1. “A CASE FOR INTER-AGENCY COLLABORATION for STREET CLIENTS”
Presentation to CPHA Conference
June 2, 2008
Jan Appleton
Community Manager
Public Health Prevention Services
Thank for opportunity to share what we’re doing where I live in Kelowna BC about a challenge we have with providing care to the homeless population.
My name is Jan Appleton and I am the Community Manager for Public Health Prevention Services in the Central Okanagan of BC. I am also the PH Manager for Outreach Urban Health which is a a Primary Healthcare service in downtown Kelowna that services street involved individuals. Public Health is a key partner along with Mental Health & Addictions, and Home and Community Care.

2. Partners in Community Case Management (PICC)
History of PICC
Silos
Spirit of community engagement
Outreach Urban Health
“We can do together what we cannot do individually” – John Nance
I would like to begin by telling you a story: Two years ago, a 42 year old former schoolteacher, who had lost her husband to cancer, sank into depression, substance abuse and homelessness. One cold night in February 2006, she was turned away from a local women’s shelter for being drunk. She slept out in a park across the street, froze and lost both of her feet. Andrew Hughes, then the new coordinator for Outreach Urban Health, connected with many other agencies and collaboratively arranged for housing and other supports for this woman. That was the birth of PICC. Today that first PICC graduate is teaching adult education at a local college.
Prior to PICC, there was a history of silo work – each sector doing it’s own thing. We wanted to reduce the silo work and it was our true belief, sincerity and vision that has enabled us to move beyond the silos.
Although there was an existing spirit of community engagement as a result of historical efforts made by PH, HCC, MH & Addictions with various community agencies it was fragmented and uncoordinated.
Today, OUH continues to host and sponsor PICC.
Last week I had the good fortune to meet John Nance (lawyer, pilot, broadcaster, writer) who many of you may know. When he said “we can do together what we cannot do individually” I thought how beautifully it sums up the work of the PICC committee.

3. How PICC works Weekly meetings More than 20 different agencies
Coordinated care plans
Shared case management
Goal setting
Motto: The right person, at the right time, providing the right service
Once a week OUH brings together frontline workers from more than 20 agencies such as Aboriginal agencies, Homeless Shelters, Alcohol & Drug treatment centres, the Brain Injury Society, and even our hospital discharge planning, who meet for 1 hour and focus on 1 individual in need. Recently they’ve started inviting the client to their meetings.
It’s all about making connections. Who can do what and ensure clients get from A to B. They have the clients best interest at heart. They target high-risk individuals and create a coordinated care plan for these clients. They share the role of case manager depending on the individuals clients needs and relationships.
PICC partners set a goal to get one person off the streets each week. Over the past year, they have more than doubled that number, with a total of 123 clients leaving street life for good.
MOTTO: The right person, at the right time, providing the right service.
For example, last winter we had an outbreak of Invasive Strep Pneumococcal disease in Kelowna. There was a homeless individual who was in ICU but was improving and the hospital wanted to discharge him. He would have been discharged to a tent. A phone call to OUH, resulted in this individual case going to PICC and the community came up with a place for him to stay. It’s all about relationships with clients, IH staff, and community agencies.

4. PICC RESULTS
88% reduction in Emergency room visits. Long term outcome shows an overall reduction of 60% less emergency room visits.
Connected 138 homeless individuals into housing over a one year period. Approximately 15 Clients returned to the street with 123 sustaining.
“Every system is perfectly designed to get the results it consistently achieves!” – Dr. Don Berwick
1. Over a six month period clients case managed through the PICC committee showed an 88% reduction in Emergency room visits. Long term outcome shows an overall reduction of 60% less emergency room visits.
2. PICC also was involved in connecting 138 homeless individuals into housing over a one year period. Approximately 15 Clients returned to the street with 123 sustaining. Their results were double to triple their goal of 1 individual per week.
3. It’s no accident that we are successful. “Every system is perfectly designed to get the results it consistently achieves” – Don Berwick. Think about it.

5. Lessons Learned Confidentiality
80+ hours of service to break the street entrenched lifestyle
Shift from interprofessional to interagency model works!
Conflict of Interest
Consistent vision – Population Health approach
Use common sense and logic
Take risks
There are barriers that need to be addressed when you bring this many agencies together. The biggest barrier we found was confidentiality. It was important to build relationships and trust with the agencies before addressing the issue of confidentiality. We took a very grassroots approach and built our social capital first by focusing on relationships and getting to know each other. Some might call our approach a bit devious as needed to ensure that the community was engaged before presenting a “confidentiality agreement”.
Not all community partners can be involved because of conflict of interest. There could be information shared about an individual that a particular agencies is compelled to act on. For example personal interests must be transparent e.g. RCMP, MEIA, and at times Forensics or Parole should not be part of the conversation. They are all recognized at key partners and are invited to join PICC at the end of the meeting to network and share. It is really an evolution.
We have found that it takes at least 80 hours of service to break the street entrenched lifestyle.
Need to have a consistent vision that focuses on addressing the social determinants of health (socioeconomic status, education, social support, housing, etc). Share your vision!
Although we already had a successful interprofessional model of care, the biggest strides/successes have come after we shifted to an interagency model of care.
Use common sense and logic. Don’t let organizational barriers get in the way and be prepared to take risks!

6. “Bring in everyone - in ways we never have before – that is the answer” – John Nance
I would like to conclude by sharing another quote from John Nance: “Bring in everyone – in ways we never have before – that is the answer”.

7. Contact Us Outreach Urban Health 455 Leon Ave Kelowna BC 250-868-2230