Integrating Healthcare and Housing Supports in Shelters: Prototyping and Lessons Learned
This post is the third in a series highlighting House of Friendship’s work on ShelterCare. Over 70% who seek emergency shelter in Waterloo region are navigating addiction, mental, and/or physical health challenges. Through the ShelterCare Solutions Lab, we will work together on designing solutions to better meet these needs through responsive and relationship-based healthcare and housing supports in emergency shelter. The previous post on Developing Design Principles can be found here.
As we moved into the next phases of work, our attention turned toward generating new ideas and putting them into action. First, we used the ideas to identify themes that were common across them to develop a set of design principles. Next, we will look for opportunities to prototype the more promising ideas in small ways.
To build on the design principles established in the previous phase, we next looked for opportunities to prototype the more promising ideas in small ways. We brought the project team together to brainstorm and test prototypes (or as some members preferred to say, “proofs of concept”) of new/improved service interactions or ways of collaborating.
Planning in a pandemic
There are unique opportunities and challenges presented by seeking to innovate in an essential work environment during a pandemic!
Change readiness: While the disruption caused by a pandemic meant that “the way we’ve always done it” was not a barrier as it can sometimes be when the environment is stable, on the other hand, many people were carrying major “change baggage” due to feeling unstable, burnt-out, and anxious.
Availability: All stakeholders involved in the local shelter system were severely capacity-constrained as focus was on COVID-19 crisis response, adapting services, and getting new shelter locations off-the-ground to serve an increasing number of people without access to housing in our community. Further, given the increased pressures on frontline work, it was challenging to find appropriate times to have direct service, shift-based workers available to participate in meetings.
Headspace: The short-term, crisis mode of pandemic response lends itself well to sparking new ideas about what needs to be done in the very short term. However, many of our Lab participants admitted feeling challenged to think or plan for longer term aspirations due to a lack of headspace and energy.
Learning from prototypes
Despite the challenges above, the team found itself naturally in an innovation mode by nature of suddenly operating in a new location and with staff from multiple organizations under one roof, and, thus, needing to figure out new ways of working together on-the-fly. This environment led to a number of prototypes – ranging from simple and tactile ideas such as a daily communication log book, to issues as complex as the way we approach addictions and harm reduction support.
Some of the prototypes we tested and learned from are as follows:
Prototype example #1: Medical log book – tested a communication tool between primary care clinic and shelter staff
What we learned by testing this prototype:
Easy, low-tech tangible solution that was well-used and understood by all
Needed to remind staff that participants need to consent to have their issue listed in the book
What new ideas or questions this sparked for us:
What better language can we use to increase clarity?
How does the medical book interact with Day Logs that are kept already by shelter staff?
Could we make a virtual blue book instead of a physical one?
Prototype example #2: Primary Care clinic hours – tried shifting the hours from daytime to some evenings, and then on different days of the week
What we learned by testing this prototype:
The best and most used times of day seem to be 10am to 3pm, Fridays are quietest
Participants liked consistency of access on weekdays
Health care providers liked the consistent weekday, daytime hours
Tried to expand to evenings and weekends – didn’t get much uptake
Found that more regular care during the daytime reduced the need for episodic/emergency care at night.
What new ideas or questions this sparked for us:
How do we secure stable ongoing funding to staff the daytime primary care clinic?
How will we offer customized responses to health care needs (e.g. harm reduction, mental health crisis, etc) in the off-hours (evenings, overnight, weekends) without having to rely so much on EMS and police?
Prototype example #3: Communication/ case conferencing between shelter and clinic – email updates and daily “huddle”
What we learned by testing this prototype:
Daily huddle during COVID peak times was helpful, but the need for this seemed to taper off as we settled into routines and there were fewer people staying on the COVID Isolation floor
Shelter staff found it helpful to get Friday email updates from the primary care nurse to know what was going on and what the shelter team needed to pay attention to over the weekend.
Different people attended the huddle depending on the day… seemed best for it to be the shift supervisor or shelter manager
What new ideas or questions this sparked for us:
True case conference approaches are constrained because shelter team members are not permitted to have access to Private Health Information (PHI)… how can shelter and primary care participant/patient information shared as we move ahead? Could there be a consent signed between primary care and shelter teams for sharing info using an electronic medical record (EMR)? View-only access to the EMR?
Is there a way to flag for the health care team when new people move in, book-outs, etc? Can the primary care team be involved in the intake process?
Prototype example #4: Add an Addictions Counselling service on site one day a week (Monday, 3-5pm)
What we learned by testing this prototype:
For those that used it, great to have an on-site option rather than just sending people to a virtual visit or another location
Limited uptake… relationships have to be built first, counsellor started going around to rooms to chat with participants
Limited hours are a barrier… participants tend to be ready to act on a willingness to seek counselling right in the moment. It is too late to wait for an appointment that is days away.
Addictions and mental health needs are significant, but participants are not always ready for counselling or treatment… earlier interventions (harm reduction) can complement.
What new ideas or questions this sparked for us:
How to significantly improve capacity for participants to go through the HERE 24/7 assessment and screening process… it is very challenging for many to complete independently. Might mental health service staff be able to come on site to support?
How could we make access available immediately rather than a lag time between moment of readiness and a first conversation with a counsellor?
Transitioning to a systems view
Next, we will be delving into the system-level work by assembling a broader project team that includes a variety of system players with a focus on disseminating our learning within and beyond Waterloo Region.
The transition to the system-level aligns well with a number of major shifts in the emergency shelter program run by House of Friendship as well as the broader system of supports serving those who are homeless in Waterloo Region. The House of Friendship shelter program is relocating to a new hotel in October 2020 and will operate under a model which has a strong emphasis on housing outcomes and continuing to increase health services on site as part of the support system that allows people to exit the cycle of homelessness.
As these shifts occur, the Solutions Lab process will serve as an excellent tool to continue to innovate and explore new ways of doing together.
Get Involved
Do you have feedback on the prototypes that were developed? Have you tested some similar ideas that might apply to our problem as well? Check out the ShelterCare website for more information and how to connect with Sarah Brown and the Solutions Lab team.
As a Solutions Lab Provider, Overlap Associates partners with organizations to work through complex housing issues and scale potential solutions. A Solutions Lab is a collaborate initiative to solve complex housing problems using innovative methods and tools. For the organizations participating, a Lab is an opportunity to develop innovative solutions to a complex housing problem, as well as build capabilities for design, collaboration and problem-solving. Learn more about our Housing Solutions Labs here.
