Street Health Community Nursing Foundation
Our Story What We Do
History of Organization
In 1986 a group of homeless people in Toronto met to discuss the healthcare issues they were facing. They felt discriminated against within the healthcare system, and given their circumstances were often unable to follow prescribed treatments. The group identified nurses as the people they would feel most comfortable going to for healthcare.
Upon learning of the initial discussions, a group of volunteer nurses opened the first Street Health nursing station in September 1986 at the Toronto Friendship Centre drop-in, in the All Saints Church at Sherbourne and Dundas. Other nursing clinics followed, located where homeless people congregated, in order to provide hands-on healthcare and assistance in accessing and navigating the existing healthcare system.
Accolades and Accomplishments
For 30 years, Street Health has been providing physical and mental health programs to homeless and under housed individuals in the southeast core of Toronto. Our work focuses on the neighbourhood around Dundas and Sherbourne Streets, which has the largest concentration of homeless shelters and drop-in centres in Canada.
We provide our services on the street, in alleys, along the lakeshore, in parks and ravines, in homeless shelters, and drop-in centres. The people we work with have lives characterized by extreme poverty, chronic unemployment and/or seniors on a fixed income, insecurity in housing, poor nutrition, high stress, and loneliness. They also have more frequent and serious illnesses, and on average die younger than the general population.
Street Health works closely with others within and outside the social service sector who want to learn about health and homelessness from our experienced staff. Presentations and training sessions are regularly given to the general public, and workers in the health, social service, and government sectors.
Our belief is that the services we provide, should ideally not be required, finds expression in our advocacy work, both as advocates for individual clients and for enduring social and political solutions.
Our Programs How We Do It
Staff nurses work with volunteer RNs and NPs to operate scheduled clinics in drop-in centres and shelters. Nursing outreach is designed to locate people living on the street who generally avoid mainstream services. The nurses advocate for clients on an individual basis. Mentoring students and other healthcare related disciplines, and conducting public education, are important components of our program.
Community Mental Health Program:
Provides support for people who are homeless or under-housed and experiencing mental health issues. The workers assist people in trying to access basic needs. Other support includes crisis intervention, outreach, informal counselling, and legal support as well as facilitating access to other community resources. The program also focuses on advocating for individual clients and addressing systemic issues of poverty, homelessness, and human rights.
Harm Reduction Program:
The street outreach team provides clients with referrals and peer support related to the harms associated with substance use. The program includes needle distribution, safer crack kit distribution, street outreach service, and support for sex workers. We have regular participation of 15 peer workers in our street outreach and kit distribution and education programs.
I.D. Replacement - Access to Health Cards for the Homeless:
Street Health’s Access to Health Cards program was established to assist homeless people with the onerous task of applying for health cards and the other personal identification they need to access health and socials services.
Homeless people can easily lose their identification due to unstable living conditions. The program offers security for homeless people by storing their important documents, helping them to maintain access to services which require proof of identification. People can also have mail delivered and stored at ID Safe.
Street Health has focused our research efforts on evaluating the effectiveness of existing programs and services.
Nursing Outreach Program
During the winter of 1998, Street Health recognized a growing need in the community and decided to take the Nursing Clinic Program a step further. It was at this point that the Outreach Team was introduced. Street Health nurses in partnership with the Mental Health and AIDS/HIV Harm Reduction Programs operate a rotating outreach schedule to ensure that a balance of expertise is present on all outreach visits. The team can be found on any given night, combing the streets, parks and alleyways of Toronto with a backpack of medical and personal hygiene supplies, searching for people in need.
The Outreach Program is aimed at treating homeless people who are living outdoors and have severe mental health issues that make it impossible for them to attend scheduled nursing clinics. These people are often very confused and isolated from society. They face increased danger to their lives as a result of violence, stress, depression, and extreme weather conditions.
The team assists approximately 75-100 people each week who are in need of nursing attention and emotional support. Over the years, the team has gradually learned of the secluded places where people are living and often do follow-up visits to these hidden makeshift shelters. Through unrelenting hard work and acceptance, the team has established trust among the most vulnerable population, and a definite presence in the community. Through treatment of these individuals on the street and in clinics, the number of homeless individuals visiting emergency rooms in Toronto has significantly decreased.
