What is a Protocol?

1. What is a Protocol? A Protocol (or good practice guideline) is an agreed way of working or an agreed practice which is shared by a number of workers. It usually identifies a number of steps, decisions, and options, but generally the aim of a protocol is to have one standard practice developed because it will get the best result for the client concerned.

2. The aim of the CBD Homelessness Health Access Protocol • Is to improve access to health services for people who are...(initially)... in the CBD of Melbourne by developing an agreed shared practice between health and community services. (welfare and homelessness services)

3. What are the elements of this shared practice? • Engage people who are homeless into addressing their health issues. • Create priority access pathways to health services. • Developing referral processes which will work • Build better relationships between health and community sector including homeless sector. • Respond to their health needs in a flexible, supportive and tailored way. • Create coordinated approach to improving health outcomes between health and homeless/welfare services

4. Agenda

5. Activity One: Why a health focus for those who are homeless?

6. History and Context Section One.

7. Historical context. • There is at least a ten year history of partnership projects between the health and homelessness sectors in the CBD which aim to address the lack of private health care providers and in particular an unwillingness of the limited private providers available to engage with the target group of concern. • MGPN research 2010 suggests same issue.

8. Policy, Evaluation and Research • Homelessness is about the absence of health and wellbeing as well as housing. • Research highlights the causal relationship between the experience of poor mental and physical health and both entering and exiting homelessness. • Best practice in alleviating homelessness requires health, wellbeing and housing outcomes to be identified and met and health equality is also fundamental to social inclusion.

9. CBD Health Access Protocol 2008 • Aim to improve health service access via improved coordination between health and welfare sectors. • Overseen by Steering Committee of PCP • City of Melbourne, Vincent Care, MGPN, NYCHS, DGCHS, DHS, RDNS, IWMHS, Youth Projects, YPHS, Wintringham, Melbourne Health, Travellor’s Aide, St Vincents, Urban Seed (on behalf of drop in centres) • Primary Care Partnership Project • Funded by City of Melbourne and DHS

10. CBD Health Access Protocol 2011 If you would like more information on how to become a member of the CBD Health and Homelessness Alliance, please contact Georgia Savage at the INW PCP on GeorgiaS@inwpcp.org.au or 9389 2262.

11. Target Group The Access Protocol was developed to assist people (and indirectly their workers) who live or spend their days in the CBD of Melbourne and are experiencing any of the following: • Primary Homelessness: people without conventional accommodation; e.g. living the streets, sleeping in derelict buildings, or using cars for temporary shelter. • Secondary Homelessness: People who move from one form of temporary shelter to another, including homelessness services, rooming houses, and residing temporarily with friends. • Tertiary Homelessness: People who live in boarding houses on a medium to long term basis.

12. Target Group Continued And/or has complex needs, defined as : a range of health conditions and behaviours - usually co-existing – that seriously limit the individual’s ability to access services and/or to obtain and retain housing. These conditions include alcohol or drug dependence, mental illness, acquired brain injury, intellectual and other disability, age related frailty, and chronic health problems, with or without challenging behaviours.

13. CBD context • Over 400 people use welfare based drop in centres every day in the CBD. • The City Of Melbourne’s Street Count held on one night in October 2008 identified 100+ people sleeping rough in the City of Melbourne. • Approximately 20 children living in tenuous circumstances or sleeping rough with their parents. • 68% of those sleeping rough, 90% of those in Crisis Accommodation and 59% of Rooming House Clients spend their days and nights in the City.

14. Research findings • Approx 60% of who come to the City will move out again within days or weeks, but many will re-enter the homelessness system. • Of the remaining 40% of homeless people: • About half are in substandard and insecure housing in which it is safer/preferable/a choice to come to the City to spend their time. • The other half are sleeping rough and have complex needs and many of this target group in the CBD may not access any drop in service without consistent and long term outreach engagement. • There are high numbers in both groups who are food insecure, malnourished and have poor health which adversely affects their capacity to uplift from their circumstances Source: City of Melbourne Feasibility Study into developing a Health Service in the CBD 2010

15. Activity One Individual Exercise Pg 6.

16. Health Issues: Research 2010 Health Issues identified in 2010 in the CBD include: • Problematic substance use health related concerns including, poor liver functioning and respiratory conditions. • Poor mental health (dementia, depression, anxiety, schizophrenic disorders, alcohol related, drug induced and other psychosis). • Poor dental health. • Poor nutrition and food insecurity impacting on health. • Eyesight problems. • Infectious diseases such as tuberculosis, viral hepatitis, STDs. • Infestation disorders from self neglect and lack of facilities for personal hygiene. • Pneumonia. • Lack of pain management and routine health care. • Low compliance with treatment and or inappropriate use of medication

17. They need • Assertive outreach models of care including mental health outreach. • Drug and alcohol counselling, dual diagnosis, detoxification and rehabilitation. • Counselling, social rehabilitation, therapeutic and practical life skills training. • Allied health services including podiatrists. • Access to Bulk billing GPs and community nurses. • Dietetic services and nutritional programs to address food insecurity and malnutrition.

