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Hospital Spotlight: ‘Our collaboration saves lives’: Niagara HELPS program works with the homeless

Posted Jan 2nd, 2024

This is an opinion column by Niagara Health Communications Specialist Diane Moore, published in the St. Catharines Standard, Niagara Falls Review and Welland Tribune.

Niagara HELPS team members

Members of the Niagara Niagara Homelessness Emergency Liaison and Peer Support team, from left: Nancy Garner, executive director; Kaitlin Taylor, peer support navigator (PSN); Keanna Schuster PSN; Tyler English, program co-ordinator; Jenny Stranges, program director; Jennifer McIntee, PSN; Robbie Bakker, PSN; Scott Cronkwright, PSN.

Scott Cronkwright struggled with addiction and homelessness for decades.

Now, he works to help people like him get the help they need so they can get off the streets and out of the health-care system.

Cronkwright’s story isn’t unique in Niagara, where nearly every day patients come to Niagara Health for care, with nowhere to go when they get better.

“We have homeless patients who are very sick, with complex needs that are further complicated by a lack of housing,” said Breanna Elliotson, a Niagara Health emergency department (ED) social worker. “After we care for them and discharge them, often those same patients end up back in the ED due to their complex social problems.”

In 2023, Niagara Region declared a state of emergency for homelessness, mental health and opioid addiction. According to the most recent statistics by Toronto Public Health, the average Canadian life expectancy for homeless women is cut in half from 83 to 42 years, and is nearly 25 years lower for homeless men, dropping from 78 to 53.

Many people experiencing homelessness also live with addictions or mental health issues.

Cronkwright was one of them.

“I was 11 years old when I used drugs for the first time,” he said.

Cronkwright said he was sexually assaulted shortly after he turned 11 and started using drugs to ease the pain. The unresolved trauma from his childhood haunted him well into his 40s, leading him to again self-medicate with prescription drugs following a major surgery. His substance use spiraled out of control. He went from being a respected business owner to living on the streets.

“The first time I ever had to spoon with three men to keep warm was my first night out in the Burgoyne Woods, living in a tent in the dead of winter,” he said. “It was hard going from being a respected member of the community to being stigmatized instantly.”

“Some of the most meaningful connections that I have had with clients are with those who are just grateful to have someone with their lived experience come and talk with them and give them a boost.”

Even after recovery, getting his career on track and going back to university, Cronkwright said the stigma of his life choices has never gone away. Now, he uses the trauma of his childhood, the addiction and the experience of homelessness to give his life purpose.

Cronkwright is a peer support navigator with Niagara HELPS — Homelessness Emergency Liaison and Peer Support — a partnership between Niagara Health and Quest Community Health Centre. HELPS offers peer support to people experiencing homelessness who come into the emergency unit for care.

“I’m passionate about it,” he said. “We deal with a lot of shame and guilt as addicts, as homeless, as someone with mental health concerns, and one of the hardest things to get back into your life is the ability to be kind to yourself.”

Rob, who didn’t want to use his last name, is also a Niagara HELPS peer support navigator. As a former homeless substance user, he is keenly aware of the emotional challenges that come with seeking care.

“When I was 19, I had an abscess as a result of IV drug use and became septic,” he said. “I was refusing to go to the hospital because of previous experiences that I had, but some kind people really encouraged me to go to Niagara Health. I finally did and, as it turns out, if I didn’t go to the hospital when I did I would have lost my arm, or possibly died.

“The staff there were really nice to me and helpful and non-judgmental. But no one came to speak to me who had been in my shoes. I think having that connection would have been really important to my recovery as a drug user.”

Internalized biases within the community and health system about people who use substances has made it difficult for some to feel safe going to hospital for care while they are actively using drugs.

It’s people like Rob and Cronkwright, with lived experience, who can be a champion for those patients.

“People are in different states of change when we meet them,” Rob said. “Some people want to go to detox, some people want treatment, some people want to get off the streets. And some people don’t want any of those things.

“Some of the most meaningful connections that I have had with clients are with those who are just grateful to have someone with their lived experience come and talk with them and give them a boost.”

In many cases, people experiencing homelessness who enter an ED are not in need of emergency medical care. Instead, they may need help finding a bed for the night, a hot meal, or someone to connect them with the right community social service.

That’s where Niagara Health’s Familiar Faces program works hand-in-hand with Niagara HELPS to ensure those people frequently entering the ED due to homelessness get the right type of care.

“Niagara Health has bent over backwards to make us feel welcome. From fruition to the point we are at today, it’s been a bit of a Christmas miracle. Our collaboration saves lives.”

“We have people coming into the ED who need good care but don't necessarily need to be hospitalized,” said Elliotson. “But because they don't have anywhere to go to continue that care, the hospital continues to provide their needs until we can refer them to the proper resources, which can be a challenge when you do not have an address.”

Familiar Faces is a patient-focused program designed to reduce ED wait times by focusing on returning patients. It is for patients who frequently visit the ED with medical and other types of concerns better suited to other forms of health care or community services.

“The emergency department is a fast-paced environment and it’s not designed to deal with a lot of social problems,” said Dr. Stephenson Strobel, an emergency department doctor with Niagara Health. “Yet, a lot of people who are homeless wind up in emergency because it’s a point of contact for primary care. A peer support navigator understands patients better than clinical staff who’ve never experienced homelessness before.”

“We work closely with the staff and physicians in the ED,” Rob said, “but we also advocate for our homeless clients and see things a little differently having come from similar situations.”

Tyler English runs the HELPS program, which has seen 2,500 individuals since 2019.

“I feel that our hospital system now really recognizes the value of peer support and leaning into each of our experiences,” he said. “We are simultaneously working very closely with our hospital health-care professionals, emergency medical services outreach and community shelters.”

It all started in 2015, when Dr. Rahat Hossain and some of his medical school colleagues started a project to understand the lived experience of people who are homeless and accessing health care in the Niagara region. After interviewing dozens of people without a place to live, a highly cited study was published.

But for doctors Strobel and Hossain, that wasn’t enough.

“From that qualitative interview study, we then worked with a theatre company to translate the findings into a play,” said Hossain. “It was participatory theatre. People could actually pause the play and replace an actor on stage to try and fix a problem in the hospital scene. One of the plays was performed specifically for people who have experienced homelessness.”

One of those who jumped up on stage to take over a scene was none other than Cronkwright.

“Afterwards, there was a whole discussion with the actors and audience and their interventions in the show,” said Hossain. “An idea that came out of that project was peer support in emergency departments.”

Niagara HELPS was born, and Cronkwright has been involved ever since.

It has proven to be so innovative that McMaster University’s office of community engagement has recognized the program with the President's Award for Community Engaged Research. With it comes $10,000 in funding to further the research on peer support and its impact on the number of homeless people entering emergency departments.

“When we put a peer support navigator in the hospital, what happens to demands for medical services?” asked Strobel. “We don’t have a handle on that yet.”

Early findings, however, are showing a positive correlation between Niagara HELPS and a reduction in repeat emergency visits.

For English, the change he hopes will take place is in the attitudes people have towards those struggling with addiction, mental health issues and homelessness.

“I myself have experienced some discrimination because of my substance use,” English said. “I always felt that I wasn't taken seriously. It's my hope that by working with NH and our community partners, we can help ensure that nobody feels like that ever again.”

Said Cronkwright, “Niagara Health has bent over backwards to make us feel welcome. From fruition to the point we are at today, it’s been a bit of a Christmas miracle. Our collaboration saves lives.”

Niagara Health System