsequently identified. The second meeting, a full day session, was held on November 11, 2011 and included nearly 100 individuals who have lived experience of homelessness (See Appendix C). Both sessions were designed and facilitated with an external consultant, in collaboration with expert partners, skilled community service providers and highly committed individuals who have lived experience of homelessness. This process was designed to be very interactive and to encourage forthright information sharing. From the feedback gained, it is clear that the group was highly successful in this regard.

CLOSINGThe input from these sessions will be shared with providers who participated in the process and offers tremendous potential for developing a system map. A working group will be established to review the information and ultimately, to identify an action plan to improve access to health care services and health outcomes. Special thanks is extended to the partners and facilitators from a variety of service organizations as well as those who were considered to be peers of those with lived experience of homelessness. As a result of the involvement of many this process was a success.

ADDENDUM 2012: MOVING FORWARDThere are three clear challenges that were brought forward again and again in this work: 1) Communication between various agencies and health care providers; 2) Health

APPENDIX B: 4


care that goes to where people are; and 3) Care that bridges the gap between hospital or long-term care and shelter or affordable housing. 1) Communication

As can be seen from the data, dozens of sites of care were represented in the consultation, and service users themselves identified twelve agencies or types of agencies where they accessed care, including hospitals and walk-in clinics which represent multiple sites. There is a lot of health care being provided to people experiencing homelessness in London. However, it was clear from the service provider perspective that quality of care is being jeopardized in contexts where service providers have limited communication. It was clear from providers that they are interested in communicating, but in many situations are simply unaware that their patients are accessing other services, or if so, what they are accessing. Many of the service users admitted to using multiple primary providers, accessing whatever is convenient or whoever is most likely to address their immediate need.Moving forward: Ideally, all service providers providing health care to people experiencing homelessness would either use a common electronic health record, or electronic health records that communicate well with each other, or have agreements in place to provide reports to each other on patient encounters.2) Mobile Health Care

Research has shown that the best health care outcomes with people experiencing homelessness come when care goes to where people are. Even the lowest barrier care with the widest open doors does not lead to health outcomes equivalent to the general population, due to the hierarchy of needs limited service seeking, and transportation challenges. Currently, there is some limited movement of health care providers amongst agencies, for example CMHA workers going to different sites, or a nurse practitioner from InterCommunity Health going to a shelter. Some use this more as a model, such as the Middlesex London Health Unit, but for most it happens based on relationships between agencies. Overall, there is no overall plan for access to primary health care in all sites where people are residing/accessing services, and no care that goes outside of service walls other than that provided by Sanctuary London and London CAReS (more social care than health care).Moving Forward: It was clear from service providers is that the last thing London needs is just another agency providing another health service. Rather, an existing agency with skill in this sector, access to electronic charting, and access to medical supplies should be provided with additional FTEs to provide ‘feet on the street’ health care. This would include going into established agencies, as well as spaces where people spend their time. Particularly appropriate agencies to do so would include the Centre of Hope Family Health Team or London InterCommunity Health Centre. These services would also be best provided outside of traditional agencies hours, such as 3pm-11pm.3) Respite Care

APPENDIX B: 5


Shelters, long-term care agencies, and those who support individuals in affordable housing have all spoken to challenges of seeing residents with complex medical needs (and often concurrent mental health and addiction challenges) in their facilities without having the skills and staff to support them. As can be expected from the research literature, this leads to poor health outcomes and the use of most-expensive modes of health care services. London is in need of bed-based health care for people with complex medical needs who aren’t quite ill enough for hospital. These services must have the highest possible level of tolerance around difficult behaviours and substance use, as these are the individuals who tend to have limited access to other equivalent services.Moving Forward: Ideally, this respite or infirmary style service will be provided by an existing agency, rather than starting from scratch, and will be very ‘high tolerance’. The most obvious mode to accomplish this would be to resource John Gordon Home to add a second site, and staff it with a higher level of health care services (ie. nurse practitioner as a minimum). John Gordon Home has experience in this type of care, and a secondary site would allow them to move from high tolerance to very high tolerance.


APPENDIX A QUESTIONNAIRE

APPENDIX B: 6


ITEM 1: HEALTH CARE IN LONDON SURVEY.................................1ITEM 2: HEALTH CARE IN LONDON SURVEY RESULTS...................2

APPENDIX B: 7


ITEM 1: HEALTH CARE IN LONDON SURVEYYou can also do this online at: http://www.surveymonkey.com/s/L92V6DL

1. Where are all the places you go to for health care in London?

2. What kind of health care issues do you get help for?

3. What has helped with your health care in London?

4. What is frustrating about health care in London?

5. What kind of health care are you looking for?

Please Return To Christy Tran: [email protected]

APPENDIX B: 8

mailto:[email protected]

http://www.surveymonkey.com/s/L92V6DL


For more info go to: http://www.londonhon.ca/?page_id=114

APPENDIX B: 9

http://www.londonhon.ca/?page_id=114


ITEM 2: HEALTH CARE IN LONDON SURVEY RESULTS

Data is presented in raw form, and categories of data are not mutually exclusive. Data will be distilled by the already established working group for 2012.

1.Where are all the places you go to for health care in London?

Respnses TotalCentre of Hope 10Family Doctor 15Hosptial (University Hospital, St. Joeseph’s HC, Victoria Hospital) 58Intercommunity 20London Health Centre 5London psychiatric hospital 1Men's Mission 2Methadone Clinics 6Middlesex London Health Unit 3None 3RHMC 1Street Scape 1Walk-in clinics 32

2.What kind of health care issues do you get help for?Responses TotalAddictions help/ Detox 16Allergies, Colds, Flu, acute sickness 14Asthma 7Blood related problems (one surveyed bleeding issues") 8Cardiac 1Chiropractic care/ Bone related issues 13Counselling 0Dental 2Dermatology 1Diabetes 4Dialysis 2Emergency 3Gastric problems 4High blood pressure/ High cholesterol 8Immune disorders 3

APPENDIX B: 10


Mental Health (PTSD, depression, bi-polar, etc.) 25Neurologlogy (eg sleep disorders) 5

(Responses for Question 2 continue on next page)

APPENDIX B: 11


Responses Continued TotalNone 1Physiotherapy 5Prescription 4Sexual Health 0Shaking, trembling, twitches 6Various 3Women's Health (Ultrasounds, pre/post natal care, etc.) 5Wound, infection, injury care 10

3.What has helped you with your health care in London?

