DTES Women’s ICMT celebrate one year anniversary

This is the second in a series of articles highlighting implemented initiatives made in the DTES through the DTES 2nd Generation Strategy. This article looks at the Women’s Intensive Case Management Team (ICMT).

Meet Angela – an Indigenous woman who has lived in the DTES for the last 15 years.  Angela had been living with her partner in an SRO hotel, but after he violently assaulted her she bravely left and was homeless and afraid for her safety.  Angela’s opioid use became increasingly risky, resulting in multiple frightening overdoses.  When Angela woke up in hospital after an overdose, she would immediately leave, only to overdose again a couple of weeks later.  

Unfortunately, stories like Angela’s are all too common in the DTES. Women make up about 40 per cent of the DTES population and are a diverse, resilient, and vital part of the community. Many of the women have experienced significant trauma, violence, racism and stigma. They don’t feel safe and have had negative experiences that have broken their trust in the health care system. VCH Vancouver Community set out to change that through the DTES 2nd Generation Strategy.

The VCH Women’s Health & Safety Companion Paper defined a gender lens as a way to ensure all health services have an explicit focus on meeting the specific needs of all genders, particularly women (trans-inclusive) experiencing multiple forms of oppression and reducing the gendered barriers they face in accessing health service in the DTES.  As part of a larger effort to improve the way VCH cares for women in the DTES, Vancouver Community created the Women’s Intensive Case Management Team (ICMT). The women’s ICMT fits the model of a traditional ICMT but with a woman-specific lens.

The team is entirely comprised of women and consist of a nurse practitioner, RNs, social workers, a health care worker and a peer specialist. They are also supported by a physician with a mental health focus.

“What makes us successful is that when we first meet a woman, we don’t come in with an agenda but start by just getting to know them,” explains Michelle Apps, Social Worker. “We use an interdisciplinary approach, including a peer specialist who knows what it’s like to live here and can connect with women on a deeper level or advise us on the best way to approach a woman.”

Angela first met the Women’s ICMT when she was staying at a low-barrier shelter.  At first, Angela was uninterested in even making eye contact with the team.  But the team continued to consistently check in with her, taking Angela’s lead to go at a pace that felt safe to her.  Slowly, Angela became more open to talking with the team’s Peer Specialist and eventually agreed to see the Mental Health physician.  With the doctor’s help, Angela has found the right medications for her, which has made it easier for her to start using harm reduction services.  She started using SisterSpace (the women’s only opioid prevention site) and volunteering at a DTES organization.  The team also supported Angela through the process of pressing criminal charges and testifying against her abusive ex-partner.   

After eight months with the team, Angela was accepted to a supportive housing program.  The team helped her through the move and got her attached to the local mental health team – attending her first few appointments with her, until she felt confident to go on her own.  Happy in her new community, able to make and keep her own appointments, Angela and the team agreed she was ready to be discharged.   

Celebrating their one-year anniversary this month, the team has served 50 women in their first year, about half of whom are Indigenous. The goal is to help women stabilize their health, reconnect with their support systems and then support them to make meaningful connections to the services they need. So far, 16 women have been discharged from the team after completing their goals of care.

“It takes time to build trust and then help them get to a place where they’re ready to be discharged,” explains Apps.

The team works closely with a variety of partner organizations in the DTES, including shelters and other outreach programs who help them find women who could benefit from their support. Using an assertive outreach approach, the team goes out to meet their clients in the community whether that’s an alley, in the street, in their home or shelter.

“One young woman had a bad abscess on her arm and she couldn’t tolerate going to a clinic and sitting in a waiting room,” recalls Apps. “The nurse practitioner prescribed antibiotics and the team would go find her daily to ensure she was taking them. She even dressed her wound on the street.”

“I want people to put their expectations aside about what very marginalized women can and can’t do,” says Apps. “Not everyone is able to sit in a waiting room. Their life experience makes that impossible. We need to provide a different way for them to get care.” And that is exactly what this team is doing.

After five years of intensive consultation, planning and implementation through the DTES 2nd Generation Strategy, Vancouver Community has substantially changed the way they provide services in the DTES. For more information, visit the DTES web site. In addition to the women’s ICMT, other services for women in the DTES include: 38 addiction recovery treatment beds at the Rice Block; a women’s only Overdose Prevention Site; and plans for a mobile health van that will be used by the women’s ICMT.

Leave a Reply