Maddern Square, Footscray

The Friday BBQ, Footscray

Part 2: Key Learnings on Delivering Health Time

1. Resources

2. Systems and Processes

3. Sustainability

4. The Cumulative Benefits of Health Time

Acknowledgements

Acknowledgements

Introduction

Part 1: The Seven Health Time Programs

St Peter’s, Eastern Hill

St Brendan’s, Flemington

The Gatwick, St Kilda

Half Moon Caravan Park, Brooklyn

Gronn Place, Brunswick West

The Steering Committee comprising representatives from VincentCare Victoria, Inner South Community Health Service, Cohealth (the former

Doutta Galla and Western Region Community Health Services) and the Victorian Department of Health would like to acknowledge the contributions to this project and Health Time programs made by:

• Anglicare Victoria Homeless Support Services

• Avalon “The Moving Wardrobe”

• Baptcare

• BridgingWorx

• Cohealth (Community Connections Programs and Outreach Allied Health Team based at the former Western Region Community Health Services and Doutta Galla Community Health Services)

• Clarendon Community Mental Health Services (CMHS)

• Cultivating Community

• Good Shepherd Family and Youth Services

• Homeless Outreach Mental Health Service

• Inner South Community Health Service (Community Connections Program, Outreach Physio and Podiatry. Drug and Alcohol Outreach, Insecure Housing Worker, Dental Outreach, Outreach

Health Nurse, Midwife and Sexual Health nurse, Assertive Mental Health Outreach)

• Merri Community Health (Allied Health and Healthy Ageing Demonstration Project)

• Moreland City Council

• Public Interest Law Clearing House Homeless Persons’ Legal Clinic

• Royal District Nursing Service (RDNS) Homeless Persons Program (HPP)

• Royal Women’s Hospital Well Women’s Clinic

• St. Peters Eastern Hill Anglican Parish Church

• The Gatwick Private Hotel Proprietors

• The Half Moon Caravan Park Proprietors

• VincentCare Victoria ( Community Connections Program and Access & Support Program)

• Wintringham Over 50’s Club

This project grew from discussions in 2012 between VincentCare Victoria and the Victorian Department of Health North

and West Metropolitan Region office about VincentCare’s efforts over the previous few years to connect people experiencing or at risk of homelessness to primary health services using a model called Health Time Days. The Victorian Department of Health North and West Metropolitan Region office was able to signpost VincentCare to Community Health Centres who were also taking a leadership role in connecting people experiencing or at risk of homelessness to their primary health services through similar models some that used the “Health Time” label.

The North and West Metropolitan Region Office was also able to support the funding of a project to create an account of several similarly focussed programs both to describe the impacts and workings. This project has achieved some key learnings through an analysis of the common and differing factors surrounding these Health Time programs that aid their initiation and enable them to be sustained as well as articulating the beneficial impacts and risks.

A steering group formed was from among the agencies who were invited to participate in the project and included representatives from the Victorian Department of Health. The steering group has both provided oversight to the project as well as acted as an important point of reference to support the project and analyse the findings. VincentCare Victoria assumed the overall responsibility for managing the project.

This report describes a flexible outreach model of health service delivery called ‘Health Time’, and summarises the key learnings from seven Health

Time programs operating across Melbourne.

Two key specialists were engaged, Peter Feldman, and Mick Cummins. Peter Feldman, specialises in human services program assessment and evaluation and had undertaken previous evaluation projects with VincentCare around both Health Time and place-based engagement and services access at VincentCare’s Ozanam Community Centre. Mick Cummings (Hand in Hand Productions) has been involved in the production of a number of video documentaries focussing on homelessness (e.g. Len’s Walk) as well as the work of Homelessness Agencies. The steering group were pleased that a working partnership conducive to the project quickly developed between the two specialists and with the steering group. Most importantly, they both demonstrated sensitivity and respect for the people and programs whose stories were being told and put in front of the lens and which is subsequently evident in the material.

The primary intended audience for this resource (this report and the companion

video documentary) are Community Health and Homelessness Services who together with other interested health and welfare agencies would like to find out more about commencing similar programs of flexible service outreach to highly marginalised or deeply disadvantaged people. The settings for this outreach include a range of marginal accommodation types such as caravan parks and rooming houses, semi-private community facilities and public open spaces where people visit for a meal, company, recreation, or simply to pass time.

Ultimately, there is one overall purpose for undertaking this project – to promote the Health Time model. The first audience are the aforementioned Community Health, Homelessness and allied human services agencies. This resource is intended to whet the appetites of services that are interested in ‘assertive outreach’ as a means to otherwise engage ‘hard to reach’ clients in health and welfare services usage.

It is hoped that a variety of funding stakeholders form a valuable secondary audience. The purpose of promoting the Health Time model to this audience is to enable them to also gain a valuable first impression of a model which the material demonstrates is capably delivering services on the ground and in a manner that is an effective low-cost primary intervention into these communities.

For funding stakeholders who are interested in answering the question ‘How do we find and assist those people who have the greatest need?’ this resource demonstrates how this can be undertaken through the described case studies. It also demonstrates that the solutions are not necessarily dense and large scale - but that well targeted, regular and reliable delivery is required over a period of time to build trust and to achieve effective engagement. It was not the scope of this project to undertake a social impact measurement or avoided costs study. However, the material suggests some of

the areas where further measurement of social impacts or avoided costs could occur in large scale evaluation studies.

The material points to the risks that are not insurmountable if they are well managed. The material provides first hand evidence that suggests that the benefits in terms of immediate health and social impacts are very concrete – as told by the clients and community spokespeople themselves.

This printed resource is a companion publication to a short video documentary

which has been developed as part of the project. The video documentary provides the viewer with a first hand impression of the Health Time model and first hand stakeholder commentary - from clients, community spokespeople, service providers and accommodation operators. Readers are urged to watch this 17-minute video to fully appreciate the environments and voices of Health Time.

The project gathered evidence about Health Time through the review of program documentation, interviews with lead agency staff, clients, partnering services and agencies, community informants, accommodation operators and other stakeholders. It gathered evidence through interviews undertaken to complete the video documentary as well as those interviews specifically used to gather evidence for this written report.

In this resource there is a more detailed description about each of the programs that the project researched.

Although they all follow the same basic formula the details of each Health Time initiative are very different, demonstrating the flexibility and robustness of the Health Time model.

The report is arranged in two parts. Part one visits the Health Time programs in turn, describing what is unique about each program as well as focusing on one or two features that are common to all.

Part two addresses the key issues and processes that Health Time programs must all deal with to function effectively and be sustainable, and summarises the benefits for Health Time clients and providers.

The resource is not a ‘how to’ guide. Instead it provides the reader with a palate of Health Time experiences and analyses. On reading the resource and viewing the video, the reader will become aware of the range and details of those issues that need to be considered in developing the model – resources, risks, opportunities, partnering, leadership and other factors that increase the likelihood of ‘success’. As such, the resource shares key learnings and understandings that the three agencies who came together for this project wanted other agencies to achieve.

Health Time programs provide assertive outreach services to people who would

otherwise fall through health, housing and support services gaps. Their clients often have complex needs, they may have difficulty accessing mainstream services and they may not fit the criteria for other outreach programs.

The primary target groups for Health Time programs are people experiencing homeless or at risk of homelessness, people who live in insecure and marginal accommodation and depending on the program, people who are more stably housed but with complex needs.

The Health Time programs are designed flexibly around the needs of their clientele to provide outreach and mainstream service access across the spectrum of health, housing and social services.

Because Health Time clients do not readily come to agencies, these programs take

services to where clients live or prefer to congregate, or otherwise attract them to venues that are local, accessible and user friendly.

The programs all provide meals, which gives people a reason to attend in the first instance and creates a more relaxed atmosphere for clients to engage with workers and services.

So the basic formula for Health Time is simple:

Health Time = Venue + Food + Services

In practice, delivering Health Time programs successfully involves substantial planning and co-ordination, and long-term commitment from project partners and workers on the ground.