Responses TotalAdvice and suggestions 3Ambulance/ paramedics 3ER 1 Getting proper medications 13Getting proper procedures done (xrays, blood tests) 4Having the available resources (EG: doctor, SW, agencies) 20Helpful staff and doctors 4My doctor 6Not much 1Nothing 12OHIP 14Transportation and accessibility 6Social benefits 6

4.What is frustrating about health care in London?Responses TotalDistance of services and where it's situated 5Everything 2Having good care 1I don't have anywhere to go 1Lack of empathy or sympathy from doctors and/or staff 2Lack of knowledge on where to get services 0Not getting desired meds 2Not getting the proper diagnosis 1Nothing 19Shortage of doctors (trouble finding a doctor) 25Wait times 41

APPENDIX B: 12


APPENDIX B: 13


5.What kind of health care are you looking for?Responses TotalAll inclusive health care 10Counselling of any sort 13Dental 9Getting a stable doctor 22Having good quality health care (fast, efficient, nonjudgemental) 20Health care that is long term/permanent 1More prescription coverage 2None 17Physiotherapy 8Psychiatric help 4Readily available emergency treatment 1Reduce the wait time 4Rehab 2Vision 1

APPENDIX B: 14



APPENDIX B QUESTIONNAIRE

OVERVIEW OF SEPTEMBER 28, 2011 WITH SERVICE PROVIDERS...1ITEM 1: SEPTEMBER 28, 2011 AGENDA.......................................3ITEM 2: SEPTEMBER 28, 2011 ATTENDEES..................................4ITEM 3: SEPTEMBER 28, 2011 FEEDBACK FORM..........................5ITEM 4: SEPTEMBER 28, 2011 SAMPLE WORKSHEET....................6ITEM 5: SEPTEMBER 28, 2011 WORKSHEET RESPONSES..............7ITEM 6: CURRENT AND MISSING SERVICES, SEPTEMBER 28, 201119ITEM 7: SUCCESSES AND CHALLENGES, SEPTEMBER 28, 2011....22

APPENDIX B: 15

There seemed to be openness as providers shared common challenges and significant successes.


OVERVIEW OF SEPTEMBER 28, 2011 WITH SERVICE PROVIDERS

The September 28th session was held at the Kinsmen Recreation Centre and was attended by approximately 60 health care and service providers. At the outset of the session, group agreements and definitions were clarified and were adhered to over the course of the session. The influence of all the determinants of health was underscored while the focus on health services was in the foreground of the discussion throughout this session.

Discussion Questions1. Who are the organizations providing health services/programs to individuals and

families experiencing absolute homelessness?• What services are provided? • A specific focus on understanding who

provides what services related to: • Immunization• Common acute conditions (EG:

cough, colds, diarrhea, aches)• Dental care• Medication replacement• First aid• Overdose• Addiction treatment• Wound/abscess care• Mental health support/counselling treatment• Dermatology/skin care• Foot care• Sexual health• Basic health advice• Pre/post natal care

2. What are the current health services your organization provides to individuals and families experiencing absolute homelessness?

• Where are these services/programs located? • What are the hours? • Who is eligible to use your services/programs?

APPENDIX B: 16


3. What are some of the successes and challenges you are currently experiencing in providing health services to individuals and families experiencing absolute homelessness?

This very successful session was marked by higher attendance of organizations than expected with substantial interaction. There seemed to be openness as providers shared common challenges and significant successes as highlighted in the following chart.

APPENDIX B: 17


Key Provider Successes Key Provider Challenges

Strong positive willingness to collaborate and build community partnerships.

Ensure that the people who need the services are aware of and can access the array of services, supports and resources available across organizations.Deep respect for those experiencing

homelessness.

At the end of the session, participants were asked to indicate their interest in being a member of an on-going Homelessness and Health Services Committee. Individuals from a variety of organizations expressed their interest, and a 15 person working group (for 2012) was formed. A session feedback form was completed by participants, and the overall message communicated was that the process was positive. There seemed to be tremendous benefit to sharing across this diverse group to improve the understanding of the complex needs of individuals and families experiencing absolute homelessness.

APPENDIX B: 18


ITEM 1: SEPTEMBER 28, 2011 AGENDA

APPENDIX B: 19

ITEM 2: SEPTEMBER 28, 2011 ATTENDEESNAME ORGANIZATION EMAIL ADDRESS


Andrea Sereda Soho FHT [email protected] Finigan LIHC [email protected] Quinn WAYS [email protected] Marchuk MLHU [email protected]

aBrian Lester RHAC BLester@hivaidsconnection.

caCarole Lambkin Salvation Army [email protected] Brubacher MLHU cassandra.brubacher@mlhu

.on.caCathie Walker MLHU [email protected].

caChandelle Kelly UWO Nursing Kelly-

[email protected]

Christy Tran UWO Nursing [email protected] Reckman Sanctuary [email protected] Nemeth Mission Services DNemeth@missionservices.

caErica Zarins MLHU [email protected] Clelland Sanctuary [email protected] McDonald London Public Library [email protected]

on.on.caHelen Padega LHSC [email protected] Buchanan Family Court [email protected]

mJeff Lounsbury Wotch [email protected] Shepherd MLHU [email protected] Curtis Physician [email protected] Jewell LHSC [email protected] Laverty YOU [email protected] Chiu Salvation Army [email protected] Gregory John Howard Society [email protected] Reid ADSTV [email protected] Heard UWO Nursing [email protected] Vermeulen LHSC [email protected]

aLynda Murray-Crozier CAS lmurray-

[email protected] Connoy Mission Services mconnoy@missionservices.

caMartha Kirkwood MLHU [email protected].

caMary-Ellen Jacobs Salvation Army [email protected] Shelley MLHU Michelle.Lee.Shelley@gmail.

comMike Godin CMHA [email protected] Powers Salvation Army [email protected] Summers MLHU [email protected]

APPENDIX A: 1


aPam Murray LIHC [email protected] Chapman LHIN [email protected].

CARichardson, Jan City of London [email protected] Coleman CCAC [email protected]

ont.caSandra Fieber [email protected] Fieber Fanshawe [email protected] Sheena Ewen LHSC [email protected] Coad RHAC [email protected]

aShelley Milos Housing Registry londonhousingregistry@bell

net.caSherri Zavitz CCAC [email protected]

ont.caStacey Thibodeau Salvation Army [email protected]

aSusan Butler Soho FHT [email protected] Rimbault John Gordon Home [email protected]

ITEM 3: SEPTEMBER 28, 2011 FEEDBACK FORM

APPENDIX A: 2


APPENDIX A: 3


ITEM 4: SEPTEMBER 28, 2011 SAMPLE WORKSHEET

APPENDIX A: 4

HEALTH SERVICES AND HOMELESSNESS IN LONDON

Sample Worksheet # 1aQuestion #1: What are the current health services your

organization provides to individuals and families experiencing absolute homelessness? Where are these services located? What

are the hours? Who is eligible to use your services?


