Walking in Their Boots: Experiences of an Outreach Team
in Vancouver's Downtown Eastside [abstract]

Evanna Brennan, RN [Home Care Nurse]
Susan Giles, RN [Home Care Nurse]
Susan Burgess, MD [Outreach Physician]

ISSUE: Providing health care to clients who are marginalized by a combination of HIV/AIDS, substance abuse and/or mental health problems is challenging. Supplying appropriate health services to these individuals often requires methodologies outside the scope of standard practice.

DESCRIPTION: An outreach team consisting of community health nurses and a physician has been working together in Vancouver's Downtown Eastside for the past 10 years. They provide case management, care and treatment to a cohort of heavily addicted individuals living and dying with AIDS. They don't wait for the client to come to them, they seek them out on the street. Through gritty trial-and-error field experience, they have pioneered a model called Action Based Care (ABC) that is truly client-centered (i.e. where the client is at in the moment). This pragmatic approach relies on:

  1. Flexibility. The team reacts immediately to rapid changes in the client's health status.
  2. Trust. The development of a relationship with the client over time by a small group of caregivers allows for easier treatment access and more predictable results when a crisis happens. Trust between team members regarding clinical assessments allows telephone consultation between physician and nurse to quickly change or initiate care.
  3. Persistence. Clients may be abusive or reluctant to engage in care at the moment. This behavior does not rule out their being accepting of help the next day, month, or crisis. This presentation will walk through a typical outreach day using case histories to illustrate the application of the ABC model in practice. ABC has been shown to provide a platform for the client to use to regain at least some control over their lives. This can and often does result in measurable improvements in their health and ability to cope with their environment.

CONCLUSION: The client may be able to maintain their independence with fewer crises requiring hospital-based care. The close client-centered working relationship between the physician and the nurses results in greater efficiency and efficacy.