When Emilie began working as a nurse with homeless people, she identified a clear gap: most of the health-related social street work was conducted when a situation had reached a level of emergency, and most often occurred at night. The reason for this was that most homeless resisted stepping into existing health care centers which were open and accessible during the day. Emilie created Infirmiers de Rue (IDR) to build the missing link between reality on the streets and existing health care centers.
Emilie has developed a strategy that progressively builds trust and step-by-step brings the homeless closer to the mainstream health system. Pairs of nurses meet the homeless on the street with a non-intimidating approach (i.e. by foot, not in uniform, and only if the person accepts a conversation). Nurses are informed of a situation by neighbors, shopkeepers, COs, or by meeting the homeless on their regular patrols. The first encounter is a way to get to know each other and conduct a first diagnosis of the homeless person’s state of hygiene and health. During the process, the nurses respect a homeless person’s autonomy and openly discuss the situation with him/her.
The patient usually falls into one of two categories depending on their health situation. For the less serious cases, IDR is reorienting the homeless with the most relevant players. For the most critical cases, IDR develops “intensive monitoring,” a file for the individual is opened and each week the nurses will assess progress, set goals, and organize cooperation with other institutions. IDR calls upon all stakeholders that are in contact with the patient (i.e. hospitals, social services, and street-workers) to exchange information and coordinate the various steps.
In Brussels, IDR has proven the importance of placing the person at the center of a collaborative network, to establish prevention mechanisms and improve the impact of each respective intervention. To strengthen, integrate and equip this network, Emilie has created tools and common assessment standards. The evaluation and selection of priority target populations are based on a “BCB score” (body, clothing, and behavior), measured by personal hygiene, cleanliness of clothing, and behavior on the margins of society (i.e. mental disorder, social misfit, and so on). Each criterion is rated between 0 and 3 and each person is graded from a maximum of 9 points. Anyone with a score below 6 is considered a patient at-risk and therefore, a priority. The BCB scoring tool was presented at the National Institute of Health Insurance Disability, which wants to use it as a national standard.
To deepen and strengthen the watchdog networks and improve their impact on each territory, IDR is leveraging its expertise to develop and implement training programs for professions that interact with the homeless, including medical and social professionals, security guards, maintenance staff, and shopkeepers. Based on the experience acquired in identifying symptoms related to levels of hygiene and adapting treatments for street patients, these trainings aim to:
• Teach the causes and consequences of poor hygiene, and explain respective possible roles to play• Train participants on how to deal with questions of hygiene• Raise awareness on the importance of a concerted management of health issues and using coordination tools
For example, IDR trains medical professionals (i.e. doctors and nurses from local hospitals, clinics, Samu Social, and Médecins du Monde) to adapt their treatment requirements to living conditions on the streets. For security guards, IDR teaches how to maintain order and cleanliness in a station or a park with people who have little access to water, toilets, and showers, and how to manage possible confrontations between the homeless and passengers. As an illustration of the high satisfaction and enthusiasm generated by the trainings, the Belgian National Railway Company decided to increase more than tenfold the number of employees that will attend IDR trainings in 2011.
These training programs are a key accelerator for IDR’s impact. Already conducted in three Belgian cities in addition to Brussels (Charleroi, Namur, and Liège), these trainings empower stakeholders to work together and equip a broad range of professionals to work toward the rehabilitation of homeless people.