St Peter’s Eastern Hill is well known to people experiencing homelessness for its breakfast program provided by Anglicare

Homeless Support Services every day of the year. St Peter’s is situated at the eastern edge of Melbourne’s CBD and can be accessed easily by foot or public transport.

Health Time barbecues are held once a week in an internal courtyard and an adjoining dining room where attendees can sit, eat and socialise or read and relax.

The program is for people who are sleeping rough or living in marginal accommodation such as rooming houses. Health Time sessions provide healthy food and access to services for 40 to 45 people every Friday.

Anglicare Homeless Support Services and Cohealth jointly manage the program, with Anglicare providing venue-staff, food, material aid and homelessness assistance, and Cohealth co-ordinating the services of visiting agencies. Anglicare provides base funding for the program covering capital costs and venue-staff.

Visiting services include nursing, allied health services such as dietitians and podiatrists, legal assistance, drug and alcohol support, housing and mental health.

Health Time at St Peter’s began in early 2012 after running for two years at a Flinders Lane venue behind St Paul’s Cathedral. The move was prompted by cramped working conditions and Occupational Health & Safety concerns at the previous site that made many agencies reluctant to provide services there.

Since moving to St Peter’s the Health Time event has expanded, with the number of clients doubling, more services attending and more types of cooked and fresh food on offer including a variety of barbecued meats, salads and fresh fruit.

There are no signs on the street advertising Health Time and the passerby has little clue of what is happening inside. Knowledge of the event is mostly by word of mouth, which spreads quickly amongst rough sleepers.

On entering the courtyard attendees can select from a range of foods prepared and served by Anglicare staff and volunteers, and then sit among friends and acquaintances – including agency and Church staff – to chat and eat together. A deliberate engagement strategy at Health Time is for workers to mingle, sit and eat with attendees to reduce the distance between client and worker.

Agency staff who service people experiencing homelessness often emphasise that for rough sleepers especially, the opportunity to sit comfortably, relax and eat a good meal in the company of others – something that most of us take for granted – is just about impossible in their normal daily life.

One St Peter’s Health Time client had this to say:

Historically when people sit down to break bread, they break bread, you sit down and talk and yarn and get friendly with each other. Well, that’s what people here do. It seems to satisfy them, like having a feed, having a full stomach, it settles people down once they know that they’ve had a feed and everything. Yes, it’s like that. Everybody’s defenses all go down, and that we all sit down, have a good yarn about things and whatnot. We help each other with our problems, the kind you get in any place, yeah.

This is the cornerstone of Health Time: providing the opportunity for people to take a load off their mind and body by meeting these fundamental human needs, and creating a moment of social inclusion where participants may be a little more ready to engage with the

rest of the world, talk with agency workers and have some of their health and other needs met.

The engagement process can take many months, as one Anglicare staff member explains:

There’s one particular fellow who has been a client of ours for many years I believe, prior to me coming on the scene. He’s a fellow who’s been in and out of housing. When we were at the other site at St Paul’s, the Health Time workers would come in and try to engage and he would put up the barriers and say “no”. We would often say to them, “don’t keep trying to engage with him because he doesn’t want to”. It took, I would think, 12 to 18 months of him watching these people coming in and engaging with other clients until he was prepared to have a conversation with someone. For him to finally engage was a huge breakthrough with him. And from that conversation he’s now been housed.

These observations are echoed in the account of another St Peter’s Health Time client, whose mental state had shut him off from the world and help that was available:

I was stressed out from work, being a chef, and I worked in a high-pressure kitchen in a large international hotel. My past caught up with me and I started to have some problems at work. I got stressed out and then I got depressed. In the end I just broke down. I just broke down because of my mental problems that I came away from home with. I lost my job. When I got depressed I had no communication with anybody, just locked myself in my house probably for about two and a half to three months. The bills just added up. I had no income or anything like that. I really needed some help.

I am so glad that I came to St. Peter’s and I ran into the nurses, and yeah, they’ve kept me on track. I was practically about

to give everything up. One of the nurses came up and introduced herself to me, and I was in a really, really bad way. I refused their services for a while because of my mental state at the time.

So I actually sussed all the nurses out, and I found the right person that would do that for me, and everything. I give all credit to St Peter’s, the staff here and the food that they serve. Also to the nurses themselves, the nurses that visit here and everything. I really, really, really appreciate the things that they’ve done, now that I’m on track and I’m ready to go back to work, and things like that.

St Peter’s Health Time also helps people who are living rough with their immediate material needs, so they do not have to wait until their longer-term problems are solved before they can have a shower, new clothes or a good pair of shoes. As one of the Anglicare workers describes:

Homeless (people), particularly the rough sleepers, tend to spend a lot of time on their feet and often have wet feet: wet shoes, wet feet. So that impacts on the condition of the hooves as it were. So the podiatry services are useful, and the supply of a decent pair of shoes. Real fundamentals, you know?

Community volunteers from five different churches get together every Monday at St Brendan’s Parish Hall to cook and serve

lunch to anyone who walks in the door. They have been doing this since 2009.

Cohealth began providing services there in 2012 following on from their Health Time program that had been running at Holland Court in the nearby public housing estate at Flemington for the previous four and a half years. Cohealth received 0.5 EFT recurrent funding for a Health Time Worker following the completion of a pilot project that established the value of Health Time in this location.

Workers from Cohealth’s Health Time and Active Connections Programs, and RDNS Homeless Persons Program attend the sessions. The Cohealth dietician and other services also attend periodically.

Lunch at St Brendan’s is unusual because unlike other Health Time events, the visitors are served at tables.

Monday lunch at St Brendan’s began in response to people calling on local churches, missions and rectories and asking for assistance. The lunch component of Health Time is staffed entirely by a team of volunteers, more or less the same fourteen people every week.

This large complement of workers makes it possible to cook and serve a three-course meal for 40 to 45 people, with numbers swelling to 65 at Christmas time. The parish hall is equipped with a full commercial kitchen, and one of the volunteers is an ex-army cook.

As people enter the hall they are welcomed by the volunteers and guided to tables set with cloths, cutlery, napkins, bread and condiments. The volunteers remember their guests’ table preferences and friendships and seat them accordingly. Full table service was chosen deliberately by the volunteers for two reasons, as a sign of respect and to enable a certain level of control over the event:

We wanted to treat them like our guests and wait on them rather than just shove things at the people. Everybody is a human being and they all deserve a certain amount of respect. I guess that comes from our church background. We made that choice initially…and also, although buffet-type meals are less labor intensive, they are also compounded by all sorts of potential problems.

Table service avoids those problems encountered at self-serve buffets of all types – whether free or not - such as jostling, overloading of plates

and food contamination. Likewise, a selection of fruit for guests to take away is supervised by a volunteer who ensures there will be enough for latecomers.

The overall effect of the seated orderliness is to create a calm and relatively quiet atmosphere in the parish hall:

Most of them I would say enjoy it. A good lunch and a good environment and a lot of them, they just sit and chat afterwards and have a cup of tea or a cup of coffee after lunch. We all mingle with them and try to make them feel comfortable or welcome. There is a need but also, let me tell you … Probably as volunteers, we have a need too. We get a lot from each other. The rapport between us is fabulous. We’ve all grown to love each other. It might sound silly but I love every one of these people that come.

While many of St Brendan’s guests live locally in public housing, some are known to be itinerant. Lunch at St Brendan’s turned into Health Time after the volunteers realised that some of their guests were sleeping rough and they contacted Cohealth requesting support services to attend.

For Cohealth this was an opportunity to continue providing Health Time in the area in association with an existing service that many of the clients already attended. The earlier Health Time project at Holland Court was labour intensive because it required all food and equipment to be bumped in and out each session. Over time a large proportion of the residents became more knowledgeable about services available to them and how to access them directly. The program was also getting less frequent attendance by people experiencing homelessness. The focus of the Program at St Brendan’s has been broadened to include aged people who have complex needs and are socially isolated via the Active Connections Program.

