Community Health Centers

I spent last week on an elective within the network of Community Health Centres in Toronto. Issues regularly addressed include homelessness, substance abuse, sex work and healthcare access for immigrants and refugees. The CHCs actually function using interdisciplinary teams of social workers, nurse practioners, physicians, housing workers, harm reduction workers and midwives. I learned about functional teams; I actually saw these teams consult on patients on a daily basis. I saw plans created for patients that addressed short-term and long-term needs. Physicians paid on salary could spend between 15 minutes and 1 hour with a patient.

The experience was incredible for many reasons, including the personalities of the doctors I worked with. They were grounded, honest, reasonable, pragmatic, helpful and kind. They also practiced excellent medicine. They were collaborative and interactive on teams; they seemed to value input from other disciplines. All of this served as an excellent example of community medicine that I hope will carry me through the harder points of clerkship next year.


3 thoughts on “Community Health Centers”

  1. Kelly,
    I have a google alert for interdisciplinary teams. I am particularly interested in such teams working in Community Health settings. Below is some “stuff” about teams working in partnership with police in Australia in the state of Victoria. I would be interested in contacting the CHC you attended.

    The police/healthcare interface has developed in an ad-hoc, issue by issue, sector by sector basis. Through this process crisis referral pathways in Victoria have evolved and are now well established , however, earlier intervention referral pathways continue to be developed to an increasing number of specialist health and welfare services. Individual sectors in healthcare have recognised the need to take a more integrated approach . Interdisciplinary Action Teams re-engineer the response at the police/healthcare interface in line with developments within healthcare and provide triage and support at a local level for people who come into contact with police and want help with a wide range of problems.

    This is achieved by healthcare services contributing to the formation of interdisciplinary teams at a municipal/police service area level. The team includes counsellors relating to Alcohol & Other Drugs, Family Violence (including existing service providers funded to receive referrals from police), Child & Family Services, Housing and Mental Health. This team approach:
    • enables the number of referral pathways from police to specialist services to be significantly reduced as police have the ability to refer victims and offenders or any person in need of assistance to a single team,
    • provides a more integrated response across sectors from health and welfare professionals,
    • provides a timely response to those people referred with contact being made within 24 hours of receipt of the referral.
    • provides a model where trust can be developed between police and health professionals leading to sustainable commitment to the concept and a change in the culture and practise of police and community services at the health/justice interface.
    • has positive occupational health and safety outcomes for operational police by reducing re-attendance by police to incidents of often escalating levels of violence and reducing levels of frustration and stress in attempting to navigate an increasingly complex labyrinth of referral pathways.

    Northern Assessment Referral & Treatment Team
    The Northern Assessment Referral and Treatment Team (NARTT) has been operating from Plenty Valley Community Health, Epping since April 2003, receiving over 2,300 referrals from 320 individual police from 3 x 24 police stations, Reservoir, Epping and Mill Park. An independent evaluation recommended the concept be implemented statewide . Evaluation of the program is ongoing. During 2007 over 900 referrals were made.

    Offender 313
    Victim 381
    Family Member 114
    Other/Unknown 96

    TOTALS Primary Issues Secondary Issues (where noted)
    Family Violence 591 31
    D&A 90 138
    Anger 70 56
    Other 51 12
    Mental Health 27 53
    Assault 26 44
    $ 5 46
    Housing 5 5
    Gambling 4 14
    Sex Offences 3 1
    Unemployment 1 28
    An evaluation of 234 people referred, 1/7/2005 – 31/12/2005 showed those referred as offenders (53) who did not take up a referral had more than double the re-involvement rate with police within six months, 73% to 33%. This was consistent with an earlier evaluation.

    NARTT was awarded the 2006 Victorian Healthcare Ministers Award for Outstanding Team Achievement and received a Certificate of Merit and prize of $7,000.00 in the 2007 Australian Crime and Violence Prevention Awards, placing it in the top 8 projects across Australia. Despite this recognition an impediment to roll out is a lack of recurrent funding available as the concept crosses funding silos, e.g. mental health, drug and alcohol, family violence.

    Interdisciplinary Action Teams now operate in metropolitan, regional centre and rural settings with the Shepparton Moira Assessment and Referral Team (SMART) operating from Goulburn Valley Community Health since July 2007 and the Border Integrated Referral Team (BIRT) operating from Echuca Regional Health since March 2007. All programs are very well supported by local police and community services. SMART and BIRT have been implemented utilising existing resources.

    Interdisciplinary Action Teams is a whole of government, cross sectoral approach, that empowers local people to solve local problems. It currently demonstrates that an integrated response and improved outcomes can be achieved across a range of sectors and healthcare disciplines. It complements the crisis response and other existing referral pathways. It enables police to refer a wide range of issues to a single team of health and welfare professionals and requires no additional Victoria Police personnel or equipment and minimal police training.

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