A new program in Niagara is helping individuals experiencing homelessness or home insecurity navigate the emergency department with the help of their peers.

Niagara Homelessness Emergency Liaison and Peer Support, also known as Niagara HELPS, is a program that pairs homeless people presenting to the emergency department with peer support navigators who have lived experience of homelessness.

The program grew from research conducted by Rahat Hossain and his colleagues while attending the Niagara Regional Campus of McMaster University’s Michael G. DeGroote School of Medicine. The team at Health & Equity Through Advocacy, Research & Transformation, known as HEART, examined the barriers that the homeless population faced when accessing the healthcare system in the Niagara Region.

A qualitative research study was undertaken to examine these issues and develop themes which was drafted into an interactive theatre play. “We converted 270 pages of transcripts into a play where audience members could interrupt the performance at any point and replace the actor to provide solutions or suggest different outcomes,” said Hossain. “This allowed us to receive community feedback which ultimately led to the development of Niagara HELPS.” 

During one of the performances, Scott Cronkwright, an individual in the audience, gave feedback about the need to create a program for those experiencing homelessness when they present to receive medical attention in the emergency department. 

Cronkwright has previous lived experience of homelessness and now provides support within the program as a peer support navigator.  

“There were a lot of different people and agencies who helped in my recovery and this is my way of giving back to my community and allowing those without a voice to be heard,” said Cronkwright.  

Suneel Upadhye, Principal Investigator of this program and Research Lead for the Emergency Medicine Researchers of Niagara (EMRoN), believes that there is importance for this kind of support in the Niagara community. 

“In my role as research lead, I facilitate new project ideas, garner funding and focus on community-based research excellence at the Niagara Regional Campus as well as in the community to foster support,” said Upadhye, a Niagara Health emergency department physician. 

The HELPS program is a research partnership between McMaster University’s Niagara Regional Campus, McMaster University’s Department of Medicine, Quest Community Health Centre, and Niagara Health. Funding comes from the United Way, Niagara Community Foundation, Ontario Trillium Foundation, and the Niagara Prosperity Initiative with additional stakeholder support. Additional planning support came from the provincial agency, the Institute for Clinical Evaluative Sciences.

The Niagara HELPS program launched in January 2020 at Niagara Health’s Niagara Falls Site with two peer support navigators; however, the program was required to pause temporarily when the COVID-19 pandemic began impacting Southern Ontario. The program relaunched in mid-October and recently expanded its operation to a second location at the St. Catharines Hospital Site on Dec 1 with a team of four peer support navigators.

“Upon launching the program, we found that Niagara Falls was very receptive to the idea of us trialing the program there. The support we have received has been tremendous and has allowed us to evaluate and expand our program to the St. Catharines hospital site of Niagara Health,” said Hossain.

Working within the hospital, some may develop pre-conceived notions around vulnerable populations that present in the emergency department. However, as Shelly Cricenti, Program Manager, Quest CHC explains, “having the added perspective of the peer support navigator enriches the experience in the emergency department, both for the individual experiencing homelessness and for the emergency department staff.”

Individuals experiencing homelessness face many barriers in accessing healthcare. Many are hesitant to seek medical assistance, and at times can be discharged back to the street. With this program, peer support navigators ensure almost all those experiencing homelessness are discharged to a safe bed, receive community resources and follow-ups.

Following consultations with clients, peer support navigators make recommendations for those seeking further care within the community. Shilpee Rana, HELPS project lead for Quest CHC says the resources available connect clients to ongoing primary health care, mental health and addictions services and other community services.

“A unique element of the program is that our clients are the drivers of the plan. They determine what agencies they would like to use, what services they would like to connect with,” says Rana. “The client’s self-determination and freedoms are always considered.”   

Enrollment within the program since re-launching in October has been strong with over 55 clients in St. Catharines and Niagara Falls.   

While this program is unique to Niagara, a similar pilot was launched in August in Toronto through the University Health Network following the early success of Niagara HELPS. 

“Longer term we would like to see this program transition into a health service that could be provided across the province,” said Hossain. 

At the hospital Alexander Laugher, Joshua D’Cunha, Skylar Burbidge and Scott Cronkwright have provided support, and since expanding the program to St. Catharines, Niagara HELPS has been able to hire two more peer support navigators.

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