The Gatwick Private Hotel is one of a few low cost accommodation houses remaining in St Kilda, providing short and

long term housing for up to 100 people. Health Time has been running at the Gatwick since 1995.

Twenty to thirty people attend Health Time every second Wednesday. The sessions attract Hotel residents and past residents as well as transient and homeless people in and around the St Kilda area.

Afternoon tea is held in a small dining room adjoining the kitchen, and the event spills out into the back lane where a ‘mobile wardrobe’ distributes clothes and a podiatrist works from a health bus.

Health Time is coordinated by Inner South Community Health Community Connections Program.

Services attending Health Time include nursing, dental, drug and alcohol, podiatry, physiotherapy, housing for the aged, mental health, assertive outreach and free clothing. Some services will not attend the Gatwick due to perceived worker safety concerns, even at Health Time.

The concept of Health Time arose in St Kilda in the early 1990s as a response to the needs of hotel proprietors and the broader community, who were dealing with large numbers of transient people with mental health and drug and alcohol issues.

Confronted with new types of crisis incidents, that they were not used to handling, and unaware of appropriate health services, hotel managers habitually called the police who were likewise not equipped to deal with these health or drug crises.

Health Time sessions began in December 1995, first at the Gatwick and spreading to other private hotels in St Kilda such as the Hollywood and the Regal. However in recent years intensive gentrification of the St Kilda Beach precinct has eliminated nearly all of the low cost hotels and boarding houses that have common areas large enough to host Health Time, leaving now just the Gatwick, which continues to be family owned and managed.

One of the Gatwick’s proprietors, Rose, comments on how the nature of difficulties with guests has changed in her 42 years of working at the Hotel:

Back then there wasn’t as many drugs. I think our biggest problem would’ve probably been a drunk but you can deal with them. There are only so many certain types of drunks. They can be happy or sad or sleepy, all out. So you know straightaway what you’re up against, whereas nowadays with the drugs you don’t know what you’re up against because they don’t even know themselves... Everybody is so angry. I think it has that sort of effect on them. They’re all so depressed and so angry. That’s why it’s good to have Health Time.

Health Time is co-ordinated by Community Connections Program (CCP) assertive outreach workers from Inner South Community Health:

We work to engage with the residents or people who are homeless for the purpose of getting them assessed and linked in with supports and services and housing. We organise the food. We make sure that people are attending and are welcomed into the space. We’ve got the occupational health and safety outlook. We are doing all the liaising, so keeping the whole session running. At the same time we are also engaging with residents and taking referrals and intake and making phone calls.

Health Time at the Gatwick also celebrates and observes significant events in the community such as birthdays, deaths, Women’s and Men’s Health days, Easter and Christmas. Every year near Christmas, Health Time organises a large street party where the street is closed by permit from the City of Port Phillip, and the local community comes together with live music, dancing, free food and “give aways”.

Good Shepherd Youth and Family Services were also involved in running Health Time from its beginning in 1995 through to December 2014, but the agency recently moved its resources from St Kilda to St Albans, where it now feels their services are needed most.

Other participating agencies have come and gone mostly for resourcing reasons, as an Inner South CCP worker explains:

We have a very strong team at the moment. It hasn’t always been this big and strong. Over the years we have had services involved and dropped out. That’s always been a tension and a challenge because I think we’re working in a very unstable and volatile physical environment, that is the Gatwick, and we’re asking services to be involved in a program that they’re not actually funded for. Sometimes it requires people to be in the space for an hour and a half. They sometimes have competing demands…There’s a local housing agency who used to come down to Gatwick, very much

their target group but I think there were just competing pressures with different programs not being funded to be away from the office - and in that space and the amount of work that generated - there wasn’t a body back at the office to be doing that.

In fact, Gatwick Health Time involves much more than the hour and a half session at the Hotel. Participating workers meet an hour beforehand to share information about current issues at the Gatwick such as tensions between residents or prevailing drug use, as well as to case conference clients in common and strategise accordingly:

If you look at the environment that we’re working, it’s challenging and complex. There are a lot of different people, different players, different issues and different themes. It’s basically about going, “Well, today we’ve heard this piece of information. Everyone’s on board. This is what’s happening.” Then everybody knows what’s happening as a team.

Workers meet again after each session to debrief and co-ordinate any follow up work with clients.

Despite the difficulties of its setting Health Time at the Gatwick is a win-win situation for the attending agencies who, through safety in numbers, are able to service highly transient and/or vulnerable populations in a potentially risky enclosed environment; and for the proprietors Rose and Etty who have fewer crises to deal with when their residents are supported by a network of services:

I think Health Time’s biggest thumbs-up was helping people connect with services and other people. It’s easy enough to say, “Connect with other services,” but when you look at the type of people that we look after, it’s very difficult for them to connect because even if they know the address of where it is they’re supposed to

go, just that fear of going inside the door or even getting to talk to somebody…generally, they won’t do it because it’s just too big a problem for them.

And for Gatwick residents and other attendees, participation in Health Time can bring far-reaching benefits. Patrick lived at the Gatwick for eight months after an extended period of transience and homelessness. He recently moved into community housing nearby but still works part-time at the Gatwick as concierge and cleaner, and still attends Health Time sessions regularly. He describes his experience of Health Time:

I’ve had a bad back for a long time and I suffer with migraine from time to time and I was suffering stress a lot and anxiety and when you suffer with both it’s not easy to cope with.

Me and the little dog Bobbie, we were hungry so we went there [Health Time] and when I got appointed my outreach worker. She must have been a saint because she turned up to see me and I’d be drunk and that and she’d say “Come back and see me next week and make sure you’re sober.” And this went on for probably about three weeks and in the end I just cracked myself out of it and that woman worked tirelessly for me to get me on the straight and narrow, help me with some legal matters, she helped me get another place.

With Health Time everything’s condensed, there was the podiatrist there, the outreach worker, there were so many opportunities like the dentist, even if you just needed someone to talk to about problems, everything was there. A lot of people that are on the streets can’t afford to travel. It’s alright to say just get the tram and the bus, go to Collingwood, and when you’ve been to Collingwood go to Hawthorn and that’s how you get it done. Everything’s there and I feel it’s one of the big advantages.

The only way Health Time could be improved was if it was publicised a little more so others that are just on the streets and that know what services are out there because you can’t get help unless you ask. And this was all new to me, and until you ask people you don’t know.

When asked about the difference that Health Time can make to living in a boarding house, Patrick had this to say:

It would be pretty much like paying to go to jail. You’re paying to go into a room where everything’s communal but you’ve got no-one to turn to, no-one to ask anything, you’ve got no-one who can provide assistance or steer you in the right direction of where to go or what to do. It’s a distinct difference. I went to two different boarding houses before I was on the streets and they were just pigs of houses and you’d come home and your door lock would be smashed off and your room would have been ransacked and, if not, there was always someone bigger and better than you that would stand over you and take whatever you had so you could never keep anything that was of any great value in your room.

Half Moon Caravan Park is situated on just over an acre of industrial land at a busy intersection of two arterial roads.

It was originally set up for visitors to the 1956 Olympics.

The Park presently contains 52 usable caravans and accommodates up to 100 people, primarily for emergency and temporary accommodation, but the Park is also a permanent home for about 25 local workers and older people.

Health Time operates every Tuesday from the shop next to the Park entrance. Hobson’s Bay Council ran the program for six years prior to Cohealth and The Salvation Army taking up co-ordination in mid-2013. This is an interim arrangement until ongoing funding can be secured for the program.

The visiting services are vital for many of the people living at the Park who have come from the streets with no possessions whatsoever, or been evicted from other premises or released from prison. There are a number of residents who never venture beyond the site’s boundaries.

Services attending Health Time include housing, nursing, legal, emergency medical, Centrelink, mental health and optometry. Some services also attend the site at other times during the week.

