Ending the plight of chronic homelessness at the individual level
Many homeless people in Toronto remain on the street or in shelter due to the fragmentation of health care and shelter care in the City resulting in the revolving door cycle between shelter, hospitals, multiple health care providers and street. The CAISI Project aims to break this cycle by enhancing the ability of multiple agencies to offer more integrated services to a homeless client, ultimately leading to placement in the community where such placement exists.
Ending the plight of chronic homelessness at the population level
Ending the chronic homelessness...
Half of Toronto shelter beds are occupied by those who are chronically homeless. Advocacy for affordable housing, supportive housing and subsidized housing could benefit from ready access to real time answers to questions, such as:
1) How many persons with severe disability (brain injury, severe mental illness, developmental handicaps, physical disability etc.) are living in emergency shelters or on the street right now, and how long have they been living this way???
2) How long have persons with severe disability been waiting in shelters or on the street to get back into the community because no community housing or placement programs exist for them???
CAISI could provide answers to questions such as these on an ongoing basis. Such answers will give decision makers the tools and mandate to immediately put resources in place to correct inadequacies that few if any would find acceptable.
Ending the plight...
While people remain homeless, there is much that can be done to reduce the plight of being homeless by providing better care for at the population level or community level. Such care can be tracked by an integration of care as offered by CAISI. Such numbers and care include:
1) Providing more integrated immunization programs and being able to track how many people who are chronically homeless have been adequately immunized against preventable illnesses such as influenza and pneumonia. This could further help in protecting those who are homeless from pandemics.
2) Providing more integrated TB and emerging illness screening and surveillance. The CAISI system would allow public health officials to know what the rates of TB infection are among those who are chronically homeless. The CAISI system would also allow care providers to incorporate active brief screening questionnaires for illness such as TB or new emerging illness such as SARS when needed in emergency situations. Vision Evolution
For a detailed evolution of our vision that includes past vision statements please see: Vision Evolution.
What does 'integration of care' mean?
The CAISI vision is 'Agencies and clients integrating care to end chronic homelessness'. By integrating care we mean integration at the individual and at the population levels. Integration at the individual level
At the individual level integration means enhancing care for individuals who are homeless to ultimately improve their movement from streets and shelters into housing. This movement can be facilitated through:
1. Early intake and appropriate referral - this means identifying chronic health and social problems early and referring clients to community programs and shelters that are best equipped to help with those problems. This is in contrast to waiting for these problems to reach a point of crisis or urgency.
2. Multi-agency case management - this means offering homeless clients the opportunity to get care from multiple agencies who are all working with a single case management plan. This can be facilitated through a common information system that tracks care provided by the multiple agencies so that a new case management plan isn't started every time a client enters a new agency be it a shelter, hospital or outreach team.
3. Support movement from streets and shelters to housing - this means that integration at the individual level is driven by the ultimate goal of ending homelessness for the individual being cared for. Homelessness ends for an individual when they have a place they can call home that they contribute toward the payment of (through earnings or social assistance) and in which their basic needs are met.
The following link goes to a diagram that provides a schematic illustration of how integration using the CAISI system can help end homelessness for an individual: CAISI Integration at the Individual level... Integration at the population level
4. Real time needs assessment - this means that with the CAISI system participating agencies will know at the push of a button how many homeless persons are living on the street or in shelters with severe mental illness, addictions and or disability. This and other type of information in the form of population level reports at the agency, program and community levels will allow agencies and planners make real time decisions based on needs assessment and indicator type data that is immediately available. With this system, agencies and planners will no longer rely on available research to have access to this type of data. 2. Real time advocacy Advocates for those who are working toward ending homelessness will have access to data as described above to better advocate for systemic change to end chronic homelessness such as more supportive housing / and resources for ending homelessness. 3. Public Health Tools The CAISI system will provide tools useful for TB control (e.g. knowledge of latent TB infection status at the individual and population levels), influenza and pneumococcal vaccine planning (knowledge of immunization rates among those who are homeless and subgroups of the homeless), pandemic planning / outbreak control (exposure information such as lists of who has been potentially exposed to TB or other infectious diseases through detailed program or bed admission records).
Help design the Population Report
Benefits of Using CAISI Verses a paper system
The following link provides a discussion about the benefits of using CAISI: Benefits What is 'open source software'?
Open source (http://www.opensource.org/docs/definition.php) is a means of developing computer software in which users have access to and can contribute to the development of the code that makes up the software.
The CAISI software is an enhancement of the OSCAR McMaster software - an open source Ministry of Health approved EMR being used by hundreds of primary care and specialist clinics throughout Canada, Brazil and Australia. CAISI has added features for coordinating comprehensive care with allied health professionals and other service providers.
If governed by a General Public Licence, open source programs can be freely downloaded, enhanced and used by anyone in the world.
 Eric Raymond has written extensively on the open source movement in a series of influential essays including 'The Cathedral and the Bazaar (http://www.firstmonday.org/issues/issue3_3/raymond/#d1)'. What is the 'open development' approach?
The idea of Open Development is borrowed from the Open Source development concept to include a wider variety of co-developers.
Open Development is program development (e.g. community programming) in which the program is in continual development and implementation and that front-line agencies, staff (including physicians, nurses and social workers), and their clients can directly contribute to the ongoing creation of the program by working alongside CAISI Project staff. In this approach, all elements of program development are open to inspection, contribution and modification.