Board Education Session Topic: Care for the Homeless: The Ottawa Inner City Health experience

Transcription

1 1900 City Park Drive, Suite 204 Ottawa, ON K1J 1A3 Tel Fax Toll Free , promenade City Park, bureau 204 Ottawa, ON K1J 1A3 Téléphone : Télécopieur : Sans frais : Board Education Session Topic: Care for the Homeless: The Ottawa Inner City Health experience Welcome and introduction September 19, :00 PM Champlain LHIN Office 1900 City Park Drive, Suite Boardroom, Ottawa TOPIC AGENDA Jean-Pierre Boisclair, Board Chair, Champlain LHIN Goal: To provide an overview of Ottawa Inner City Health s innovative model to deliver health care services to homeless individuals. Areas of focus will include mental health and addictions. Presenters: Wendy Muckle, Executive Director, Ottawa Inner City Health Dr. Jeffrey Turnbull, Medical Director, Ottawa Inner City Health TIME 12:00 12:05 12:05 12:50 Discussion 12:50 13:55 Adjournment 14:00 This education session will be available through videoconferencing (OTN). If you wish to join via OTN, please register your site by 11:00am on September 19, Event: # Link: IMPORTANT: In order to avoid technical difficulties we recommend you download any materials onto your computer prior to the session. If available, materials will be posted on our website by 9:00 a.m. September 19, 2018 through this link La session sera offerte en anglais, l ordre du jour sera disponible en français.

2 Ottawa Inner City Health, Inc Collaborative Health Care for the Homeless In Ottawa

3 Background Ottawa Inner City Health is an organization which was established in 2001 to provide health care for people who are chronically homeless with complex needs The organization operates a number of specialized health care units which are located inside shelters for the homeless in addition to providing supportive housing for people with complex long term support needs

4 OICH Corporate Members Ottawa Hospital University of Ottawa The Royal Community Health Centres The Mission The Salvation Army Options Bytown Cornerstone Shepherds of Good Hope Canadian Mental Health Association Carefor Health and Community Services John Howard Society Ottawa Public Health Key Partners, Ottawa Police, Ottawa Paramedics, Champlain LHIN

5 History of OICH Grew out of concern that health needs of chronically homeless were not addressed adequately despite high rates of health service utilization and associated cost Recognised obligation to care for to people with severe and persistent mental illness and or substance use disorder who were otherwise barred from receiving services

6 To an Integrated Service System Hospital Care Justice System Home Care Social Services Community Heath Housing Shelters and Services for the Homeless

7 Priority Populations? Focus on homeless adults living with overwhelming substance use disorder in combination with SMI Seniors, ABI, DD, cognitively impaired High proportion of indigenous clients Current focus on people who use drugs and the impacts of the opiate crisis

8 Integrated Model of Care Coordination of care is fundamental to all programs and services (ie our primary role) Silver bullet is to address mental health, physical health, housing, and substance use simultaneously Harm reduction approach integrated into all aspects of treatment and care Inclusion of people with lived experience (past and current) in all aspects of programs and services Members of Inuit Task Force preparing country food for community feast

9 Programs and Services Shelter Based Mission Hospice Mission Primary Care Clinic Special Care for Women Special Care for Men MAP TED SIS Outreach to Cornerstone Housing Based Oaks Booth House Rita Thompson Residence Caruthers*** Hope Living Chronic Palliative Care Outreach

10 Outcomes for OICHI Clients 50 % of people are admitted for less than 90 days and do not return to shelter after discharge 25% of people are with us two years or less and eventually transition into housing with intensive supports 25% of people remain with us more than 2 years and live with us either in housing or shelter very long term when housing is not available for them

11 Mental Health Team Accessible to any OICHI client in any location Mental Health Nurses 2.6 FTE (LHIN funded positions in CHC, MH, SA programs), Psychiatrists (Royal) sessional fees Peer Workers (LHIN funded) Intensive Case Management 2.0 FTE purchase of service from CMHA with LHIN funding Focus on engagement, trust, helping the client to access the help needed to meet their needs Low barrier access to care with a focus on immediate safety for the client and those around them Support to help the client engage in treatment needed to help them exit homelessness and address health needs in accordance with their life goals in the long term