Arriving at Half Moon Caravan Park tells a person they have reached the end of the line. One resident, a retired truck driver, described his first reaction as “shock and awe”.

The 52 operational caravans are very old, and there are a further 11 on site which are unlivable mostly because of trashing by residents. One van had to be burnt on advice from a biohazard team who were called in to clean up after a tenant who did not leave the van at all for three months.

The caravans contain sleeping and cooking facilities but no bathrooms. Residents use a central shower block with fixtures for six males and six females.

Casual visitors to Half Moon Caravan Park may find themselves confronted in unexpected ways as two law students on placement found out:

It’s a lot more confronting than what you think when it’s actually right in front of you, and a lot of the time they come across as abrasive but we just basically said hello and greeted them. Some of the people I saw here, I thought, oh, they look quite well presented and they don’t look like they’d be in that kind of situation. I suppose that was the most confronting thing: they weren’t what I would picture as facing homelessness or mental health issues or things like that.

You need to do things like this to get outside the small box that is your life…You wake up in the morning you think, oh shit, there’s no fricking cereal, and it ruins your morning. Whereas you come here, you witness this, and you just think oh well, I’ve got a lot less things to worry about.

Turnover at Half Moon is high – more than 350 people pass through the Park each year with the majority of exits being evictions. The Park’s manager maintains a zero tolerance policy on violence and drugs, and he keeps a list of names – currently 500 – of people who are barred

from re-entry. The Park does not accept children due to the criminal histories of some residents, and more generally because of the bizarre or violent behaviours that children could witness. According to the manager, twenty percent of residents have major mental health issues, and the Park is a common referral destination for people experiencing homelessness including the youth bracket (18-25) and those exiting the prison system with nowhere to go. Consequently the Park receives priority attention from mental health services including the local Crisis Assessement Team (CAT), and from police who do a nightly patrol as much as to keep an eye on known offenders as keep the peace.

Despite having to continuously hose down tensions, break up fights, evict tenants and handle death threats, Colin, the manager, keeps an upbeat perspective on the role that he and Half Moon can play in helping people to get back on track:

You do tend to find there is some social benefit for the people that are here. They do get off the streets. A lot of the people who come in here have been living in their cars. Now you see that and I see that and think, ‘well, they’ve got an opportunity here’. I’m not a psychologist, I’m not a bouncer, I’m not a babysitter but I do talk to them. Because they actually, all they need sometimes is just someone to talk to.

We have a shopping centre which is five minutes down the road. We are central to three Centrelink locations. There are medical practices less than 5 minutes away and public transport is directly out the front. So with that plus the services provided, it’s a good opportunity for people to get back on their feet. And we try to help them out as much as possible. A lot of them have found their own premises, which is great.

Colin believes that Health Time plays a crucial role for many of the residents and should be

expanded to at least two days a week. He has between five and ten tenants who rarely leave their vans and never leave the Park, so the visiting services are the only ones they see. Also many residents are on Newstart and often miss out on Health Time because of outside appointments.

Colin’s opinions are echoed by a lady who has lived at the Park for 12 months with her partner who works at a local meatworks:

There’s people here with all different types of issues, so there should be people here a bit more constant to help maybe deal with the people they work with a bit more, one on one more, instead of the once-a-week. They have a bit of a chat, and then, bang, they’re gone. They don‘t see them for a week. The agencies should be working together to help get those people out as quick as they’re in here. They should be helped along to be out of here for their own good. There’s every type of help here but it’s just not constant enough.

One resident of eight months has made best use of the opportunities available at Half Moon and at Health Time sessions:

We seem to get really good service. We get visits from a lot of people. They sort of oversee the mental things and medical. I’ve had my eyes done. I’ve had my teeth done and other medical things done and it just helps so much really. If there’s something wrong they want to know about it straight away and they look after you.

I’m on the pension. I make my money last from week to week. The only way I can make it last is being in a place like this where I can get some money ahead to move out of this place into a proper unit. That’s what I want to do is eventually move out of here. I’m 65 now and I just want to live the quiet life.

Health Time at Half Moon Caravan Park is a good example of how devoting relatively small amounts of resources in the right places can prevent much larger spending downstream on emergency and custodial services. One of the managers responsible for Cohealth’s Health Time programs makes this observation:

We are talking about a client group who traditionally are in and out of jail, in and out of hospital, in and out of accident and emergencies. They will be multi-presenters at any of those institutions. You are saving money if you can stop someone going into jail because you’ve engaged with them and done some support around them, if you can stop

someone going back into hospital for long periods of time, or stop someone going to accident and emergency regularly because that’s their only access to treatment. If you can do all of those things you’re saving the community bucket-loads of money.

Unfortunately Health Time is presently struggling to survive at Half Moon Caravan Park. The capital costs of Health Time – rent for the shop and food - are largely covered by Hobson’s Bay Council and Foodbank Victoria respectively, but staffing for the event is insecure. Beyond the visiting specialist services, two facilitators plus volunteers are needed to conduct sessions safely and provide a basic level of outreach service, but only one of the current facilitators is funded flexibly enough to cover these types of duties. The sustainability of the other facilitator’s involvement, which extends far beyond initial expectations due to cessation of project funds, is very uncertain.

Health Time at Gronn Place is the latest incarnation of a series of Health Time programs that have operated on or near

public housing estates within the Moreland and Hume municipalities since 2008.

Gronn Place was chosen to host Health Time because of high levels of complex unmet needs among the culturally and demographically diverse population at the estate. The issues include mental health, substance use, ageing, maternal and child health, overcrowding, transience, poor housing conditions, child protection, disengagement from primary and secondary education, neighbourhood disputes and cultural tensions.

Sessions were initially held as a monthly barbecue in the estate’s central courtyard. However safety issues, constraints on workers’ time for engaging participants and inclement weather prompted the organisers, VincentCare Victoria, to move the event to an adjoining community hall. Food is now brought to the hall ready-made, allowing workers to concentrate on engaging with attendees, assisting with linkages and completing follow-up tasks.

Overall, a mix of families, singles, younger and older adults attend Health Time sessions. Services provided include nursing, allied health, maternal and child health, multicultural youth workers, the Office of Housing for maintenance issues, and guests invited for themed events.

Homeless and vulnerable populations are less visible in the outer suburbs than the inner city: they may be dwelling in unsafe and unregistered rooming houses, sleeping in sheds and cars, or couchsurfing at public housing estates and overcrowded private houses.

In addition, the agencies funded to deliver services to these populations are spread far apart, making distance and transport a significant service access and engagement barrier.

Public housing estates were selected by VincentCare Victoria as best venues for Health Time due to their clustering of multiple-needs residents and transient visitors, with the first year of program operation being at the Hilda St estate in Glenroy. However relatively stable populations at housing estates mean that eventually the success of Health Time at one venue demands that the project moves on to a new venue with greater levels of unmet need.

The Health Time team tried shifting the event to non-estate venues such as Neighbourhood Houses and parks close to independent living units but attendance was limited, so Health Time returned to public housing at Gronn Place in 2011.

Because they are dealing with these relatively stable communities, including many families, agency workers view Health Time through a broader public health and wellbeing lens, as a Moreland Council Home and Community Care (HACC) worker with long involvement in the project explains:

When you’re in group living situations, for all intents and purposes it’s what the housing estates are, they can have drastic effects on surrounding neighbours and also the quality of life that people have in these estates. There’s a greater benefit to the whole community, as well, because a high percentage of the people that we come in contact with have multiple ongoing social issues or social problems,

and good practice seems to say that you can’t treat one and discuss one problem in isolation from another. So if you’re not addressing people’s health and their wellbeing, then it’s extremely difficult to address their housing issues, it’s difficult to address their employment issues because they’re all interrelated.