Funding and Program Partners
Street Health recieves funding from the provincial government, Health Canada and several private funders in order to effectively run this program.
In 2015/16 Street Health had more than 26,400 client visits, with 13,968 Nursing and Community Mental Health client visits.
Toronto's Vital Signs® indicator(s) addressed by Program
"Homeless people suffer far higher rates of chronic disease and premature death than those who are housed, and have more difficulty accessing health services."
Nursing is considered to be one of the most vital programs at Street Health. Our nurses work tirelessly to provide care and compassion in a community where disease and infection spread easily and the hope for recovery is bleak. We currently have four full-time staff nurses and eight rotating volunteer nurses. Staff nurses and volunteers operate scheduled clinics on a daily basis in drop-in centres and shelters.
Our nurses deal with every type of health related issue including, tuberculosis, malnutrition, heart disease, hepatitis, and HIV/AIDS. The appreciation and respect that our nurses receive from the community cannot be duplicated.
Leonard first came to Toronto over 40 years ago as part of a travelling carnival group that set up shows all over southern Ontario. He was the “Birthday Game Man”. Leonard loved the carnival: meeting new and interesting people, travelling, seeing the smiles on children’s faces, and watching people make happy family memories. When the show went out of business, Leonard settled in Toronto near Dundas and Sherbourne Streets. He worked several jobs over the years to make ends meet. He worked hard and had a full life.
As he got older, Leonard’s income began to dwindle. Life became more expensive over the decades and he wasn’t able to keep up. Try as he might to make ends meet, he was eventually forced out of his apartment and into a shelter. In an effort to stay independent and healthy as long as possible, he found Street Health and began visiting the nursing clinics for regular check-ups.
One day, in his early 70’s, Leonard was waiting for a streetcar when out of nowhere he was jumped by two men. They struck Leonard over the head with a golf club but were chased off before stealing his money. Luckily, Leonard was in the vicinity of Street Health when this happened and a nurse came out to provide assistance. He was taken to the emergency department at St. Michael’s Hospital where it was determined he had suffered a major head trauma. His speech was slurred, he had difficulty remembering simple things, and his balance and vision were affected.
Leonard went to live at a nursing home temporarily while he recovered from his injury. Much of his long term memory was gone; he was unable to recall details about his family or his childhood. Leonard had been robbed of his history. After a year Leonard decided he was well enough to leave the nursing home, determined to reclaim his independence. Leonard was now an old man and homeless, living on the streets and occasionally in a shelter. He often snuck onto the grounds of the nursing home at night and slept under a tree because it was familiar and felt safe. His memory and vision were very bad. Again, Street Health was there for Leonard as he began visiting our nurses twice a week.
Today, Anne Marie, a nurse at Street Health provides care to Leonard. She has spent countless hours with him, talking and providing much needed nursing care. Leonard is often confused, with feelings of hopelessness. He has persistent sores on his legs as a result of poor circulation which need to be cleaned and bandaged frequently. He has glaucoma in both eyes. Anne Marie does her best to assist Leonard in maintaining his health, by organizing his weekly medications, making and keeping track of his many doctors’ appointments, as well as accompanying him to these appointments. She has also arranged for his mail to be sent to Street Health and she helps him sort his bills.
Each time Leonard leaves the nursing clinic, he whispers to Anne Marie, “Okay bye, I’m gonna miss ya.” It is profoundly sad for Anne Marie to see Leonard living on the streets at 82 years old. “When I first came to Street Health I was prepared to see a lot of terrible things. But I never thought I would be treating a man in his 80’s who sleeps outside almost every night,” says Anne Marie.
Anne Marie’s greatest accomplishment for Leonard was recently finding him a home. After almost five full years of living on the street, Leonard will be moving into an assisted living apartment in May. Street Health and Anne Marie worked tirelessly for months to secure Leonard a place in a brand new facility and when Leonard toured his new home, he said only “I’ve never seen a place so beautiful”.
Leonard is like many elderly men and women living on the streets of Toronto today. These people have worked hard their whole lives but in old age do not have enough money to live on and do not have family to care for them. Their life-altering circumstances have led them to a place of suffering. Leonard could be your father, your grandfather, or your brother. This is where Street Health steps in; we provide care for people who have nowhere else to go. We are often their entry point into the healthcare system. We give hope to the hopeless.
