Creating a healthier, stronger inner city: A three-prong approach

    “The inner-city population deserves to have access to the same, high-quality evidence-based care that everybody else has,” says Ginetta Salvalaggio.

    By Rachel Harper on November 13, 2015

    In 2012, half of Albertan adults living with addiction or mental health problems were unable to access one or more support services. In addition, 82 per cent of Edmonton area socially-marginalized people who use illicit drugs have unmet service needs.

    So, how do we remove barriers to ensure all Albertans are receiving the care and services they need and deserve? Two School of Public Health alumnae, Kathryn Dong (MSc ’07, MD ‘99) and Ginetta Salvalaggio (MSc ’08, MD ‘99) are working towards a solution.

    Dong and Salvalaggio are two integral members of Edmonton’s Inner City Health and Wellness Program (ICHWP) located at the Royal Alexandra Hospital. The ICHWP is a three-year; $3.5 million pilot project funded by the Royal Alexandra Hospital Foundation. This project was created due to a growing need for public health intervention services in hospital settings.

    ICHWP takes a three-prong approach to inner-city health and strives for excellence in direct patient care, research and education. This approach helps physicians, researchers, educators and the community address the complex issues and needs of the area’s residents.

    “We take a community-engaged approach in everything we do,” explains Salvalaggio, research director of ICHWP.

    “Our community advisory group and liaison provides us with the opportunity to ask the community directly what it needs, seek guidance and, in turn, support individuals toward better health.”

    The clinical arm, launched in 2014, consists of a team of six physicians on one-week rotation as well as one full-time nurse practitioner, one full-time social worker and an addiction counsellor. This group forms the Addiction Recovery and Community Health (ARCH) team, which has worked with over 700 unique patients in its first year.

    The ARCH team provides recommendations for everything from evidence-based addiction treatment to direct connection to services that facilitate social stabilization to harm reduction and overdose prevention. All interventions are designed to meet the individual wherever they may be on their journey to better health.

    “You don’t have to want to stop using drugs or other substances in order to benefit from our team.” explains Dong, director of ICHWP. “Our goal is to develop a relationship of trust and understanding with the patient, start interventions based on their needs and connect them to services in the community that will continue to help them stabilize and meet their goals after they leave the hospital.”

    The research arm, which is led by Salvalaggio, evaluates the effects of the program on inner-city health. Her work includes performing a patient outcomes evaluation, gathering stakeholders’ views on clinical services performed by the ARCH team, gathering data to identify gaps in service to advocate for expanded access and developing a vision for inner-city health research in Edmonton.

    “Research in inner-city communities is often considered challenging regarding methodology and logistics, but through our research, I hope to demonstrate the art of possible,” says Salvalaggio.

    “This population deserves to have access to the same, high-quality evidence that everybody else has. Through our research we hope to demonstrate effectiveness, share models for implementation and see some of our innovations used in other settings.”

    The education arm, which has just been launched, provides education for frontline staff, an inner-city health elective for University of Alberta medical residents and will provide educational sessions for in-patients starting in December.

    Through this three-prong approach, ICHWP has expanded access to evidence-based addiction treatment at the Royal Alexandra Hospital. It has also helped identify and refer patients who are at risk of poor health outcomes due to social instability. And, through their community engagement and partnerships with groups like Boyle McCauley Health Centre, Streetworks and Homeward Trust, ICHWP has become a trusted safe place to go for the inner-city community.

    “When you have built-in communication with a community, and are willing to take advice and accept guidance, you develop trust and legitimacy as an organization,” explains Dong. “We are then better able to provide the services our patients really need.”

    ”Ultimately, we are creating a healthier, stronger community for all.”