Consequently Health Time at Gronn Place takes a broad-brush holistic approach to wellbeing. Every Health Time session has a theme with accompanying give-aways and activities that tie in with the theme. Examples include healthy eating - with sample foods and recipe packs complete with ingredients, dental hygiene clinics, gardening, SunSmart and hairdressing.

Staff find that they need to begin their health promotion strategies at a more basic level than the approaches aimed at the general population:

A lot of the health programs that are coming out now are aimed at people that have fairly high literacy levels and who are actually engaged and thinking about their health and wellbeing. This cohort of people are not those people. They’re not thinking about their health and wellbeing. They’re often very pushed for time and/or money. So the last thing they’re thinking of is whether they’re going to join the gym or come into a life program or a HEAL [healthy lifestyle] program or any of those things because they don’t know. Even if you’ve got information in someone’s language you are assuming that they are literate in that language. Well there’s a big percentage of those people who are not.

A lot of them certainly are at risk of

diabetes, blood pressure problems, renal problems, kidney problems. There’s a whole range of illnesses that they may have had in their families that they’ve never taken any notice of. They’re often malnourished or overweight. There’s both end of the spectrums because their eating habits are poor. They’re not feeling well and they don’t know why they’re not feeling well.

And at the individual level, Health Time staff, who are working with clients with multiple issues, often find that their clinical objectives have to take a back seat temporarily until a non-health issue that is blocking the person from engaging with services is resolved. For one client this was getting her drivers’ licence renewed before it lapsed –not that she had a car, but her anxiety over the prospect of going back to a learners’ permit was overwhelming. Another Health Time client, an elderly man with terminal illness, was not ready to talk about services until his more pressing issue was dealt with:

I was in his home and we were working with him and I said to him “If I had a magic wand and I can grant you anything you like, except for your health back, I can’t do that, but what is it that you would like that I could make better?” - thinking that it would be “I’d like to walk a bit further to the shop.” He said to me he’d like to have his car spray painted because he sits inside the house and he looks out at his car and it’s a terrible mess. He can no longer take his car to get fixed. Now, how do I talk about heart disease when the thing that he worries about is the car outside his window? Then you say right-o. How about I look into who we can get to do your car, but how about today I work with you around your heart disease? And I’ll get onto your car tomorrow. He’ll say, okay. And we have, we’ve worked around that.

For the residents at Gronn Place, Health Time sessions have brought people together who would otherwise be isolated in their community.

Resident Pherina remembers a time when the estate was more community-oriented. When Pherina came to Gronn Place 13 years ago with a young child, she started up a community group aimed at providing diversionary activities for the children and youth living there. Before long her group attracted Council funding and expanded to cover all ages with activities like volleyball, karaoke, trips to the snow, community meetings, embroidery classes and more. However after running the group for six years she returned to work out of necessity, and the activities faded away. Six years on from the end of the community group, she now observes the effect of Health Time on the newer residents:

They come and they have a chat with the ladies, because some of the ladies they don’t come out of their house so now they’re coming out. I’m not shy, I’m from the Cook Islands. But for the other ladies sometimes it’s a bit different. Lately they all come out and we all have a good chat, we all get on really well now. They’re not as shy as they used to be. Staying at Gronn we come from all different countries but we have to be all one family. At the moment I’m thinking that I should get the community group going again to help out our children and youth and everything.

Maddern Square is a small public space hidden behind shops that front Footscray’s main streets. Health Time

moved there in 2011 when its previous venue – a park near the railway station frequented by daytime drinkers and users of other substances – was taken over for infrastructure development.

Despite the new venue’s CCTV and alcohol-free zoning, the square is a popular place for people to hang out and Health Time attracts a large number of participants to its barbecue every month: people who are experiencing homelessness or at risk, and people with complex health needs - along with the occasional elderly passerby interested in a free meal.

The event is coordinated by Cohealth Centre and hosted on rotation by the Centre and its agency partners in the Assertive Outreach Program.

Services regularly attending include nursing, housing, mental health, tenants union, legal, alcohol and drug, Centrelink, and blood testing by the Burnet Institute.

A free barbecue in the park is for most people an irresistible meal invitation, not least for its aromatic self-advertising. This informal approach to meal delivery works hand in hand with the intention of Maddern Square Health Time to create a positive model of service interaction by bringing needed services to a place where clients choose to be. It also ensures that attendees, of whom many would prioritise substance use over food, eat at least one good meal in the month.

The barbecue attracts 60 to 80 people each session, with many looking forward to it as a means of catching up with friends and acquaintances, and making contact with services:

I know a lot of people there. Even though I don’t use no more I still go there and still talk to them. They’re still my mates, I still care about them. Two of my close friends died last year from overdoses and it made me think just because I don’t use doesn’t mean I don’t care and I shouldn’t worry about them now, but I do, I still worry about people and tell them to be careful if they’re having a hit or whatever. I just go there and catch up on all the goss and catch up with the workers. You feel safe and you feel like you’re not getting judged when you go there. You feel comfortable and if you have any problems you just go up to the workers and you talk to the workers and they direct you in whichever way you have to go. Whatever’s wrong with you they help you.

Health Time at Maddern Square has a large number of attending services to match the volume of participants. Consequently, if a worker can’t help with someone’s problem it is more than likely they can introduce the person to another worker on site who can:

So if somebody has some obvious health needs I can quite readily face to face, at one of our events, refer the individual to

one of the nursing services or a health centre. Again, if someone’s in need of housing we’ve got local housing organisations represented. We all prefer what, in my business, we call ‘warm transfers’. Far easier that I bring someone directly to a service, introduce them and indicate this person requires some advice about their podiatry than just send them off into the distance assuming it all gets sorted. And it just builds for good relationships there as well, whether it’s my client base or the other stakeholders I work with.

In many instances a worker is able to deal with a client’s issue on the spot by phone, which gives the person confidence in the worker and the service, perhaps enough for them to make a subsequent visit to the agency:

For my service users it might be around pharmacotherapy like methadone, those sorts of things. They might be having problems with their chemist or whatever it might be. So we would be able to call Harm Reduction Victoria who have a program for PAMS, which is the Pharmacotherapy Advocacy and Mediation Service and they can call the chemist or the doctor and advocate on the service user’s behalf. That all could be done standing out there.

So if you can then resolve that issue but they’ve still got a couple of other issues that need addressing, they are more likely then when you say, “Why don’t you come down to Health Works after the barbecue or tomorrow or when you have time and we can look at addressing those other things that you mentioned to me today?” They have more confidence and trust that you’ll be doing something.

Hence this model of service delivery works in favour of agencies as well as clients by reducing the amount of time workers spend identifying, locating and chasing up people, especially if they are charged with delivering outreach services. The Maddern Square barbecue is an

efficient way for workers to contact multiple clients who otherwise can be very difficult to engage or locate, as people who live in rooming houses or sleep rough often leave when they get up and don’t return until late at night.

Health Time at Maddern Square also overcomes some of the other obstacles facing outreach services. For example, it is not practical for Needle and Syringe Programs to do outreach at accommodation places with zero tolerance policies, since their visits can identify residents who are injecting drug users and cause their eviction.

Though at its current site for only two years, Maddern Square Health Time is the product of ten years’ co-operation between agencies involved in the Assertive Outreach Program. Some agency partners are not technically funded to do outreach but find Health Time the most effective means of reaching their target groups. Other agencies, like Centrelink, have services that are funded to do exactly this type of work:

We’re actually funded through the White Paper of the Australian Government to support people who are homeless or at risk of homelessness. A lot of the people with service outside the mainstream office environment have a range of reasons for not attending the Centrelink office. It may be because of a previous incident which resulted in them not being allowed to attend an office. It may be just because their lives are so chaotic that by the time you’ve worked out where you’re going to get your next meal from, you’ve had your medical appointments, you’re working out where you’re going to sleep tonight, it’s close of business. So it’s easier for people to access our services where they’re going to be than us force them into a relatively structured environment where a lot of us don’t feel comfortable. So it’s a no brainer, that’s the way I see it.

