Making a difference in Vancouvers Downtown Eastside

The Report: April / May 2008 vol.29 num.1

by LAURA BUSHEIKIN

ancouvers Downtown Eastside, known as the -worst postal code in Canada" due to the despairingly high level of drug addiction, homelessness, mental illness, extreme poverty and general social dysfunction experienced by its residents, is ‘the office for HSA member Sandra Boyd.

Her clients have both a mental health and addiction problem, which is commonly referred to as a concurrent disorder. She works with them to support them in getting the services they need, and to stabilize their lives and health as much as possible.

Boyd, a social worker, is a Client Care Coordinator with the Urgent Response Team of the Vancouver Coastal Health Authority, working with about 20 colleagues as part of an innovative program that aims to bridge clients to a network of services and facilities.

In describing a typical client, Boyd paints an overwhelming picture: -Many clients have had untreated health problems for many years. It could be social anxiety or chronic depression all the way up to untreated schizophrenia. Many have chronic poly-substance misuse issues over many years. They may have started drinking or smoking cigarettes as young as 10 or 12 years old and now, 20, 30, or 40 years later, they are maybe still drinking alcohol and also doing crack cocaine. They are often chronically or cyclically homeless, living sometimes in a single-room-occupancy (SRO), sometimes on the street, sometimes couch surfing or using the shelter system.

-The clients often have complex medical problems such as HIV, Hep C, or COPD (chronic obstructive pulmonary disease). Intravenous drug users can end up with abscesses and infection that can require intravenous antibiotics and many times they have difficulty complying with twice daily visits to the hospital for treatment.

-Many of them have no financial assistance because theyre not able to jump through the hoops to get it. Theyve been living outside, so they often have street feet ... its like trench foot; theyve been wearing the same shoes and socks and their feet are wet the whole time. Its terrible," says Boyd

It would be easy to think of these as hopeless cases and just give up. But Boyd says there is much that can be done to measurably improve her clients health and life situations. This leads to more efficient use of healthcare and community resources; in particular, reducing visits to hospital emergency rooms ... one of the programs goals.

The key is setting realistic goals.

-You have to measure success in increments," she says. -For instance, someone has an addiction problem and an untreated mental health problem and is homeless, and has become a frequent user of Emergency. If I can stabilize them in an SRO with a primary care physician and they get onto appropriate meds for their mental health problem, but they continue to use drugs, I would still consider this a huge success because they are no longer on the street, no longer homeless, no longer untreated in their mental health problems, and no longer a frequent Emergency user."

Boyd says her 16 years of social work experience have given her the maturity to stay focused on what works, rather than getting overwhelmed with all the challenges. -I have a lot of experience to fall back on in terms of boundaries. Its a nice place to find ... that place of compassion and caring without over-investment. To find the balance where you are present to your client, present in their lives, but you can go home at night and live your own separate life," she said.

Boyd, who is an HSA steward, earned her Bachelor of Social Work at Ryerson University. She joined the Urgent Response Team when the program was starting up in 2005.

One thing she loves about the program is that it allows her to get out into the community where the clients live.

-We work from an assertive case management model," she explains. -We dont wait for them to come to us; we go out to where they are. I have the autonomy to help a client follow through with their plan rather than just giving them a phone number or directions to somewhere." This
includes going with clients to appointments or sitting down with them to fill out income assistance or disability claim applications.

The program also liaises with agencies to improve services. For instance, they have partnered with the Ministry of Employment and Income Assistance to address barriers facing Urgent Response Team clients. -The URT has made some amazing strides forward in terms of trying to reach
out and connect with the most vulnerable in our community," Boyd said.

She likes the community and feels relatively safe on its streets, although she doesnt want to minimize the extent of the problems there.

-When I first moved here, even though I had worked as an outreach worker for six years in Toronto, nothing could have prepared me for the serious drug problems that are here." At the same time, she says, it is a neighbourhood. -But it takes a while to see that. As a passerby, youre not going to stop at the Eastside Coffee Bar and get a coffee. You have no idea that Tom, who runs the coffee shop, makes some of the best organic Americanos and lattes in the city. But youd never stop because its on Powell Street and doesnt even look open. This is a community you really have to be in before you know what its about."

Her job gives her an advantage, she says. -Our jackets say Vancouver Coastal Health. That says ‘we will help you. I can walk down the street at night in the pouring rain and I never have any problems."

It may be a tough assignment, but Sandra Boyd is clearly happy to take on the challenge.