18. They need • Specialist interventions for diseases of poverty including, dental care, health information, treatment for injury and wounds, sore feet, STDs, HIV and all forms of hepatitis, asthma, liver failure, cancers, epilepsy and diabetes. • Health education, health screenings and preventative health approaches. • Youth service transition support for young adults leaving youth specific services. • A variety of women’s specific programs including, health screenings, sexual health support. • Tailored aged care and disability support services.

19. Case studies for health service access Section Two Training Document

20. ACTIVITY THREE: SECTION TWO • Case studies 5 Groups. • Discuss the case study questions • Report key points to the broader group • General practitioner • Mental health case study • Women’s Health Case study • Youth Case study • Complex needs case study

21. Quiz Time Section three; identifying best practice

22. Key Elements of the Access Protocol Documents Governance

23. Access Protocol Outcomes • Client consent • Secondary consultations from agencies listed as Key Access Points. • Clear referral process and documentation. • Facilitated and supported referral practice accepted. • Improved and updated information on health agencies. • Valuing welfare workers’ role in improving health service access. • Health service development. (e.g.. priority access, outreach no appointments required). • Improved coordination between health and community services (feed back). • Governance and relationships • enabling new health initiatives • Shared training and development • Building the necessary relationships to achieve health, wellbeing and housing outcomes.

24. www.inwpcp.org.au • The CBD Homelessness Health Access Protocol • Guidelines to Making Referrals to a Health Service (p 23) • Guidelines for Receiving Referrals in a Health Service (p 24) • Key Access Points in Health (p 26) • Guide to Accessing Services • Agency Checklist • Training Handbook and online information

25. BARRIERS TO ACCESS ACTIVITY PG 22. GUIDELINES FOR MAKING AND RECEIVING REFERRALS.

26. Key Access Point Agency • Supporting people who are experiencing homelessness and their workers to access health services. • Secondary consults on health conditions. • Provision of information about services. • Assistance with assessment and referral. • Pg 26

27. Making and receiving referrals Section four; referral documentation

28. Verbal Referral • Verbal Referrals • Verbal Referral Fill in Client Consent

29. Written Referral; Single Service • Written to single service • Written Referral for a single service- Client Consent form plus Referral Cover Sheet

30. Complex Referral: Multiple Service • Initial Needs Assessment • Same documents as single service referral +the Consumer information Form and the Summary of Referral and Information Form.

31. READ PAGES 28-30

32. Working through the Documents together

33. Future plans for implementation of the Protocol Section Five

34. What to do if you are having problems? Section Five, page 34

35. Monitoring in the Future • Monitoring use of the protocol with surveys • Ongoing information sessions • On line reports • CBD Health and Homelessness Coordination Network implementation support • Contact: • GEORGIA SAVAGE Project Officer • Inner North West Primary Care partnership • Tel 03 9389 2262| Email: GeorgiaS@inwpcp.org.au • Web www.inwpcp.org.au

36. Key Message Homelessness and Community Sector Health agencies supporting the protocol will give your referrals priority and will work with you to ensure your clients get the services they need

37. Key Message: Health Sector By working with homelessness and community sector workers you are much more likely to achieve success in engaging people who are homeless, ensuring they get the health services they need.

38. Key Message For All If we can address health issues earlier, better health, wellbeing and housing outcomes can be achieved. What ever the services you provide (health or homelessness) we need you to consider broad health and welfare needs and assist your clients to have the

39. Thank you for attending today • Your Trainer/ Facilitator • Maureen Dawson-Smith, Live Work Relate • maureen@liveworkrelate.com • Protocol project officer • GEORGIA SAVAGE Project Officer • Inner North West Primary Care partnership • Tel 03 9389 2262| Email: GeorgiaS@inwpcp.org.au • Web www.inwpcp.org.au

40. Evaluation Evaluation of information sessions