Cohealth, which is involved in several other Health Time events as well, finds spare capacity in diverse program areas to help resource these projects because the agency sees Health Time as a means of achieving one of its core business objectives:

From a human rights perspective everyone has a right to health care. And by “everyone” we also include people who are more marginalised and have more complex needs and who are more disenfranchised as being “everyone”. And that permeates throughout the whole organisation which means it’s core business. So we’re able to then draw on those resources. You have to look at who doesn’t have access to health care, why they don’t have access to health care, and what does that look like? In many instances that’s actually the people who aren’t coming into traditional health services. So therefore you have to change what you do. And Health Time helps support that process.

Every Friday, Cohealth hosts a barbecue and drop in space in the courtyard of their Nicholson St Footscray premises.

This Health Time is primarily aimed at young Africans who are at risk of a lifetime of social marginalisation, substance abuse, periodic incarceration and deepening health crises.

Four program partners including Footscray Police materially support and facilitate Health Time sessions on a rostered basis and a fifth agency co-ordinates the responsibilities of partner agencies and other visiting services.

A DJ plays music every session and invites people to get up and rap. Visiting services attend on a rostered basis so as not to overwhelm the participants’ space.

The Health Time sessions are held on Fridays to coincide with the availability of on-site GPs as well as ensuring that participants eat a good meal before the start of the weekend.

For several years the venue for this Friday barbecue followed the movements of an extended cohort of 35 to 45 mostly male and Sudanese young people aged from late teens to early thirties, taking the event to wherever they would hang out in the Footscray-St Albans area. Many of the group are without housing and couchsurf in large numbers at the homes of friends, often resulting in noise complaints and tenancy problems for people they stay with.

The most recent move to Cohealth premises is designed to give participants a safe space that is theirs for the afternoon for socialising, rapping and dancing, where they can attend even if intoxicated and engage with agency workers and health services. Ten to fifteen people attend each session, with eight or so attending most sessions and the rest of the group attending on and off.

Barkly Arts Centre provides music, a DJ and a microphone for participants to join in. Kauma the DJ explains why:

Maybe they haven’t had time to hear music in the whole week. Sometimes they want to dance. When you get on the mike they’re supposed to free whatever they feel like in their mind. It’s all right if they think out some negative lyrics, that’s fine because every human being have those lyrics. Instead of using your physical energy and go out there and fight or whatever, I think it could help you release the stress by saying all the frustration you’ve had in a week. That’s what the music does really. We’re hoping that more people come around and know about this thing on Friday so that they can get more involved in the positive doings instead of negative.

Most of the cohort have multiple health issues including alcohol abuse, depression, post-traumatic stress disorder or a significant disease such as tuberculosis. Some of the older men were child soldiers. Many were orphaned by

civil war, and most came to Australia via refugee camps in Kenya, Uganda and Egypt.

Collectively they call themselves ‘the boys’ and strong bonds of loyalty tie them together as in a family, which is how the group functions for members.

One older member of the cohort making his first appearance at the barbecue explained why he came:

It’s not because I’m hungry that’s why I come here to eat at barbecue, it’s not because of that. Because we want to come and sit together and recognise ourself and talk. Your problem I can’t solve it and you can’t solve my problem, but it’s not because of just the food I come here. I want to come and meet a lot of my colleagues here and we will …they will tell me what is wrong with me, and I got to tell them what is wrong with them. If we didn’t come and get together, how are we going to tell each other the truth?

The group as a whole is stigmatised by the broader community because they congregate in large numbers in public places, they may drink alcohol in those places or cause a public disturbance or damage property, and they are very visible because of their skin colour and height.

Over time their behaviours led to increasingly confrontational encounters with police as the latter attempted to disperse the group, make arrests or serve warrants for unpaid fines from previous encounters. Local agencies recognised that if nothing was done to stop the spiral of marginalisation there was a high risk the group would evolve into a ghetto-style gang, destroying the life chances of members and seriously damaging multicultural relations in the broader community.

Community agencies together with Footscray Police have put in a continuous effort over

several years to break down barriers on both sides by running barbecues, music and education programs, and participating in leadership camps together. The barbecues act as an initial engagement mechanism and ensure continuity of contact, while the camps provide opportunities for deeper and quicker understanding between parties. At these camps agency workers, police and young men who are chosen for their group leadership potential undertake physical challenges together, see each other get pushed out of their comfort zones, and learn to understand each other as humans first.

These engagement strategies are significantly improving police-group relations, especially during law enforcement encounters that could otherwise escalate into violent confrontations. Jodie, a police officer who has worked with the group for several years describes one example:

I had an email from a sergeant in Sunshine and he said, “Well, we had an arrest. The guy had warrants at the train station,” and they were just expecting the situation to get ugly. But instead they got cooperation, and interaction with the group was good. They actually walked back to Sunshine station with this big group of African guys, and there was banter and whatever. The sergeant asked them something like “How come you guys are so good?” One of them, who was calming the others down said, “I went to a camp with Jodie last week”. So these opportunities have a good ripple effect.

In terms of health, agency workers say that progress for the group as a whole is incremental, yet also fundamental as members shift towards a more considered and pro-active approach to looking after themselves:

I think one of the changes that I’ve seen is that the young people are taking more responsibility in terms of their health. They are taking more pride in who they are as young people, and more responsibility in terms of their drinking and all that sort of thing. More responsible in terms of the decisions they make, life choices and what their future projections are. So you’ll start hearing that shift of what they want to be, what they want, whether they can get support around different things, which was really different from before.

Results for individuals can be very significant. Several group members have started or returned to tertiary education and others have found work or stable housing. One young man now works for Cohealth and is studying at university. Although he keeps connected with the group, he decided to change his life after the deaths of two friends:

The barbecue was the doorway to everything. It’s opened the door to health facilities, recreational facilities, music, everything. I know most of the boys, I’ve seen a whole lot of people go down the drain. We had two friends die within two months. I thought look, it’s time for us to wake up. If no-one wakes up we’re all just gonna die to be honest. That was my whole perspective. My friends

started drinking and I thought that’s not me, it’s not going to solve my grieving and everything. I’d rather do something productive.

The Friday barbecue is an inspiring example of how relatively small amounts of resources focused consistently in the right direction can produce big results for individuals and the wider community. Jodie from Footscray Police comments:

It’s always hard to prove what you prevented. But I can absolutely say it’s really playing a big part in preventing a lot of crime, a lot of unnecessary deaths, of all those problematic behaviours just going to the full extent.

The necessary material resources are venue, facilities and food. Human resources require core service providers, program co-ordinators and event facilitators.

Venues:

Health Time projects need to adapt their approach and delivery to the environment of the client.

Venues must be highly accessible, convenient and user friendly. Health Time clients will not attend locations that are difficult for them to get to or where they feel out of place or threatened. An unsuitable choice of location will result in poor attendance.

When a Health Time program sets out to engage clients where they live, it is more successful when sessions are held exactly at their site of residence. Examples are the Gatwick, Half Moon Caravan Park and Gronn Place.

It is instructive to note that prior to running Health Time at Gronn Place, the program attempted to attract residents from a housing estate in Coburg to Health Time sessions being held for them at a Neighbourhood House just around the corner. The results were dismal with just a few clients attending. This was despite advertising the sessions with flyers and having already run Health Time successfully inside the same housing estate a few years earlier. Even with Health Time at Gronn Place, moving the sessions from the estate courtyard to the community hall next door lost participants, particularly single people.

When a Health Time program’s intended clients do not all live in the same place or do not have

accommodation, Health Time sessions can be held at places where people like to hang out, such as Maddern Square; or failing this sessions can be held at accessible, user-friendly venues that are credible and trustworthy to clients. St Peter’s, St Brendan’s and the Friday BBQ at Cohealth fall into this category. St Peter’s was already well known by people experiencing homelessness; Cohealth’s program partners had been servicing their Friday BBQ clients for several years prior to moving the sessions to agency premises; and the St Brendan’s site was familiar to many of the clients who had been attending the Holland Court Health Time program.