HEALTH SERVICE FOCUS AREA: Medication Replacement

Organization

Services Provided

Location of Service

Hours of Service

Eligibility

1.2.3.4.5.

HEALTH SERVICE FOCUS AREA: First AidOrganizat

ionServices Provided

Location of Service

Hours of Service

Eligibility

1.2.3.4.5.

ITEM 5: SEPTEMBER 28, 2011 WORKSHEET RESPONSES

APPENDIX A: 5

Health Service Focus Areas: (1) Immunization, 2) Medication Replacement, 3) First Aid, (4) Overdose, (5) Addiction Treatment, (6) Wound/ Abscess Care, (7) Mental Health Support/Counselling/Treatment, (8) Dermatology/Skin Care, (9) Foot Care, (10) Sexual Health, (11) Cough/ Colds/Diarrhea/Aches, (12) Dental Care, (13) Basic Health Advice, (14) Pre/Post Natal Care, and (15) Additional areas

HEALTH SERVICE FOCUS AREA: ImmunizationOrganizat

ionServices Provided

Location of Service

Hours of Service

Eligibility

1.2.3.4.5.


The following charts contain data that is largely unedited so as to preserve the integrity of the commentary.

APPENDIX A: 6

ORGANIZATION

SERVICES LOCATION HOURS ELIGIBILITY

IMM

UN

IZA

TIO

NS

Centre of Hope Family Health Team (FHT)

Flu services All immunizations Children and

adults Seasonal flu clinic All vaccinations,

measles, mumps, etc

281 Wellington Rd.

M-F, 8-4

W, 5-8

Rostered patients

Health card

Centre of Hope

Middlesex Health Unit

Flu shots

281 Wellington Rd.

As required

No health Card

London Health Sciences Centre

Emergency Tetanus Rabies Flu Prophylaxis

Victoria Hospital

University Hospital

24/7 Health card preferred

London InterCommunity Health Centre

Seasoned clinic 457 York St.

MSC CMHP

1 day annually

Health Card No referrals

open

Centre of Hope Family Health Team (FHT)

Flu services All immunizations Children and

adults Seasonal flu clinic All vaccinations,

measles, mumps, etc

281 Wellington Rd.

M-F, 8-4

W, 5-8

Rostered patients

Health card

Urgent Care Emergency Tetanus Rabies Flu Prophylaxis

St Joseph’s HC

M-F, 8-4 Health Card preferred


APPENDIX A: 7


ORGANIZATION

SERVICES LOCATION HOURS ELIGIBILITYM

ED

ICA

TIO

N R

EP

LA

CE

MW

NT

Centre of Hope FHT

Medical care Assessments Prescriptions

and medications

281 Wellington Rd.

M-F, 8-4 W, 5-9

Registered clients

Health Card

Emergency Room/Urgent Care

Prescriptions and medications

Outpatient referrals

Victoria Hospital

University Hospital

St Joseph’s Health Centre

Hospitals 24/7

St Joseph 8-4

All


Family medicine 659 Dundas St. 9-5 No Health Card

Registered clients


No services to homeless individuals

Huron and Highbury

Walk-In Clinics

Various Health Card

ORGANIZATION SERVICES LOCATION HOURS ELIGIBILITY

Emergency/Urgent care

Acute medical treatment

Admission for med care only

Outpatient referral

Victoria Hospital

University Hospital

St Joseph’s HC

24/7 24/7 8-4

No Restrictions

Emergency Medical Services

Acute med treatment

City wide mobile 24/7 All

London Police Safety management

Transportation of aggressive/

City wide mobile 24/7 All

APPENDIX A: 8


OVERDOSE

reluctant clients

APPENDIX A: 9

ORGANIZATION


FIR

ST

AID

Centre of Hope FHT

Assessment Prescriptions Treatments Medical care

281 Wellington Rd.

M-F, 8-4W, 5-8

Rostered clients

Health Card

Emergency Medical Services

24/7 No Health Card


Emergency Admission to

medicine CCTC Sepsis

treatment

Victoria Hospital

University Hospital

24/7 Health card preferred

Salvation Army Centre of Hope

All staff are First Aid and CPR trained

281 Wellington Rd.

24/7 Maybe required

Salvation Army Operation Mobilizing Hope (street RV)

Minor wound care

Counseling Referral to

other services Nursing

assessment Vitamins

London Coffee House

Across from Ark Aid on Dundas St.

Thurs, 7:30-8:30 pm

Thurs, 8:30-9:30 pm

Drop in No Health

Card


ORGANIZATION

SERVICES LOCATION HOURS ELIGIBILITYA

DD

ICT

ION

TR

EA

TM

EN

T Addiction

Services Thames Valley

Heartspace for women, mothers

Freshstart (employment barriers)

Substance abuse counseling

CAReS

200 Queens Ave Suite 260

M-T, 8:30-8

W-F, 0:30-16:30

Self referral No Health

Card Some

restrictions with hours

Centre of Hope

Non medical withdrawal assessment

281Wellington Rd.

24/7 Self referral Male and

female 16 years of age

No HC needed

APPENDIX A: 10


ORGANIZATION

SERVICES LOCATION HOURS

ELIGIBILITY

Centre of Hope FHT

Withdrawal meds and assessment

Addiction counseling

Harm reduction

281 Wellington Rd.

M-F, 8-4

W, 5-8

Rostered patients

Shelter patients

Counterpoint Harm Reduction Needle Syringe

Needle syringe program

Outreach-exchange

186 King St.City wide

M-F, 9-5

M-F, 11-6

Self referral

Dr. Sadex Methadone Suboxone

Oxford/ Wharncliffe

Health Card No referral

London Drug Treatment Court

Intensive rehabilitation

London Court House

Tu, 12-3

Must be court referred

Methadone Clinic

Methadone maintenance program

502 Oxford St

528 Dundas St

Middlesex-London Health Unit

Needle Exchange Program

50 King St M-Th, 8:30-7

Drop-in No health

cardQuintin Warner House

Residential treatment Queens/Maitland

24/7 Fit admission criteria

Referral including self

Supported Housing for Addictions (WOTCH/ADSTV)

Housing for persons struggling with substance abuse

39 Tecumseh 24/7 Must be referred by ADSTV

Turning Point

Residential treatment programs for male and female

Mornington Ave

Wharncliffe

24/7 Fit admission criteria

APPENDIX A: 11


ADDICTION TREATMENT CONTINUED

Westover Treatment Centre

Aftercare and family groups

Dundas/ Waterloo

Tu-W, PM

Graduates of residential treatment

Youth Action Centre

Needle exchange Dundas St. M-S, 3-7

Under 25 years old

APPENDIX A: 12


ORGANIZATION

SERVICES LOCATION

HOURS ELIGIBILITY

Canadian Mental Health Association

Advocacy Counseling Support Referrals

Court House, London

M-F, 9-5 18+ incurred criminal charges, Axis I

No health card

Centre of Hope

Full service 281 Wellington

M-F, 8-4 W, 5-8

Rostered clients Health card

Elgin Middlesex Detention Centre

Trauma crisis Social workers

711 Exeter

M-F Selected inmates

John Howard Society

Trauma Counseling

Anger management

Mental health counseling services

Healthcare referrals

601 Queens Ave

M-F, 8:30-4:30

Closed F, 3

Closed 12-1

Youth support 16-24

Homeless or at risk

Persons/families involved/at risk in crime/justice


Social workers 659 Dundas St.

