Team approach used by Edmonton health program helps break cycle of ER visits for homeless

Troubled by a deep rooted crack cocaine and drinking problem, Shawn Kelly couldn’t see any way out of a life burdened by addictions.
Shawn Kelly's drinking and drug-using lifestyle led doctors at the Royal Alexandra to connect him to ARCH, a pilot project at the hospital to help fight addiction 2:35

Troubled by a deep rooted crack cocaine and drinking problem, Shawn Kelly couldn't see any way out of a life burdened by addictions.

"I was addicted to cocaine and alcohol, I was addicted to both, and that's all I knew and had," said the 42-year-old Edmontonian.

When Kelly showed up at sister Kim Kelly's house after moving to Alberta from Ontario earlier this year, she didn't know what to do. But seeing that he was on a one-way path to misery and pain, she took him to the emergency at Royal Alexandra Hospital in April.

It was a decision that would change his life. If that hadn't happened, Kelly said he has no doubt where he would be today.

"I'd probably be on the street in a shelter, living outside, drinking," he said.

It was his drinking and drug-using lifestyle that led doctors at the Royal Alex to connect him to a pilot project at the hospital. It began in 2014 as a way to offer more help and support to people showing up at the emergency with a myriad of complicated issues in addition to their health problems.

"I saw many patients that would come back to our emergency department," said Dr. Kathryn Dong, director of the inner city health and wellness program. "We were very good at dealing with the acute medical issues, but there was so much underlying that. Untreated substance use disorders, poverty, homelessness."

As an emergency room physician at the time, Dong was inspired to figure out how to do more for the type of patients who might get treatment for pneumonia, but then get sent back to the street.

Dong asked her patients what kind of additional help they needed to avoid the cycle of returning to the ER for treatment after being put back on the street.

Miracle workers

What emerged was a brand new approach, and the forming of a clinical team involving six doctors who work alongside a nurse practitioner, a social worker and an addictions counsellor.

The program is called ARCH, or Addictions Recovery and Community Health.

All the physicians who are part of the team have expertise and extra training in addictions medicine.

But Dong said she believes it's the addition of the team — supporting the doctors — that is key to the project's success.

"Those team members are really our miracle workers," said Dong. "They are unbelievable in getting patients into housing, into treatment, programs linking them to income and other supports that exist in the community and really providing a bridge that we didn't have before at this site."

When Dr. Kathryn Dong was an ER physician, she decided to find a way to break the cycle of addictions, poverty and homelessness that keeps driving people back to hospital emergency rooms.
The team has been able to work those "miracles" to help Kelly turn things around.

They began by helping remove some of the barriers preventing him from getting the kind of care he needed.

Something as simple as not having an Alberta health card was one thing standing in the way of him getting into addictions treatment fast.  

"He wasn't able to secure a family doctor because of that, so our doctors were able to help with getting him the medications he really needed and keeping him from needing to be in an emergency situation in the hospital in crisis," said Esther Leung, the social worker on the team.

Because identification opens up so many options for social supports and programs, the ARCH team now has its own ID program, offering identification without any certificates and at no cost.

Innovative program a model for other cities

The cost of the three-year pilot project is $3.5 million. The money was provided by the Royal Alexandra Hospital Foundation, which views the results so far as promising. More than 800 patients, nearly half of them homeless, have benefited from the clinic's team approach.

As well, the foundation argues the project is saving money across the system.

It's doing research to illustrate that in the program's final year, in order to make a case for consistent and stable government funding.

Andrew Otway, president and chief executive officer of the foundation, said it's hoped the program can be funded in the long term through Alberta Health and sources outside the foundation. But it must be shown the program is "worthwhile for great patient outcomes" and have an overall positive impact on the health system, he said.

Otway credits Dong for coming up with a visionary program, which he said could end up being a model for Calgary and other Canadian cities.

But Dong said the patients themselves are a big reason for the strides being made.

"They get a lot of credit because they have a lot of input into our program, and we've done it in a partnership with our community and they really drive the direction," Dong said.

Meanwhile,  Kelly said he feels like things are looking up in his life for the first time in years, thanks to support and compassion from the ARCH team.

"I had absolutely nothing and now I feel healthy," he said.

He completed an intensive addictions treatment program at a centre in Ponoka, after the ARCH team secured him a spot there.

He's proud that he's been clean for about six months. His next goal is to look for work, something he never imagined possible during his homeless days.

Kelly's sister confirms her brother is a "different person" today. She's developed a newfound trust and respect for him, and said she is happy to have him live in her house while he finds his feet.