Emma’s Story and how the DTES 2nd Generation Strategy will help her

Emma lives in the DTES. She has diabetes, bipolar disorder, and trauma from abuse. She is on medications for her conditions, but she also uses street opioids. She sees a counsellor, a psychiatrist, a GP, a social worker and a pharmacist. Her care needs are complex. But she isn’t unique to the clients we see in the DTES.

It is because of clients like Emma that VC set out to review our services in the DTES and change them for the better. Prior to the DTES 2nd Generation Strategy, Emma’s care was spread across multiple sites and she was often confused about where to go for what and when. She wasn’t the only one frustrated by this system. Her care workers also felt frustration over the fact that they couldn’t collaborate on their clients’ care plan and coordinate proper follow-through.

“We wanted to become more client-focused in our care,” explains Bonnie Wilson, Director, Inner City and MHSU, VC. “We also wanted our staff to feel more empowered and satisfied with the work they are doing.”  In the previous care structure in the DTES, Emma had to meet multiple clinicians at different locations and retell her story to each of them – reliving the trauma over and over again. And because she had been assaulted in the past, she worried she might see her assaulter at one of the clinics. She also felt uncomfortable with male physicians. Emma’s care needs were not tailored to her.

What’s changed in the DTES?

After five years of intensive consultation, planning and implementation through the DTES 2nd Generation Strategy, Vancouver Community is substantially changing the way we provide services in the DTES. Please see Opening of Heatley CHC marks New Model of Care in DTES in this edition to read about the new structure. In the meantime, here is a look at what these changes mean to Emma and others like her in the DTES:

  • Emma will now go to one of our three integrated Community Health Centres (CHC) for all her care needs.
  • She will have a care coordinator who will develop a plan tailored to her needs.
  • We have Integrated Care Teams (ICTs) and Emma is assigned to one of these teams.
  • Peer members at the clinic make Emma feel welcome.
  • We have extended hours at our CHCs and 24/7 on-call services.
  • (See Opening of Heatley CHC article for full list of benefits)

“We’re excited by the changes,” adds Wilson. “The ICTs will be critical in building the relationship with clients to help them address all aspects of their care needs and changing their patterns of use, employing harm reduction strategies, accessing treatment, adhering to treatment. It’s about focusing on the client and helping them get their life back.”

To see Emma’s full story: DTES Health Service Integration future state – Emma’s story – 2018-01-09.

 

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