Facilities:

Since the location of the program is dependent on the preferences of clients not agencies, Health Time providers must improvise with any existing venue facilities.

In the case of programs held at indoor locations, the ideal venue would be equipped with a full commercial kitchen, adequate seating and tables for participants, plus enough workers to do all the cooking, serving and cleaning. Only St Brendan’s has all of these ingredients, including importantly a volunteer professional cook. At the other indoor venues – the Gatwick, Half Moon Caravan Park and Gronn Place - which have lesser kitchen facilities and fewer workers available for kitchen duty, food is partially or fully prepared elsewhere before the sessions.

The three events held outdoors – St Peter’s, the Friday BBQ and Maddern Square - cook on site using a barbecue. St Peter’s and the Friday BBQ have the advantage of being held in courtyard premises that allow for equipment storage and at least semi-permanent hygiene and fire safety measures, whereas Maddern Square requires all necessary equipment to be bumped in and out each session. This is a significant time and energy factor for agency staff, who may spend more time looking after event logistics

then engaging with clients. These issues plus repeated foul weather prompted Gronn Place Health Time to shift from the estate’s courtyard to the neighbouring community hall.

Food:

All the Health Time programs aim to provide healthy food that their clients may not always have an opportunity to eat, so proteins, vegetables and salads are present in abundance. Water is often provided as a preferred drink, while tea, coffee or fruit juice are offered at some venues.

Most programs receive donated food from SecondBite or Foodbank Victoria and then buy the remaining ingredients needed for each session. For Gronn Place which has a large Muslim population, workers buy ready-made halal food from a nearby take-away restaurant.

On site service providers:

To get up and running, Health Time programs need core service providers who are funded to, or otherwise have the freedom to work flexible outreach duties.

Depending on agency resources these positions are usually drawn from a Community Connections Program and the RDNS Homeless Persons Program, or otherwise a Community Health Nurse. These two positions of outreach worker and nurse provide the core service capabilities around which a Health Time program can be built.

The visiting services most needed by clients are:

• housing information and referral

• nursing

• legal

• mental health

• drug and alcohol

• Centrelink

• allied health, especially podiatry.

Constant high demand for legal services often makes it difficult for these agencies to provide outreach.

Co-ordinators and facilitators:

Every Health Time program needs a co-ordinator to organise all activities and logistics surrounding Health Time sessions. These duties include:

• Preparing a timetable of Health Time sessions for the coming months or year.

• Preparing advertising material eg flyers.

• Rostering all duties and responsibilities for every session.

• Rostering and/or confirming the presence of visiting services for every session.

• Organising pre- and post-event debrief meetings.

• Ensuring that Occupational Health and Safety (OH&S) protocols for Health Time sessions are developed and followed by participating workers and agencies.

• Organising food (if this responsibility is not devolved by rostering to a program partner.)

• Communicating the above to all partner agencies and positions.

Event facilitators (who may also be program co-ordinator) are needed to run the Health Time sessions on the day. Their duties include:

• Doorknocking at venues where clients live

• Setting up equipment

• Buying, preparing, cooking and serving food

• Monitoring OH&S issues

• Managing participants and handling any incidents

• Liaising with venue proprietors

• Welcoming and engaging clients, facilitating linkages to other workers.

• Taking referrals and providing information.

• Facilitating the pre and post debrief sessions.

More often than not the event facilitators are, themselves, outreach workers, who must fit their outreach work around their facilitation duties as best they can. This is where community volunteers can be most useful, as at St Peter’s where volunteers do some of the cooking and serving; and at St Brendan’s where the large team of volunteers look after every aspect of providing for and managing Health Time sessions, leaving service providers to focus solely on their work.

Good food and a good location help make the setting right for clients to engage with services. The next part is up to the workers.

All agency workers say the same thing about engaging with clients or guests at Health Time sessions: it all starts with building a relationship:

You tend to have a conversation where they’re thinking that you’re just having a chat to you but actually I’m having a health assessment, without too much fuss. It’s a much nicer, easier forum to work in because they’re not feeling threatened and you’re on their turf

basically. So they feel quite comfortable with that, so they’ll often tell you a whole lot more about their health because they feel more relaxed.

I tend to say to a lot of volunteers that come and work with us that they need a sense of humor, broad shoulders and thick skin. I think that’s pretty much the case with workers too, is that you have to be quite tolerant and patient. Sometimes it takes time to build a relationship, as in a lot of other spheres of life and for trust to be built up.

Consistency builds confidence and trust. In order to gain the confidence and trust of people whose lives are characterised by instability and periodic chaos, Health Time needs to happen at the same time, same day every session:

It has to be long-term and it has to be consistent. The thing that wins is that you’re there, every month, rain, hail or shine and that you’re consistently listening and providing for them.

Continuity of staff is also important. When a client takes a risk on building a relationship with a worker and that worker is suddenly replaced by another, this can be a negative experience for the client if done without careful planning and preparation.

Consistency helps venue proprietors too, so they can remind clients and new arrivals that Health Time will occur on a particular day, or discuss concerns they may have about clients with Health Time workers.

The multi-disciplinary environment of Health Time is one of its greatest assets, as it demands constant knowledge transfer between workers about services and clients. One Health Time coordinator who recently moved to Victoria found it a revelation:

I’m from New South Wales where you work on your own. If you meet with another organisation it’s a case conference about a client, you don’t work together like this. This is so unique for me. So to be able to do that, and be coordinator of that is an amazing way to network and keep you interested in the role, making you feel like you’re making a difference. You really get a good understanding of how other organisations work as opposed to reading a website or having one conversation on the phone. It really gives you a good understanding.

All Health Time programs hold planning and debrief meetings between Health Time sessions. These meetings are also opportunities to co-ordinate service responses to the needs of individual clients.

If the venue is in a fast-changing or volatile environment, the debriefing arrangements used for the Gatwick are a commendable example. There workers meet immediately before and after each session to share up-to-date knowledge about clientele changes, current drug use, incidents and risks; arrange follow-up work; and ensure that workers have an opportunity to talk about any incident or conversation during the Health Time session that may have impacted on their wellbeing.

Occupational health and safety (OH&S) is a serious consideration for Health Time projects. Beyond observing routine outreach safety procedures such as always working in pairs, specific OH&S and emergency protocols are developed for each venue.

Cramped venues with limited entry and exit points should be avoided where possible. Anglicare Homeless Support Services in consultation with Cohealth closed the venue near St Paul’s Cathedral because of these

problems, and moved Health Time to St.Peter’s which offers more space with multiple exits.

At the Gatwick Health Time, which does operate in a confined space with narrow entry and exit points, the workers keep a constant eye out for their own safety and the safety of clients, and observe a strict protocol as follows:

If the lead person who’s running the show that day says, “We have to go now” we go. Whatever that person says goes. We don’t argue, we leave and discuss it later. It might be that person’s got word from Rose or Etty or someone, there is someone there that it’s not good for us to be around, they’re in a bad way, they’re very drunk, or they’re having a psychosis and we need to be out. We don’t ask questions we just go.

Despite the apparent risks, Health Time workers report that they experience very few incidents.

Cooking with barbecues presents extra risks, especially for clients. In these outdoor situations Health Time workers position the barbecues to limit access as much as possible, and arrange trestle tables to serve as barriers. At events where children are present these precautions may not be enough: Gronn Place workers came to dread school holidays when their Health Time sessions involved barbecuing in the estate’s courtyard.

Health Time projects tend to operate in the grey area between funding agreements and position descriptions. Several but not all of the projects described in this report are sustained by Low Cost Accommodation Support Programs such as the Community Connections and Active Connections Programs which provide the flexibility and assertive outreach capacity that underpin the Health Time approach.

Occasionally a program may be kick-started or revived by limited project funding, but on the whole Health Time programs get by without any dedicated funding, continuing from year to year on the goodwill and commitment of partner agencies and/or individual workers.

