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.

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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)

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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

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Agenda
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Activity One

• Why a health focus for those who are homeless?

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History and Context

• Section One.

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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.

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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.

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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, Travellors Aide,
  St Vincents, Urban Seed (on behalf of drop in
  centres)
• Primary Care Partnership Project
• Funded by City of Melbourne and DHS

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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_at_inwpcp.org.au
or 9389 2262.
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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.

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Target Group Continued

• And/or has complex needs, defined as
• a range of health conditions and behaviours -
  usually co-existing that seriously limit the
  individuals 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.

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CBD context

• Over 400 people use welfare based drop in centres
  every day in the CBD.
• The City Of Melbournes 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.

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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

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Activity One

• Individual Exercise Pg 6.

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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

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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.

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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 womens specific programs including,
  health screenings, sexual health support.
• Tailored aged care and disability support
  services.

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Case studies for health service access

• Section Two Training Document

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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
• Womens Health Case study
• Youth Case study
• Complex needs case study

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Quiz Time

• Section three identifying best practice

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Key Elements of the Access Protocol

• Documents
• Governance

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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.

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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

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BARRIERS TO ACCESS ACTIVITY

• PG 22. GUIDELINES FOR MAKING AND RECEIVING
  REFERRALS.

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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

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Making and receiving referrals

• Section four referral documentation

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Verbal Referral

• Verbal Referrals
• Verbal Referral Fill in Client Consent

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Written Referral Single Service

• Written to single service
• Written Referral for a single service- Client
  Consent form plus Referral Cover Sheet

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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.

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READ PAGES 28-30
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Working through the Documents together
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Future plans for implementation of the Protocol

• Section Five

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What to do if you are having problems?

• Section Five, page 34

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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 [phone] Email GeorgiaS_at_inwpcp.org.au
• Web www.inwpcp.org.au

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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.

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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

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Thank you for attending today

• Your Trainer/ Facilitator
• Maureen Dawson-Smith, Live Work Relate
• maureen_at_liveworkrelate.com
• Protocol project officer
• GEORGIA SAVAGE Project Officer
• Inner North West Primary Care partnership
• Tel [phone] Email GeorgiaS_at_inwpcp.org.au
• Web www.inwpcp.org.au

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Evaluation

• Evaluation of information sessions