Street Health in collaboration with Regent Park Community Health Centre (RPCHC) offers an integrated model of care for individuals who are struggling with complex issues such as homelessness, substance use, and mental health concerns. It is our experience that these citizens experience the deeper influences of poverty and the social disadvantage on health that radically increases their risk of: contracting infections such as HIV, Hepatitis C and TB, experiencing trauma and related mental health concerns, or acquiring head injuries and other physical injuries. Our collaborative programming increases access to health and social services and builds upon participants' unique strengths enhancing the ability to take greater control over one’s life. Weekly drop-in components offer a safe, unstructured format where participants are able to rest, socialize, enjoy healthy food, access phones, laundry, and shower facilities. In addition, participants are able to access health and support services such as nursing care and housing assistance. Nursing care provides a broad range of assistance from prevention services, to crisis intervention and primary care. Drop-in staff and peer workers link participants to appropriate services, provide support, encouragement and education. The project excels at providing accessible and effective care to populations who are often described as “hard to reach”.
Funding and Program Partners
Street Health and the RPCHC initiated this partnership in 2005. Both agencies contribute to the funding of this project.
The project has continued to improve access to primary and preventative healthcare: 70% of participants report utilizing health services. This model of care is able to provide easy and essential access to clinical and support services.
80% of participants report an increased sense of belonging and feelings of hope from participating in the drop-in programming. The following significant impacts for participants have been reported through project evaluations: increased sense of community belonging, increased self-esteem and self-worth, increased ability to manage substance use.
30% of drop-in participants found housing with the support of the housing worker.
Toronto's Vital Signs® indicator(s) addressed by Program
"Toronto’s homeless are hospitalized more often than the general population, (the rate is estimated at 23 hospitalizations per 100 people per year, compared to 5 per 100 per year in the general population). They enter hospital with more acute health problems (particularly mental health issues) and stay longer, often because they cannot return to a shelter and have nowhere else to go."
Our integrated model of care provides preventative health and social services that help to reduce hospital admissions. Participants are able to significantly advance in their ability to stabilize, find housing, increase support networks and engage in their personal healthcare.
"The drop-in is a great place to connect with people. It is safe for those who struggle with drug use and or homelessness. There are lots of supports offered and if you are lonely you can socialize with others and that could help – believe me I know. I learned lots at the drop-in:
- I learned to be healthier, making wiser choices for my health: now my life is a lot better and more stable
- I got connected to other programs that broadened my knowledge
- I get help maintaining my positive changes
- I am NOT using today – because of all the support I received
- I have closer relationships with other people
I don’t think I’ll go back to using drugs ‘cause it would end my life. I know my life has changed tremendously. I have gotten the support I needed which helped me get my life back to normal. IT WAS WORTH ALL OF THE WORK! I like myself at this point in time, a lot better than before when my life was so unmanageable.
I try to remember two main things the drop-in program has taught me: Good people do drugs too and I am able to believe in myself and other people again."
What You Can Do
Nursing Outreach Program
Activities a donation will support
By supporting our programs at Street Health, your contributions will help to enhance and expand the Nursing Clinic and Outreach Programs for homeless and poor individuals. Funding would allow Street Health to better serve the needs of the rapidly growing homeless population in Toronto. This would include: expanding the staff, purchasing much needed medical equipment, nursing materials, and the provision of hygiene supplies to our clients.
Supporting the Street Health Nursing Outreach Program will allow us to:
- Purchase nursing and outreach supplies such as over the counter medications, socks, hats and mitts, and sleeping bags
- Enhance and expand our existing programs
Activities a donation will support
A donation of $300 allows us to provide nourishing food for project participants for one month. A donation of $320 assists us in maintaining the crucial peer support component for one month. A donation of $1000 helps us to provide social recreational activities for drop-in participants such as camping, skating, or summer picnics.
Investment in our integrated model of care allows Street Health and the Regent Park Community Health Centre to reach isolated populations and provide critical supports that allow individuals who struggle with complex issues to take greater control over their lives.