What is a Protocol?

1. INFORMATION SESSIONSfor senior managers , supervisors and team leaders in health and homelessness agencies that work with people experiencing homelessness in Melbourne’s CBD

2. 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.

3. Information Session Objectives • To provide an understanding of the importance of implementing the CBD Homelessness Health Access Protocol. • To provide an opportunity for managers, team leaders and supervisors to learn about, or refresh their understanding of this Protocol. • To identify the governance structure, plan for implementation, key support contacts and documentation which has been developed to support the Protocol’s implementation. • To highlight the practice responsibilities of organisations within the protocol and provide an opportunity to reflect on what is required. This includes determining what staff in other agencies may expect of your staff. • To provide information about the on line and face to face training available for front line staff and how to access it.

4. Agenda 1.Why are we here? 2.A quiz for busting myths about health service referral 3.Key elements of the Protocol 4. Familiarise yourself with the training 5. What does it mean for your agency? 6. Information about Training Sessions 7.Evaluation

5. History and Context Long term commitment to this development.

6. 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.

7. 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.

8. CBD Health Access Protocol 2008 • Aim to improve health service access via improved coordination between the health and homeless sectors. • Primary Care Partnership Project • Funded by City of Melbourne and DHS • 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)

9. The CBD Homelessness Health Access Protocol Aims to improve health service access to people experiencing homelessness in the CBD by: • Building better relationships between health and homelessness service providers • Developing an agreed practice for referral processes that will work. • Ensuring health services implement policies for prioritising people experiencing homelessness. • Ensuring homelessness workers have access to information and advice about health when they need it.

10. The Target Group Understanding the health needs of people who are experiencing homelessness.

11. Target Group The 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. 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

16. 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.

17. 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.

18. Quiz Time Myth Buster

19. Key Elements of the Access Protocol Documents Governance

20. 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.

21. The Documents • The CBD Homelessness Health Access Protocol • Guidelines to Making Referrals to a Health Service • Guidelines for Receiving Referrals in a Health Service • Key Access Points in Health • Guide to Accessing Services • Agency Checklist • Training Handbook and online information

22. Governance 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.

23. Training Handbook Have a look at the Handbook Q and A

24. Your Agency and the Protocol Direct to agency checklist activity

25. Key Access Point Agencies • 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. • Reception staff understand? • Who is the person/people who will undertake this role? • How can your staff encourage and support people to get the services they need?

26. Training Sessions Information on Training Sessions Direct to information sheet

27. Evaluation Evaluation of information sessions