This article about the Connexion program is the third in a series presented in 360.
The Connexion team is made up of two social workers and one active nurse who take to the streets of Montreal to work with the homeless that are disconnected from services offered in our CIUSSS.
Myriam Kaszap, a Street Nurse for eight months and Judith Sigouin, a Social Worker with Connexion since 2013 spoke to 360 about their experiences with this unique program based out of CLSC Metro.
360: How is practicing outdoors different from a conventional setting?
Connexion: Our team works outside of four walls, that’s certainly quite new. Working with people on the street, where our interventions take place in community organizations, is a different approach. What is also unique is that we go to people before they come to us. We extend a helping hand without being asked, when someone appears to need it.
We work on a case-by-case basis. The concrete actions that we take, such as accompanying someone to the hospital for several hours, helping them to clean up, or searching for housing on Kijiji, these are not necessarily the job requirements of a social worker. That said, there are more and more healthcare professionals that are taking on these tasks because otherwise, their care plan will stall. They are actions that need to be taken, and they take a lot of time. It’s about being creative with each intervention and going above the mandate.
If you want to achieve a clinical objective—such as health or psychosocial stability—in-office consults might not be what is needed. Nor is it necessarily helpful for the client to become autonomous. We learned these formulas in school but in our work, we serve a population that is very marginalized, and we have to adapt our objectives to that reality.
360: What character traits do you need to carry out this kind of work?
Connexion: You have to be resourceful, comfortable working in the margins, and creative in devising solutions when there may be few, if any. You also have to be at ease working without a fixed framework, though we are supported by colleagues and supervisors.
Our program requires that you constantly adopt new ways of acting and thinking. For the moment, especially seeing as we are still a small team, we must assume that our rhythm of work is ever-changing. A crisis can materialize at any time, as well as other situations that are challenging to manage, and you may not necessarily have someone by your side to help you.
360: Have you ever felt fearful or under threat?
Connexion Myriam: Yes, I felt uncomfortable once but I put an end to the intervention before it escalated. As for feeling fearful, I was once in a resource centre and when I left, I realized that had the situation degenerated, I would have screamed but there wouldn’t have been anyone there to hear me. I don’t think there was any direct threat, but at that moment, I was scared. Since then, I adjusted the way I work.
Connexion Judith: At first, when Connexion had just launched, I was confronted with difficult situations when I worked alone and had inadequate protection. It was a little all over the place. I felt safer at community organizations because my colleagues knew where I was and what I was doing. At the time, I did not exercise as much prudence as I do now. With experience comes a sense of knowing what to do and what not to do. I am more careful to follow my intuition about people.
It is important to clarify though that the people we work with are not dangerous. They know, regardless of how psychologically unstable they may be, that they are not very high in the social hierarchy. They feel that they don’t have much power in relation to anyone they come by, be they passersby, police officers or healthcare workers. The people we work with might get mad or agitated, but they know that ultimately we are there to help.
360: What is your biggest obstacle?
Connexion: We struggle most with collaboration. The clients, in general, want nothing to do with the system and the system wants nothing to do with the clients. They are not necessarily adapted for one another. The itinerant goes from hospital to hospital, he wants to drink. He does not want to wait, does not want to be confined to a stretcher for days on end. But that is what treatment requires. The hospitals, meanwhile, are teeming, and the itinerant resents not being spoken to respectfully, and he may respond in kind. Ultimately, though, it is expected that the individual conform to the system, rather than the system adapt to the person.
There are services that Connexion cannot offer. We are two professionals who are supposed to direct people toward services. We don’t offer certain medical and psychiatric aid, specialized interventions that can only be given in a hospital, therapy centres or shelters. Having doors shut on us regularly, despite our efforts at being “politically correct”— that becomes burdensome.
But, this is our mandate, it’s what we’re here for. It is our team’s battle.
360: What do you find most rewarding in your work?
Connexion: The moments, when after a long process, a person says, “Thank you for having believed in me”. It’s rare, but not uncommon at the same time. That’s really it. They are people who are really disconnected from services, they no longer seek out services, they have been clients time and again, have been institutionalized since they were children, and may have had difficult experiences whether in the system, in hospitals, prisons or youth facilities. They know who social workers and nurses are. They know the services, which is exactly why they feel that no one believed in them any longer.