9-5 M-F Adults

Regional Support Associates

London Office

Mental health/counseling

Behaviour management

Psychiatric support

633 Colborne St.

M-F, 8:30-4:30

After hours available

Adults with intellectual disabilities

Referral from Developmental Services Ontario- SW

St. Leonard’s Community Services

Social workers Main office 405 Dundas

Adults SLCCS clients

only

Western Area Youth services

Short term crisis support

Referral to youth

Community based-will

M-F, days

Flexible

Youth 13-18 Referral needed

from crisis and

APPENDIX A: 13


MENTAL HEALTH SUPPORT/COUNSELLING/TREATMENT

Mental health assessments

travel to client

714 York St

evenings intake team

Western Ontario Therapeutic Community Hostel

Mental health support

Case management

Housing Family med Psychiatrist Clinic support

534 Queens

My Sister’s Place

8:30-4:30 Referred

ORGANIZATION


APPENDIX A: 14


WO

UN

D A

BC

ES

S C

AR

ECentre of Hope FHT

Prescriptions Assessment Medical care Follow-up

281 Wellington St.

M-F, 9-4 W, 5-8

Rostered patients

Health Card


Prescriptions Assessment Medical care Follow-up

659 Dundas St. M-F, 9-5 Th,

10:30 -5

Rostered clients

London Heath Sciences Centre

Prescriptions Assessment Referrals Emergency Medicine Outpatient care

University Hospital

Victoria Hospital

24/7

Specific days

Health Card preferred

Referrals

St. Elizabeth Community Care Access Centre (CCAC)

Prescriptions Homeless

specific Assessment Referral

CMHP MSL 457 York St

10-11AM No referrals No health

card

St. Joseph’s Urgent Care

Prescriptions Assessment Referral

St. Joseph’s HC Referral

ORGANIZATION SERVICES LOCATION

HOURS ELIGIBILITY

Centre of Hope FHT

Foot care clinic 281 Wellington

Thurs 8-4 Rostered clients

Health Card


Advanced foot care 659 Dundas St.

M-F, 9-5 No Th AM

Reigstered clients (some first aid)

Mission Services CMHP

Foot care volunteers

457 York St.

Announced 16 and above

Western Ontario Therapeutic

Footcare Diabetes support

APPENDIX A: 15


FOOT CARE

Community Hostel

and screening

APPENDIX A: 16


APPENDIX A: 17

ORGANIZATION SERVICES LOCATION HOURS ELIGIBILITYC

OM

MO

N A

CU

TE

CO

ND

ITIO

NS

Centre of Hope FHT

Common acute condition assessment

Wellington Rd

M-F 8-4 W 5-8

Rostered clients

Elgin-Middlesex Detention Centre


711 Exeter 7-12 Women and men in custody

No Health Card


Emergency (Social work, referrals and payment of meds)

Victoria Hospital

University Hospital

24/7` Health card preferred



Doctor/NP/RN Minor first aid

659 Dundas St

Men’s Mission York St

M-F No Th

AM

Adults No Health

Card



Wellington Rd.

450 Clarke 42 Stanley

St Hill St

M-F Depend

ent on shelter

Half day per week

Women and children

No Health Card

No referrals At shelter

St. Elizabeth CCAC

Emergency 456 York 10-11AM Drop-in

Urgent Care St Joseph’s HC

8-4 M-F Health card preferred

Walk-In clinics London Health CardWestern Ontario Therapeutic Community Hostel


534 Queens MSP

M-F, 8:30-4:30

M-F 10-3

Referred and non referred


APPENDIX A: 18


APPENDIX A: 19


ORGANIZATION


APPENDIX A: 20

ORGANIZATION


BA

SIC

HE

AL

TH

AD

VIC

E

Centre of Hope Family Health Team

Full service medical care

NP/Doctors/ Nurses/Social Workers

Specialist physician referrals

281 Wellington Rd.

M-F, 8-4 W, 5-8

Rostered patients

Health Card

Emergency/Urgent Care

Acute medical Treatment/

Counselling Outpatient

referral

Victoria Hospital

University Hospital

St. Joseph’s HC

24/7 24/7 8-4

No restrictions

London Public Library (MLHU, St Joseph’s, LHSC, LHS providers)

Health info programs, Q& A

Books, pamphlets In person experts

251 Dundas and 15 other locations

9-9 F-T 9-6 F 9-5 Sat

All


Ask a nurse Pre/postnatal Communicable

Disease Acute illness referrals

Rothelome WCH 101

Wellington 2nd Stage

(450 Clarke St)

Zhaawanong

M -W, PM Th, AM F, AM

Residents of shelter


Phone/in-person advice through Family Health Services

Communicable diseases

Sexual health services

Bed bugs and environmental health

50 King St. Health

connection phone # 519 850 2280

CD 519 663 5317 ext 2330

Bed bugs- 519 663 5317 ext?

SHS 663 5446

Health Connection 8:30-4:30

CD 24/7 Bed

bugs 24/7

Self, no referrals

No Health Card,

No fee Drop-in

St. Leonard’s Community Services

Family services Food issues

405 Dundas St. Clients

Telehealth Phone advice From any phone

24/7

Western Ontario Therapeutic

Nutrition, diabetes support

534 Queens Ave also MSP

M-F 8:30-4:30

Referrals and non referrals


PR

E/P

OS

T N

AT

AL

& P

RE

GN

AN

CY

ADSTV Heartspace

Addiction Treatment

High risk infant Development

worker Parenting

supports

260-200 Queens

M-F, 8:30-4:30

Self referral Facilitated

referrals 0-6 Children

Centre of Hope FTH

Pre/postnatal care 281 Wellington St

M-F 8-4

W 5-8

Rostered patients

Women in shelter



Referral for outpatient OB, Womens Health

Victoria Hospital

University Hospital

St Joseph’s HC

24/7 24/7 8-4

All

London’s Crisis Pregnancy Centre

Support services to pregnant women and couples

Referrals

261 Piccadilly St


MD/NP/RN 659 Dundas St.

