EXPLORING EFFECTIVE SYSTEMS RESPONSES TO HOMELESSNESS

INTER-SECTORAL COLLABORATIONS
IT’S A BIRD,
IT’S A PLANE,
IT’S INTEGRATED CARE
Redesigning an integrated system-wide response to homelessness is no simple task. Yet,
as the H1N1 study highlighted, the current fragmented nature of the homelessness
sector may be contributing to the poor health of homeless clients. In the same way
that Albert Einstein defines insanity as doing the same thing over and over and
expecting different results, Dorrell (2015) notes that, “we run partitioned services
and wonder why we fail to deliver integrated care” (13). Perhaps the complexity of
planning and operating an integrated care model for high-needs clients, such as
the homeless, seems too daunting a task to undertake. Van Laere and Withers
(2008) counter this view when they write:
Services are organized and managed
in such a complex manner that policy
makers and managers tend to think
that homeless people do have complex
needs. This is not true. Needs are not
complex at all. Tackling the health issues
of the homeless requires a systematic
approach by dedicated homeless health
care professionals (5).
Shifting the ideology to one that sees the homelessness
and public health sectors not as separate and distinct
but as one holistic system brings with it the prospect
of adopting better ways of working together, of
addressing the current gaps and of considering the
needs of the service user in different ways.
In the United Kingdom, integrated care has been
considered the holy grail of policy making for several
decades (Burstow, 2015; Keohane, 2015). As such, the
UK has formulated a nationally agreed upon definition
of what integrated care means for an individual,
which is that, “I can plan my care with people who
work together to understand me and my carer(s),
allow me to control, and bring together services
to achieve the outcomes important to me” (Public
Health England, 2015: 4). This definition indicates
a strong, collaborative relationship between care and
cure sectors, while emphasizing the client’s ability to
formulate their own service needs.
In Canada, to date, there is no comparably recognized
national definition of what integrated care means.
Canada is not alone in this definitional ambiguity.
Even within the UK, integrated care is known by
several names, including ‘personalized care,’ ‘patientcentered
care,’ ‘joined-up care,’ and ‘whole person care’
(Keohane, 2015). “Like a Rorschach test, integrated
care has many meanings;” Kodner and Spreeuwenberg
(2002) note, “it is often used by different people to
mean different things” (1). Integrated care may be
considered the Superman of service provision. Not
only is it lauded as a saviour, but it is an entity that
appears in shapeshifting forms. In a recent conceptual
analysis of integrated care, Kodner (2009) highlights its
ambiguity by comparing it to a tree, a precise surgical
procedure, a country and the proverbial elephant that
everyone touches but no one can fully grasp. Reading
this article brings to mind the old line, “It’s a bird, it’s
a plane, it’s Superman!” Only now, it has been changed
to (the much less catchy), “It’s a tree, it’s a country,
it’s an elephant, it’s integrated care!” Over time the
concept of integrated care has changed and developed,
leaving it under-defined and open to interpretation.
As part of a larger study, in the summer of 2015
interviews were conducted with three staff members
of a local health authority in Ontario pertaining to
issues of health, homelessness and integrated care. The
research participants were senior level officials who
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