Theme: Models of Care Year: 2024
Background: In Québec, urban Indigenous peoples experience higher rates of poverty, unemployment, violence, homelessness, and substance use. This situation is explained in part by intergenerational trauma and the loss of cultural identity caused by abusive assimilation practices. First Nations, Métis and Inuit (FNIM) people have a difficult relationship with the health care system whose approach is often quite rigid and doesn’t consider their values, cultures, and ways of doing and of knowing, hindering access to care.
Methods: Improving access to addiction medical services for homeless Indigenous peoples in Montreal is the focus of an integrated care model spanning primary care and hospital-based addiction services. The collaborative effort involves the Centre hospitalier de l’Université de Montréal (CHUM), Médecins du Monde (MdM), and the Native Friendship Centre of Montreal (NFCM).
Results: The Proximity Clinic, operates as a drop-in day center for FNIM homeless populations, offering health services in a culturally sensitive environment. Utilizing a “go to them” and “no wrong door” approach, the clinic provides primary care access and hospital-based addiction services via telemedicine, aiming to break down barriers to care.
Between September 2023 and March 2024, the Indigenous nurse practitioner conducted over 430 consultations for more than 175 patients, with over 54% of visits focusing on infectious disease and/or substance use screening. Patients cited accessibility, nonjudgmentalism, and cultural safety as reasons for participating in screenings.
Conclusion: The integrated care model developed by MdM, NFCM, and CHUM strives to address the complex needs of Indigenous individuals with chronic illnesses and substance use issues, including hepatitis C. By fostering a culturally safe and inclusive environment, the clinic aims to dismantle barriers to care and ensure respect and understanding within cultural and social contexts.
Moving forward, the collaborative efforts aim to sustain and expand the model, enhancing access to vital services for Montreal’s homeless Indigenous population.