It’s a multilevel approach because it is unfunded. The energy has got to make up for the funding. That’s why some people drop out because they haven’t got funding or they haven’t got the energy.

Unless there is the capacity for the department to provide some core funding for this on a regular basis then we’ll always have these conversations over the next number of years as people are trying to work out how do we keep this going.

Programs that operate inside territories that are relatively dense with outreach services for people experiencing homelessness – such as St Peter’s in the CBD – are able to draw on this concentration of resources to keep their programs running. This is not to say that managers do not need to be frugal and creative to resource their Health Time sessions.

Health Time projects further away from the city centre struggle much more to keep running continuously from year to year: they are located in suburban landscapes where homelessness and disadvantage are more hidden, and agencies that would be ideal partners for Health Time are thinner on the ground and not all of them see this type of outreach service as part of their core funding mandate.

One of these suburban Health Time projects, working with some of the most disadvantaged and marginalised people in Victoria, has been bridging the resource gap by the perseverance and commitment of a particular worker. Another project that has fought hard since its inception to gain partner agencies has been relying for years on the commitment of a single

worker to keep one partner agency involved, and the project gained management support at another vital agency after a new incumbent took over the CEO role.

Without dedicated funding and inter-agency MOUs, Health Time programs are underpinned by a high degree of uncertainty and rely upon a large degree of worker resourcefulness and personal commitment from year to year for their continued operation.

If commitment is one wing, creative partnership is the other that together enable Health Time programs to stay airborne.

Health Time workers and managers recognise that sustainability requires multi-level partnership between agencies:

Unless you’ve got buy-in from very high up it’s not going to work. It’s a two tiered system so your level of managers who can sign off on brokerage and funding and all of that say yes, we can give X amount of clinicians in kind, and then you need the workers. You need to have the coordination of what’s happening on the ground and who’s responsible for the door knock and the day-to-day running, but you then need to have the managerial buy-in up here.

I’ve always been involved in establishing the services rather than just leaving it to the workers because you need that buy-in, because we know that people won’t see the worth for six months. If people buy out in that six months because they can’t see the worth, they’re not seeing anybody, then where will that leave us?

Some projects draw together the most unlikely partnerships to service their clients. For example, the coordination component of the Friday BBQ at Footscray is funded for the time being by the Victorian Multicultural Commission via a Transition to Independence program operating from the Maribyrnong and Mooney Valley

Local Learning and Employment Network. The other agency partners materially supporting this program are the Centre for Multicultural Youth, Footscray Police, YSAS (Youth Support and Advocacy Service) and CoHealth.

This collaboration demonstrates that ultimately it is the program beneficiaries that determine the project partners because there is no single way of ‘doing’ Health Time, rather it is a flexible approach to supporting a client group:

As opposed to coming in and saying “this is what it’s going to look like, you’ve got to do this, you’ve got to do it this way,” the model itself comes out of working together to engage clients who aren’t engaging in services.

Health Time programs bring diverse benefits that spread far beyond their clients.

• An opportunity to have healthy food that is in itself an ultimate good for people experiencing homelessness or in marginal housing, and for people who are struggling financially and experiencing food insecurity.

• Streamlined and prioritised access to services they would not or could not normally attend, such as dentistry, podiatry, physiotherapy and nurse health checks. This leads to better engagement and follow-through with mainstream services.

• Opportunities for social connectedness and social inclusion. These opportunities to relax, eat and chat with others or just sit near other people in relative comfort and safety can be rare for many Health Time clients.

• Safer access to their clients by working within a team.

• Easier access to clients when you know where they will be.

• Identification of vulnerable and isolated residents who need support but are not already linked in or accessing services.

• Proprietors have improved access to services and referral pathways for residents, and increased knowledge of the service sector and intake processes.

• Opportunistic and “on-the-spot” referrals to services and appointments with improved assessment, care planning and linkages.

• Increased awareness of community and client issues that are impacting clients such as drugs, violence and health vulnerabilities.

• Learning opportunities through working in multi-disciplinary teams.

• Faster and/or deeper client engagement.

• Better access to otherwise hard-to-reach target groups.

• More efficient assertive outreach processes.

• Decreasing ‘did not attends’ from Health Time clients as they become more confident in using agency-based services. For services like dental this can be a significant saving.

• Decreasing aggressive behaviour at agency shopfronts, according to some reports.

Health Time also benefits the places where people live. Programs that operate in very difficult residential environments like the Gatwick and Half Moon Caravan Park do a large amount of preventative work in terms of averting crises that can negatively affect all residents.

This points to the broader social advantages of Health Time as an assertive outreach platform: by engaging their clientele the programs not only assist people to move forward, they also protect those individuals from greater harm.

In economic terms this protection creates savings in emergency and tertiary services.

In terms of social inequality, the Health Time model provides a robust vehicle for health and welfare agencies to fulfil their charters:

If we’re going to address social inequalities from a human rights perspective you have to look at who doesn’t have access to health care, why they don’t have access to health care, and what does that look like? In many instances that’s actually the people who aren’t coming into traditional health services. So we kind of say that the clients who don’t come in the door are probably the clients that we need to be seeing more of, so therefore that’s where our attention goes to.

And so you have to actually find ways of engaging that community. Taking services to where the clients are, in their environments, in their spaces is important. And we recognise that that’s a really effective tool in terms of engaging clients. So health time activities are a way of taking services to the clients or potential clients, and building up a relationship with them so that they actually then feel more comfortable coming in the door.

Text and interviews by Peter Feldman (pfeldman1605@gmail.com).

Images by Adis Hondo and Peter Feldman

Report and DVD artwork designed by Vira Falcone (virafalcone@hotmail.com).

Editorial input provided by the Health Time Programs Key Learning and Dissemination Steering Group comprising: Karen Antrim, Helen Ferguson, Leonie Kenny, Judith Prigg, Lisa Sammut, Brian Sardeson, Jo Serafim, Paul Spratt, Ian Symmons and Paul Zanatta.

The development of this publication was made possible by support and funding from the North West Metropolitan Department of Health.

Thanks to the Department of Human Services (Office of Housing), VincentCare Victoria, Inner South Community Health, Cohealth (formerly Western Region Health Centre and Doutta Galla Community Health Service), Anglicare Victoria Homeless Support Services, St Brendan’s Parish Hall volunteers and all the other agencies and individuals involved in the Health Time programs:

Doutta Galla Community Health, Western Region Health Centre and North Yarra Community Health merged to become Cohealth in May 2014.

And a special thanks to all the Health Time participants who generously gave their time to be interviewed for this report.

• Anglicare Victoria Homeless Support Services

• Avalon “The Moving Wardrobe”

• Baptcare

• BridgingWorx

• Cohealth (Community Connections Programs and Outreach Allied Health Team based at the former Western Region Community Health Services and Doutta Galla Community Health Services)

• Clarendon Community Mental Health Services (CMHS)

• Cultivating Community

• Good Shepherd Family and Youth Services

• Homeless Outreach Mental Health Service

• Inner South Community Health Service (Community Connections Program, Outreach Physio and Podiatry. Drug and Alcohol Outreach, Insecure Housing Worker, Dental Outreach, Outreach

Health Nurse, Midwife and Sexual Health nurse, Assertive Mental Health Outreach)

• Merri Community Health (Allied Health and Healthy Ageing Demonstration Project)

• Moreland City Council

• Public Interest Law Clearing House Homeless Persons’ Legal Clinic

• Royal District Nursing Service (RDNS) Homeless Persons Program (HPP)

• Royal Women’s Hospital Well Women’s Clinic

• St. Peters Eastern Hill Anglican Parish Church

• The Gatwick Private Hotel Proprietors

• The Half Moon Caravan Park Proprietors

• VincentCare Victoria ( Community Connections Program and Access & Support Program)

• Wintringham Over 50’s Club