12 Case Study 22 year old with SMI and polysubstance abuse HX of trauma, homeless, constant interactions with police and paramedics Re-engaged with family Attending school to become a social worker Works for OICHI as a peer worker Engagement through TED, transfer to Women s Special Care Unit, housed with CMHA, ICM support, CD treatment,

13 Approaches to Substance Use Treatment Approach In general, the mainstream addictions treatment system including addictions medicine has failed this population Chronic disease management approach is proven effective in reducing harm, improving health, life expectancy How? Harm reduction Unconventional treatments for those refractory to conventional treatment (MAP, MOP) Treatment which focuses on the priorities of the person-not necessarily just on substance use Access to adjunct treatments (ie accu) Positive engagement in the drug using community

14 What Works? Low barrier access to treatment at the point of greatest need and risk Plan of treatment and care which is individualized and non linear Housing with intensive, integrated treatment Employment and community engagement Working in partnership with organizations with varied expertise Focus on recovery with an expectation of chronic relapse of negative symptoms

15 Housing with intensive, integrated treatment Oaks Booth Gardner Caruthers Need for 24 hour intensive treatment and care Built on recovery model with appreciation of the chronic relapsing nature of the diseases impacting their lives Focus on gradual improvements in health, coping skills, community integration balanced with the reality of living with life limiting disease processes

16 Cognitive Impairment 50% of the residents have a cognitive impairment comparable to living with Alzheimer's

17 Mental Health Diagnosis-Self Report

18 Acquired Brain Injury

19 Employment and community engagement Recovery from mental illness, homelessness, substance use normally discourages contact with those communities However, social exclusion, loneliness and isolation are known to have significant impact on recovery Inclusion of peers as part of the interdisciplinary team provides a way to include the community in caring for their own members

20 Working with People With Lived Experience Employed in a variety of roles at OICHI Interdisciplinary team always includes peer workers as full members of the team Encourage people who are using services to see themselves as people who will be providing services Provides very low barrier opportunity to gain employment experience

21 Working in partnership with organizations with varied expertise OICHI does not exist and cannot function without our partners The complexity of client need cannot be addressed by any single organization or sector Requires investment of time to develop and maintain relationship but, it is critical if we want anything different than what we have today

22 Focus on recovery with an expectation of chronic relapse of negative symptoms Understanding what the recipe to success is for the client Learning the early warning signals and helping the client see them Having a safety net so that relapse does not mean the return to the starting point every time (nonlinear approach to recovery)

23 The Opiate Crisis in Ottawa The opiate crisis has had a profound and seemingly irreversible impact on our community Gross underestimate of number of people injecting opiates Illicit drug supply which is unpredictable in terms of availability and effect Community of drug users who are marginalised and who have already failed to be helped by conventional treatment programs

24 Supervised Injection Site Average 120 visits per day (approx. 300 injections) 25,000 visits in 6 month Temporary location with insufficient service capacity 147 reversals with Naloxone (312 doses of Naloxone used)

25 Where Are We Doing Well? Flooding the market with Naloxone Acceptance of new services Excellent work with police on community safety needs Alignment and support with OPH and other organizations working with this community High uptake of opiate substitution treatment MOP is a game changer! High uptake for other services (primary care, mental health, housing, food) Engaging service users to work in the SIS =start of treatment

26 What Keeps Us Up at Night? Despite good uptake into treatment, we see no reduction in the numbers or demand from new people Overdoses are more serious and impact multiple body systems (ie seizures + respiratory depression) The levels of violence and chaos in the community continue to grow despite our collective best efforts It is impossible to mediate the impact of the toxic drug supply Access to MOP is limited so people are literally dying on the waiting list We are completely unable to provide any meaningful care to people who smoke drugs despite the growing risk profile We are failing to educate the public and politicians about the optimal approaches to this crisis (ie focus on residential treatment not evidence based)

27 Managed Opiate Program Meaningful and effective response to the toxic illicit drug supply Provides injectable/oral hydromorphone to those whose lives are at imminent risk due to opiate addiction Intervention informed by research and body of evidence

28 Thanks to the LHIN We appreciate the opportunity to collaborate with the LHIN and are thankful for the leadership and commitment to improving the health of our most vulnerable citizens