Health regions are exploring new ways to deliver services that better meet the needs of patients and clients. Several of these innovative practices were highlighted at the April 21 meeting of the Provincial Stakeholder Advisory Group, which helps steer the ED Waits and Patient Flow Initiative. While three of the four new programs are community based, all hold significant potential for shortening ED waits and improving patient flow in acute care. Below is the story of Saskatoon’s Journey Home program.
For at-risk individuals, access to adequate, affordable housing – along with key supports to meet their physical and mental health needs – can be a big help in getting back on their feet and started down a more positive path.
That’s the philosophy behind Journey Home, a Housing First program run by Saskatoon Crisis Intervention Services, and funded by the Saskatoon United Way. Now in its third year, it is based on the successful At Home/Chez Moi program developed in response to the Mental Health Commission of Canada. Journey Home applies an intensive case management approach to working with individuals who are chronically and episodically homeless, and who are also struggling with mental or physical health issues, substance abuse, or financial and legal issues.
The program’s case managers work closely with clinicians in mental health and addictions, psychiatry, the justice system, and with First Nations cultural supports to coordinate access to service. Journey Home staff serve as lead case managers, to establish the community care plan in collaboration with each client. The program puts client choice at the centre of planning and selection of housing; clients actually go apartment hunting and furniture shopping with case managers. As a result, clients take more responsibility for their apartments and are less likely to be evicted.
Jordan Mills, team leader for the Housing First program, says the working relationship is for a minimum of one year, but for most clients it’s more likely to span two to five years, given the immense amount of work it takes to ‘move the needle’ with people who have untreated mental illness and chronic substance abuse issues. The central intake point is at Saskatoon’s Friendship Inn.
“The first three months is a critical phase involving intensive support, which if done well establishes stability for ongoing success.” (Jordan Mills, team leader)
At the ED Waits meeting in Saskatoon, Mills presented some very promising results from Year 1 of the Journey Home initiative. Many of the people that Journey Home is designed to help are high users of health and social services, ranging from detox, incarceration, and emergency shelters, to ED visits and hospital stays. In the year before enrolment in the initiative, the 24 participants visited Saskatoon EDs 399 times and had 375 hospital admissions.
They also made 286 ambulance trips. In the year after participants were provided with housing and individualized supports, EDs visits dropped to 84, hospitalizations fell to 116, and ambulance rides were reduced to just 66. Not surprisingly, reduction in crisis service use translated to significant costs savings: a 50-year-old male’s costs dropped from $103,118 (in the year prior to Journey Home) to $30,654 (in the year after enrolment in Journey Home), while those for a woman in her mid-20s fell from $37,018 to just $900.
Mills says Journey Home is about collaborating with someone in ending their homelessness, in which housing is just the first step.
“The real work is ultimately facilitating a reclaiming of one’s citizenship, and helping them re-author a better story for themselves. If we’re faithful to the model, including consumer choice, the results are always remarkable.” (Jordan Mills)
“Clients’ lives are improved, and there’s usually a significant reduction in expensive and inappropriate use of emergency services,” says Mills. “It’s a win for the participants in our program, and a win for the Health, Justice, and Social Services sectors.”