M-F 8-4

W 5-8

Rostered clients


Pre/postnatal education

WCH M, 1-3 W, 1-3

Shelter residents

No health cardMiddlesex-London Health Unit

Pre/post natal outreach

Salvation Army Centre of Hope

On call

M-F, 8-4

Women in shelter

No fee No health Card


PHN Roth home 42 Stanley St

54 Riverview Besthesda

Th 9-12

M, 3-4 W,

9:30-10:30

Women in shelter

No fee No health card

Smart Start Prenatal classes Dundas Tu, 6- Registration less

APPENDIX A: 21


For Babies Nutrition advice Bus tickets Food vouchers

OEXC MLHU- 50

King

8 W, 6-8

than 20 weeks gestation

Thames Valley Midwives

Pre/post natal care

Midwives

Travel WCH

Facilitated by My Sister’s Place

Women’s Health Care-LWSC Prenatal care

Prenatal care TA

Baseline/Wellington Rd.

M-F Health Card No referrals

ORGANIZATION SERVICES LOCATION HOURS ELIGIBILITY

Centre of Hope (FHT)

Full services related to sexual health

281 Wellington St

M-F, 8-4 W, 5-8

Rostered clients

Health card

Elgin Middlesex Detention Centre

Sexual Health Harm reduction

(LMHU) provide services

711 Exeter Rd M,1:30-3 Women


Emergency STI testing and

treatment Education

Victoria Hospital

University Hospital

St. Joseph’s HC

24/7 24/7 M-F, 8-4

Card preferred

All welcomed


Options (anonymous testing)

659 Dundas St.

Outreach

9-5 Some

Middlesex London Health Unit

Sex health groups clinics

WCH 450 Clarke 101

Wellington

Scheduled No Health card

No Referrals

Middlesex London Health Unit, The Clinic

STI testing/treatment

Birth control

50 King St. F, 8:30-10:30

M,W, 5-7

Any age No OHIP No referrals

APPENDIX A: 22


S EX UA L H EA LT H

Middlesex-London Health Unit, Sexual Health Promotion

Student support Health

promotion

On site at facility

EMDC Western,

Fanshawe CAS,

Families First LFCC

M-F PM Weeken

ds

No health card

No referrals


Sex worker support

Counseling

My Sister’s Place

M-F, 10-3 Walk in

ORGANIZATION


DE

RM

AT

OL

OG

Y/S

KIN

CA

RE

St. Elizabeth CCAC

Mission services MOU

Cellulitis/Wound care

Various 457 York CMHP

7-? Clinic hours

10-11 daily

No card No referrals Health Card

is mandatory for CCAC to assist


Foot care 534 Queens My Sister’s

Place 140 Langarth

Referrals

Salvation Army Family Health Team

London InterCommunity Health

Doctor/NP 281 Wellington

659 Dundas St.

9-5 Must be registered patient

COH will see shelter patients

APPENDIX A: 23


Centre


NP clinics Sherwood Forest Mall

550 Hamilton Rd

Northbrae South Lon 119 Jalna

BlvdEmergency/Urgent care


Follow up CCACA referral Outpatient

referral Burns Cellulitis Clinic

University Hospital

Victoria Hospital

St Joseph’s HC

24/7 24/7 8-4

No restrictions

APPENDIX A: 24


ORGANIZATION SERVICES

LOCATION HOURS ELIGIBILITYD

EN

TA

L C

AR

E

Docs Basic 184 Horton None


Basic care

50 King St. 8:30-4:30

Clients under 18 Healthy Smiles

OntarioPrivate dental office

Any Anywhere Discretionary benefits

OWSt Joseph’s Dental Clinic

Dental Mt Hope 346 Platt’s

Lane

ODSP OW

UWO Dental Emergency

Emergency

LHSC 24/7 None

APPENDIX A: 25


ITEM 6: CURRENT AND MISSING SERVICES, SEPTEMBER 28, 2011

Who are the organizations providing health services/programs to individuals and families experiencing homelessness?ORGANIZATION SERVICES

Addiction Services of Thames Valley

WOTCH- MSP Centre of Hope Family Health Team ASH-TV HS S.A Program Freshstart CAReS

Bethesda Centre Pre/postnatal care Public health nurse Counsellor- Family court

Community Care Access Centre (CCAC)

Home Care/St. Elizabeth

Centre of Hope Family Health Team (FHT) Addiction Services Volunteer Chiropractic Services Shelter Withdrawal Management

Drug Stores

Elgin Middlesex Detention Centre (EMDC)

Health department housing Health care

Health Zone Nurse Practitioner Clinics at 3 sites Outreach clinics opening soon

o MSPo Glen Carino WCH

Intercommunity Health

John Gordon Home

London Family Clinic

APPENDIX A: 26


London Health Sciences Centre (LHSC)

Emergency Rooms St. Joseph’s Health Centre Obstetrics clinic


London Public Library Middlesex-London Health Unit (MLHU) Western Ontario Therapeutic Community

Hostel (WOTCH) Canadian Mental Health Association (CMHA)

Men’s Mission

Methadone Clinic

Middlesex-London Health Unit – London (LMHU)

Family Health Dental Sexual Health Infectious disease Vaccines Healthy Babies Healthy Children (HBHC) Nurse Practitioners Clinic Free Sexually Transmitted Infection

medication Needle exchange Sexually Transmitted Infection testing and

referralsMission Services of London Quinton Warner House

Addiction servicesMy Sister’s Place Diabetes and foot care

Smoking cessation Sexual health Primary care (soon through Nurse

Practitioner) Men’s health through MLHU on site Needle exchange

Regional HIV/AIDS Connection Counterpoint Harm EducationRegional Support Associates - London

Supporting adults with intellectual disabilities Mental health/behaviour management Psychiatric support Primary care/medical management

Salvation Army: Operation Mobilizing Hope

Nurse at London Coffee House across from Ark Aid

Wound care Counseling Vitamins Referral to other resources

APPENDIX A: 27


St. Leonard's Community Services

Facilitates residents to get initial medications at emergency rooms

Streetscape Provide ADAT


Western Ontario Therapeutic Community Hostel (WOTCH)

Psychiatry Family doctor Diabetes clinic Foot clinic Hoarding groups and consultation

Women’s Community House Shelters Outreach Help line Addictions support counselor Mental health counselors through CHMA Public health nurse Sexual health Nurse practitioner