This is why it is important to devise interventions that are outside of the box. Going to the hospital with someone and making sure they can hide beer in their backpack so that they can tough it out, it’s not everyone that would agree. But it allows the person to receive a diagnosis and things begin to advance, rather than remaining stuck in a wheel that spins but moves nowhere. To hear that the person is then appreciative because you were so obliging, it’s very gratifying.
It’s the fact that they understand that we believed in them against all odds.
360: Are there some improvements that you feel can be made to the system?
Connexion: This is a good time for Connexion because there has been progress. We’ve been saying for the longest time that before anything else, we need more staff on the ground, and now it’s happening.
There are many areas we need to address. Some services need to be improved and more flexible. We have many informal corridors because at the other end of the line is our friend who can help us access a doctor. But, if our friend is no longer there or is too busy, things don’t work. It shouldn’t be that way.
We are not asking that all services become more flexible, but just that a small corner of entry be more open. That in and of itself would be a nice improvement.
Better communication with centres outside the CIUSSS would also be good. It takes so much time. We write everything down, over and over for the professional orders. It feels like we are constantly repeating ourselves because establishments are so big now and the CIUSSSs are enormous. With homeless people, who are very isolated and don’t frequent the same hospitals all the time or have follow ups done, we have to redo all the files with everyone, tell their story all over again.
From there, many details fall through the cracks because people don’t listen until the end or don’t finish reading reports. It becomes like broken telephone, and we end up seeing this in the report post-hospitalization. Sometimes, this breakdown happens within the same centre. A client’s story is told to someone who is no longer there the following day. Then, there’s no follow up. We work in an environment where people don’t always stay at the same worksite, and that means reestablishing links with new people. It’s a waste of time. Dossiers need to be more clear and accessible.
360: If you had a message to share with professionals and the general population about the homeless in Montreal, what would it be?
Connexion: What makes our job very interesting and hard at the same time is that there isn’t one recipe that works for everybody. To say that all homeless people are the same is completely wrong. It seems very obvious, but they are human beings.
Nevertheless, it seems like people are more informed today. For the past few years, homelessness has been coming to the fore.
We have to remember that these individuals had different and difficult trajectories, but sometimes not so different. They can be in a crisis situation and when you investigate a little further, you realize that there are people who you know who would also turn to the streets if they were isolated, had health problems, or would face dilemmas later in life. There are many people who became homeless who had not led a marginal life.
There is a vicious circle in the system. That’s what we have to remember. Becoming anchored in homelessness is dangerous. We can turn things around if we act in a timely manner. When a person comes from out of province, for example, and doesn’t have any identification, it is very hard for them to get a health insurance card. In this case, they would need to request a document like a birth certificate. But, if they don’t have money to do so, then what? This all takes time, and leaves the person feeling depressed and despairing.
During this time, the person finds their place in the streets. They get used to it, figure things out and learn about what they have access to. They wind up disaffiliating themselves and don’t think that they can live alone. This becomes heavy for society, but there was a lot that could have been dealt with before that point.
360: Are there career opportunities in this field?
Connexion: There is a need. Homelessness is growing, unfortunately. There are many people who don’t “fit” the systemic trajectories set by the CIUSSS and institutions. A team like Connexion is needed to connect people who are cut off from the system.
There is a need for more workers in this milieu. At first glance, it isn’t as popular but at the same time, we are often surprised by how many people are interested when we explain our job. The more healthcare professionals that are integrated into the system, the better the system will function and the more efficiently its existing services will run. The larger healthcare system will benefit from having small teams who do the ground work.
The Connexion team have fully embraced a person-centred approach, concludes Tung Tran, the Associate Director of the Mental Health and Addiction Programs. The performance of this team is complex, and cannot merely be measured according to volumes or timelines. Efforts are focused on outcomes, such as improving health status, independence, quality of life and patient experience through the creation of a flexible care plan that recognizes the individual health and social-service needs of our clients.