Community collaboration during COVID-19

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By: Jasmine Salazar

The COVID-19 pandemic presents a host of significant health, social, and economic challenges. Factors such as high rates of chronic health conditions, congregate sheltering and housing instability increases the risk of infection among people at risk of or experiencing homelessness, which are further compounded by the disruption of services due to a changing social and health service landscape. 

To ensure our community members experiencing homelessness had access to critical services and supports during the pandemic, Edmonton’s homeless-serving sector organized a response plan that coordinated community, health system and government efforts. Priority concerns were access to healthcare, safe spaces and continued supports, especially with many organizations forced to shut down their brick-and-mortar sites. The result was opening the Edmonton EXPO Centre as a centralized hub for critical services and supports via a daytime drop-in program as well as a 24/7 isolation shelter for those showing COVID-like symptoms. 

Part of the response involved mobilizing a medical station at the EXPO Centre—an effort that involved several health organizations, including HomeCare, Indigenous Wellness Clinic, Streetworks, Mint Health + Drugs, Primary Care Network and Mobile Integrated Healthcare Paramedics providing a range of health services under one roof. Services available included: wound care, foot care, STI testing, pregnancy testing, case management, medication inquiries and support, connecting to community health resources and other general health concerns

For our community members, this centralization of services meant that their immediate needs could be met more efficiently in a barrier-free environment. Since opening on April 28, 2020, the medical station has helped more than 1400 people. 

What are the benefits of working alongside each other this way, and how is this different than business as usual?

Stephen, Alberta Health Services Homecare: Normally our programs work separately in the community—our teams usually work in their own silos. By being together under one roof we have been able to streamline processes and support each other in areas where we may not be as strong. Being together in one station has shown that our programs are much more complimentary to each other. 

Andrew, Mint Health + Drugs: Ability to think creatively to collaborate between different healthcare providers. It has been a unique situation to allow us to work together in a more holistic approach than usual.

Kelsey, Indigenous Wellness Clinic: We all have a different skillset that allows us to help the population to the fullest potential. We can collaborate effectively and work as a team to ensure the client receives the best care possible. 

Elaine, Community Paramedic: The inter-professional collaboration has been valuable since each practitioner brings a specialty to assist patients. Our multi-faceted team has been able to deliver quality patient-centred care during these times when accessing and navigating primary healthcare is extra difficult. We have learned a lot from each other, and how best our resources can be used in the future to collaborate.

Denise, Streetworks: We all have different scopes of practice so between all of us we can fill in any gaps in service that would exist if we were working here solo. 

Lanie, Primary Care Network: We can utilize each others’ resources to come up with a concise plan of care that will be the most effective in providing care to the patients. 

How has this collaboration helped maintain access to health care for community members experiencing homelessness in the context of pandemic?

Stephen: The pandemic has displaced many community members from where they normally access supports. Additionally, many of these sites had shut down or reduced hours. Coming together in the way we have has allowed us to provide short-term relief and support to help manage people’s medical concerns while they are away from their normal supports. We have been able to help a large volume of people maintain a positive health status in the community during the pandemic.

Andrew: The EXPO allows people to access all resources (social and medical) and allows for a patient-centered approach with services. Working together under one roof has been extremely positive and demonstrated what an interdisciplinary practice in the inner city could look like.

Denise: Through the partnerships formed here, continuity of care has increased because we can easily collaborate on care plans and performing front line medical care for people experiencing homelessness and facing multiple barriers to accessing health care. 

Elaine: Our specialties cater to most of our patients needs. We have been able to support patients with barriers to healthcare, especially during these times of pandemic.

Lanie: The collaboration has ensured that patients do not fall through the cracks or get forgotten about. But most importantly, it lets the community members know that through thick and thin they are not forgotten about and that their needs will be met during a pandemic. We are here to support them. 

Can you share a story of someone who was helped by receiving services from the medical station? 

Andrew: A patient came in with a lower limb infection with multiple skin lesions, redness, and swelling. The community paramedics conducted a culture swab and collaborated with an on-call MD. The RN and LPNs handled the wound care by cleansing the affected area then applying a dressing. Lastly, the pharmacy staff was able to assess the appropriateness of the prescription and initiate medication therapy. All of this occurred within a timely manner, without the need for the patient to travel to different health care settings and potentially delaying treatment. This perfectly depicts the benefits of inter-professional collaboration and most importantly, sets the gold standard for patient-centred care.

Kelsey: I saw a patient two months ago who was experiencing withdrawal from fentanyl use. I had helped him get an appointment to start OAT. I recently saw him again and he informed me that hadn’t used fentanyl for two months. 

What do you hope emerges from this collaboration?

Stephen: I hope this will facilitate an openness to future projects and collaborations with our community partners. This experience has shown its effectiveness. I hope we can carry that over to our community roles when we are no longer all under one roof.

Denise: We have built interprofessional relationships that allow us to collaborate across sectors more easily in the future after Expo. Ultimately better continuity of care will hopefully be possible within Edmonton’s inner city.

Andrew: We are grateful to have been part of such a unique and collaborative program, which demonstrated the synergy of interdisciplinary teamwork. I hope this partnership will serve as a catalyst for continued collaboration, and transitions into a site where participants are able to continue accessing housing, social and medical services.

Kelsey: I hope the partnerships will evolve, and that continuous communication and collaboration can continue. Now that we all know how we can integrate care for our clients, we can move forward to ensure that the inner city population has better access to care, is connected to the appropriate resources, and that overall we can prevent people from falling through the cracks. 

Lanie: I hope that more information on how to help and support those who suffer with mental health and drug addictions will be more readily available. With community members, first impressions are lasting impressions and it’s important to make that good first impression so they can continue to feel safe and comfortable to seek help when needed.