What organizations are missing?CHMA: Access team Infectious Disease Care (St. Joseph’s HC)

Dale Brown Injury Service LHSC Women's Health

Dental Outreach London Crisis Pregnancy Centre

Dental Outreach Community Services Methadone clinics

Emergency Response Services (EMS, Fire, Police)

Pharmacies

First Nation Services RMHC

Health Zone (Nurse Practitioners) Youth Access Centre Addiction services

APPENDIX A: 28


ITEM 7: SUCCESSES AND CHALLENGES, SEPTEMBER 28, 2011SUCCESSES RESPONSE

SAbility to make appropriate referrals for treatment 2Ability to help clients complete follow-up 1Ability to provide bus tickets to clients for appointments 1Building one-to-one relationships 2CAReS 1Changes are emerging in patients (diet is better) 1Community collaborations and partnerships 8Diagnosis and treatment of complex mental health issues 1Diversity and team approaches when working with clients 2Drop-ins for medications such as Plan B 1Exiting relationships (need to build)*Focus on health care for the homeless population 1Free drop-in clinics 1Free sexual health services and medications (EG: STI testing) 1Good quality health care by agencies 1Graduation from ASH-TV 1Great partnerships exist*Housing support 1Implementation of plans or resources 2Inclusion of outreach workers/support network 3Increase "open door" approach 2Increase awareness about needs and services 3Increase collaboration among services 1Increase in support funding (e.g ODSP) 1Increased numbers of individuals served/getting referrals 1LDTC 1Less "silo-ing" 1London CAReS collaborative (EG: NEP partnerships at MSP)*Mental health focus (LHINS)MSP 1Network of services 4New housing (transitional for homeless addicted: ASH) 2No health card required for STI clinic 1Opportunities for students at UWO*People are excited about changes 1People who discover recovery 1Portable services 1Providing correct information 1Range/Diversity in this Region is Amazing*Reducing discharge from psychiatric ward to homeless shelters 1Research UWO-focused/common data*Services more portable than in past*Social work 1Speaking engagements where experts answer questions 1Successful withdrawal of individual 1This summit itself (Reassuring to see a multidisciplinary) 1Variety of health services/ support and resources 11

APPENDIX A: 29


Willingness to discuss this difficult topic*

CHALLENGES RESPONSESAbility attend scheduled appointments 2Ability to focus on health when daily housing is a struggle 1Adherence 1Affordable housing 4Attitudes of staff (tend to give up easily and easily frustrated) 1Consent required from agencies also working with clients 1Continuity of care vs. confidentiality 1Continuity of relationships in care 1Criteria not meeting all needs 1Dual diagnosis (some services won't support if there are dual present) 2Effectiveness of services? 2Emergency long waits*Expectations; criticism of the addict. System 1Feedback, perspective of lived experience*Fees for referrals when there is no family doctor 1Follow up (Cannot contact individual) 7Funding sustainability* 9Health coverage 2Historical perspective sometimes missing (to assess growth/success)*Identification of who is homeless, addicted/identification in general 2Immediate services for "crisis" 1Inability to access med clearance from pregnant women 1Inability to access medical support (EG medications, wound care and support) 3Inconvenient of hours 2Increased illness or disease (EG: brain injury and Hepatitis C) 2Integration with other determination of health 1Lack of awareness of services 6Lack of communication within supports being accessed/among agencies 5Lack of medical history*Lack of physicians 2Lack of primary care providers who will treat without health card 1Limited services for new clients 1Limited time for treatment 1Literacy (paperwork, forms to fill-out) 2Little flexibility with legal system (advocacy can be difficult) 1Managing the expectation of providers in the systems 1Measurement of outcomes 1Mobilizing similar services 1Navigating through the system 1Need for more portable services 1Need more outreach services 1No shows*Not enough long term support 1Number of homeless experiencing mental health issues (diagnosed or not) 1Obtaining referrals in timely manner 4Ongoing health care 1Orientation of provider*

APPENDIX A: 30


Outreach shelter on site work more immediate in shelter care 1CHALLENGES CONTINUED RESPONSESPatient funded system (working with it)*Perception of need: Provider v. client 2Physical space (too small) 1Physician lack knowledge about where to send homeless people for care 1Post client negative experiences 1Pre/post pregnancy onsite rather than at agency 1Relationship quality, continuity with provider*Right treatment, time, place, hours*Safe housing for 18 under 1Services only cover individual until their 18th birthday (such as dental) 4Stigma surrounding homeless 2Strict policies (EG: One "no show" and client is discharged) 1The limits in length of shelter say 1The relationship of non-medical models and medical models 1Thinking creatively 1Time and staffing 2Time commitments elsewhere (no crossover with them day-to-day) 1Transportation problems/accessibility 7Treat all humans with respect and grace/making them feel comfortable 4Trying new ways to deliver service 1Waitlists/wait time for treatment or resources 6Weighing consumer responses equitably 1Working through resistance to change with clients 1Youth focused services (adult-youth dynamic)*

* denotes response expressed during the large group session

APPENDIX A: 31



APPENDIX C QUESTIONNAIRE

OVERVIEW OF NOVEMBER 11, 2011 WITH INDIVIDUALS EXPERIENCING HOMELESSNESS.........................................................................1ITEM 1: NOVEMBER 11, 2011 AGENDA........................................2ITEM 2: SERVICES USED.............................................................3ITEM 3: IDENTIFIED SUCCESSES AND AREAS OF IMPROVEMENT...7

APPENDIX A: 32


OVERVIEW OF NOVEMBER 11, 2011 WITH INDIVIDUALS EXPERIENCING HOMELESSNESSThe November 11th full day session with individuals experiencing homelessness was held at CitiPlaza, London so that access would be easier if participants were using public transportation. The agenda was developed in consultation with two individuals with prior experience of homelessness who provided some very helpful suggestions. For example, it was determined that it was best to have “peers encouraging peers.” For this reason, three members of the Regional HIV/AIDS Connection Harm Reduction Services were stationed at CitiPlaza entrances to provide a “peer to peer” welcome and to give directions to the storefront location. A nourishing meal was available all day long and enjoyed by 99 individuals with lived experiences of homelessness. It was decided that there would be no formal presentations and that those caregivers and service providers who have worked with individuals and families experiencing homelessness would best explain the purpose and obtain the information. Twelve small group facilitators were prepared in advance and during the day masterfully created a safe and open space for individuals to share their experiences. Staff from Regional HIV/AIDS Connection, Western Ontario Therapeutic Community Hostel (WOTCH), Middlesex London Health Unit (MLHU) and London Intercommunity Health Centre (LIHC) served as facilitators and guided individual and small group discussions using a common set of questions.

Discussion Questions:1. What services have you used? 2. How would you describe your experience?

What worked well for you? What didn’t work for you? What would make it better or easier for you?

3. How did the different services that you used seem to work together? What worked well?

4. How could the movement (transfer) from one service to another be improved for you?

This session was characterized as respectful, calm and focused as a multitude of individuals and small groups shared their experiences and reflected on the questions posed by facilitators. Highlights of the conversations were posted on wall charts for all to see. A summary of the input is provided and the common challenges and successes that could be readily distilled are noted below:Key Service Successes Identified by Individuals with Lived Experience of Homelessness

Key Challenges Identified by Individuals with Lived Experience of Homelessness:

Many services were identified More financial support/subsidy to assist

APPENDIX A: 33


with housing

Service providers were frequently felt to be respectful

Concern about the stigma and discrimination attached to having a history of being a drug user

Not surprisingly, participants responded favorably to sharing a meal and being given space to talk about their personal experiences with interested facilitators. Special thanks are extended to all facilitators and members of the Peer Program at the Regional HIV/AIDS Connection for their support which led to a smooth and well organized and well attended session.

ITEM 1: NOVEMBER 11, 2011 AGENDA

APPENDIX A: 34


ITEM 2: SERVICES USED

APPENDIX A: 35


The following charts contain data that is largely unedited so as to preserve the integrity of the commentary.

SERVICE USED COMMENTS

Atlousa Good program, lack of funding Provides lunch

Blood labs on Central

Canadian Mental Health Association

Centre of Hope Food bank Centre Point Great, friendly staffChildrens Aid Society Good place to go if pregnant

Give up Change their visitation policy.

Chiropractor Staff is nice First come first serve Accommodating

Coffeehouse

Community clothing centers

Lacks clothing for bigger people

Dental for adults $20 cleaningFamily Health Tem Nurses are very niceFood bank/Meal programs

Hospitals Takes too long Urgent care: provided good treatment for one

week Sometimes there is too much judgment and

discrimination among the homeless and those who are suffering from addiction. Assumed that those who are addicted are just seeking out more pills however in actuality they are seeking help or in real pain

Good, helpful people Improve hours of operation Accessibility

APPENDIX A: 36


Be less restrictiveSERVICE USED COMMENTS

Intercommunity Service Practical services. Great ”Dr. Harris is welcoming and great”

Library Have addiction counselor there Safe injection site Good overall Not enough help finding stuff

London Cares Helpful Basic needs Good service

London Crisis Centre

London Health Sciences Centre Emergency

Was treated nicely

London Housing

London InterCommunity Health Centre (LIHC)

Men’s Mission Not too bad Good food Good people Agreeable staff Dirty Too many shooters Jim Henderssen and Megan Vander are always

happy with people and services From one male: lived there, a good place to live

when he was homelessMethadone Clinics “Should not be able to just cut you off”Middlesex-London Health Unit (MLHU)

“Had to watch what was being said” Doesn’t want to say anything bad or they won’t

help you “Excellent”

Mission Resource Centre Meals and a cot Puts you on your feet quickly Better answers rather than just kicking people

out into the street

APPENDIX A: 37



My Sister’s Place More health needs are met Laundry Food Good programs “Donna is very good” (foot lady from WOTCH) “The best”

Needle exchange Good experienceOntario Disability Support Program

Ontario Works

OTHER We need better services for the drug users and Listerine drinkers

The kids shooting drugs on the streets are a danger to the public, they need a place to go

Why did they shut down the drop ins. We need more places for street people to go not less and longer hours on weekends.

Health care services are well coordinated More recovery homes for street addicts Number of food providers such as the SAcOH,

Mission, and Daily Bread Some services did not really help.

o Made excuses for poor health. o Did not believe individual was ill, but

found out she was ill, suffering in pain, in/out of hospitals all her life.

o Diagnosed with osteoarthritis after being in a lot of pain.

Doctors found it in every bone, originally from pelvic bone and then it transferred throughout individual's body.

Paramedics “Worked well” Charge of 45 dollars for a ride

Pharmacies According to one female: they are always nice to her

Explains things clearly United Way Pharmacy treats everyone well and

waived fees (sometimes)

APPENDIX A: 38



Police Have a hard time being believed by the police when making a complaint

Quinten Warner House They are awesomeRegional HIV/AIDS Connection (RHAC)

Awesome Non judgmental Thorough Really care

SACoh They treat individuals with respect They do a great job

Salvation Army Good experiences overall People are kind, courteous, treat patients well Never had a problem in 6 years” “Homeless this year for the first time and stayed

at the Sally”St Leonard’s “We will support your drug habit”St. Paul’s

Stratford Free sex clinic More around London, cleaner "Staff doesn’t know how things are ran and

everyone has an opinion"Streetscape

Turning Point Good staff Really care

Walk-in clinics From one male: use the walk ins because he doesn’t have a GP

Different doctor you don’t always have the same one

Never had a doctor since he was marriedWestern Ontario Therapeutic Community Hostel

Friendly “Management people don’t know the policies”

YOSWA

Youth Action Community Good service Nice staff

APPENDIX A: 39

“Staff is friendly, resourceful and respectful, and services are easily accessible.”


Zhaawanong Shelter

ITEM 3: IDENTIFIED SUCCESSES AND AREAS OF IMPROVEMENTWhat is working?(The following data is largely unedited so as to preserve the integrity of the commentary.)

Very fast service Within walking distance From an older lady: “my experience has been very good”

o Therapy was needed for a full year after being blown over by the windo Treated with respect and dignity by the staff

Overall, it’s okay Staff is friendly, resourceful, and respectful and services are easily accessible. Good overall Youth services are really good OW was more easily accessible My Sister's Place meets basic needs and has been good

o Clients are respected, feelings and privacy- don’t have to put up with rowdy behaviour

o Good information (educational health) o No appointments needed or required. o Talk to a nurse, really friendly

Most are working fine just need to fine up a few things A lot of service staffs are welcoming most of the time The shelters treat people nicely and with dignity, they are also supportive Great health care at the hospitals Greater access like Peer Day event where

common needs are met The services that have been acquired were very

good. Staff was very friendly and helpful. I know where to go (LIHC) to get medical

supplies. Was told by a staff at the walk in clinic that he needed to buy medical supplies, but due to lack of $ this was difficult. LIHC supplied the medical necessities.

Access to services, very supportive, assisting with forms

Happy to access walk-ins Supportive of client issues Investing time in client

APPENDIX A: 40


Compassionate and thorough Client followed up with clients Personable

APPENDIX A: 41

“Constant presumptions by health care workers that I don’t know anything about my health.”


What is not working? How can it be improved? Wish there are places that didn’t require health card in order to use services “Too many children” I want to know why I am getting less money through ODSP Not enough shelter for women Single abused fathers need a place for them and their

kids to go Want support person for legal matters, medical

appointments, dental surgery, transportation, extra medical prescriptions

Getting extra medical prescriptions Getting extra clothing for winter and summer Paying rent if in medical distress or incarcerated, cannot work or

unable to get ODSP/ OW forms in on time. Funding for a scooter Funding for school supplies for grand children Funding for family deaths/ transportation etc Funding for new beds because of bed bugs Funding to move women into new apartments (packers and movers needed) “Highly paid health care people. Ridiculous wages. Why?” Judgmental and untrusting paramedics

o “Paramedics called the cops and made assumptions about my health status. They wouldn’t believe me.”

“Constant presumptions by health care workers that I don’t know anything about my health”

GP won’t listen to me because she thinks my judgment is impaired due to mental health issues.

Dr. won’t release a quantity of prescriptions so I can’t get out of town because of suicide

I don’t often get fair treatment because health care providers have a view point that I don’t need the help because I am a service user and a service provider (peer worker)

o “What are you doing here?” We need a paid social planning council staffed with people who have lived

experience. o It should be inclusive and broad in scopeo Fundamental question being always asked: “What kind of community do we

want?” I am a “wounded healer” but health care professionals do not grant me the same

respect or value as they do with their colleagues We need 24/7 safe drop-ins with a supervised injection site “Where do folks go to be safe if they are zoned?”

APPENDIX A: 42


Split the detox from SACoh More places like Coffeehouse on Dundas which are out of the core Judgmental healthcare providers who are unwilling to accept people as they are Portland Hotel Society in London Ask more “what do you need” not “what you should do.” Don’t like that the police are providing the health care services. If police are going

to be the health care providers they need to have a higher level of training, have higher regard for the vulnerable people, and be more sympathetic

More access within a community for diabetes support, psychiatric services Help people apply for health card Interpreters Social workers Dieticians, “HIV on-site” Pay to stay policy at some shelters Walk-in clinics unwilling to prescribe medications that individual has been using for

a long time Nurses cannot give prescriptions without doctors Family doctor or psychiatrist would be easier to go to “Hate the police” Need more doctors Need more visual art to raise awareness Incorporate art therapy Limited supply at food banks (30 days)

o No meato Not enough foodo Too much hoop jumping

“Treated poorly” at Ontario Workso Unrealistic o “Just horrible”o Not interested in clients circumstances

Salvation Army provides good services, however, too quick and impersonal Coffeehouse is not wheelchair accessible Have hangout places for people who don’t have homes Put the money in the important places Forced to stop using drugs and judged by society Need more mental health support More stuff for kids Need more education for parents Doctors talk down to you when you have abscesses and other injection drug issues Doctors don’t listen to you when you talk about pain because you are an addict Waiting in the emergency room until they are pill sick and end up leaving I won’t tell the doc about any drug use because of stigma of how other people have

been treated

APPENDIX A: 43

“Recognize the coordination need.”


Hospitals have a stigma about homeless people Housing is difficult to get into because process of references Lack of services for adults Food programs doesn’t provide enough Finding a doctor is like “entertainment in

community” Fair chance housing Better services could make quality of service/life easier Have more affordable housing Stigma about intravenous drug users Obtaining a health card is a difficult process Lack of resources for the homeless Too many unrealistic rules and regulations “Native shelters?” No doctors, no access to medicine No access to phone Legal system is too slow My Sister’s Place doesn’t work for health reasons

o Workers get really busy and forget to help one on one o Cleanliness is most importanto Only serve homeless people

Didn’t feel safe as a woman Change the actual delivery of services Just get a “smile” on their faces will relax people Show people that they are just people not just a number for more services Explanation of why you have to wait for medical appointment OW needs more money Need transportation to get to appointments Medical operations Can shelters prescribe medication?

o Are shelters giving medications to clients on time “People using these organizations, why the things are they way they are?” “Why send clients from Toronto/elsewhere to go to the methadone clinic? Who is

paying?” Housing is difficult because some landlords will not rent to people who are new to

the area, especially immigrants. Assistance and resources for recent immigrants seeking employment Recognize the coordination need “We need more places where people can have shelter and food” “Despite having a roof over their heads, people also need clothes and other

necessities” Ongoing support is needed after people have found a home. Organizations need to regularly meet as a group to examine what is working and

what are the gaps

APPENDIX A: 44


Need to keep busy in order to feel like a part of something beyond current struggles.

Denied family doctor at InterCommunity because of an open file at walk-in clinic Need family doctor to get on ODSP No information on how to get a family doctor Wait times are just too long for family doctor Refuse to access Centre of Hope because clients and staff “too much drama” Police are not helpful, understanding, or supportive Enough care is offered, but not enough communication between agencies or staff

at agency More screening or intake needed At Salvation Army there are clients from different backgrounds who cannot relate

to each other and cause fights.o Doesn’t work for any clients

Not all staff follow proper protocol Inconsistent service Clients not treated with dignity or respect StreetScape needs longer hours Nothing for homeless to get shelter for the day Centre of Hope has “dirty residents” Need more help with finding a place to live More “stuff” for youth in crisis Food Banks do not have enough food choices, healthy options and variety. Looking for a GP is very difficult Services are far and transportation is an issue Need subsidized bus passes Everyone dumps their feelings , and people don’t have time to listen Treatment by the police is not good Lack of respect for client concern with addiction Very unfriendly Need a baseline assessment Reduce stigma Adequate pain management for clients Reassess client needs on individual basis Don’t clusters us into groups; each individual is unique Identify gaps in services Wait times Ability to access interpreters, for some staff it is important to be more sensitive for

new comers when English is not their first language. Increasing support during transition from new country Appreciation of different languages. Male doctors need to be more accepting of different cultures and open to explain

therapies and importance of identifying each individual’s uniqueness Time to invest in each individual Respect client concerns

APPENDIX A: 45


Make medication more accessible Cost can be a barrier to needed medications Hospitals only help working people. Treat you better according to your address Hospitals need to take people seriously, when going to the hospital. Don’t just send them away when they are talking “suicide” Health care is adequate in this city

APPENDIX A: 46

Documents

HEALTH SERVICES & HOMELESSNESS€¦ · Web viewHEALTH SERVICES & HOMELESSNESS FINAL SUMMARY REPORT (V1) Executive Summary "Individually, we are one drop. Together, we are an ocean."-SatoroRyunosuke