Every day of the year, between 250 to 350 people come to our inner-Melbourne hub service for meals and support. Along with hot, nutritious meals, we provide outreach engagement, case management, crisis intervention, specialist aged care support, along with pathways to AoD treatment and mental health support for people who are homeless or at risk.
From August 2021 to June 2022, we operated an on-site vaccination clinic in collaboration with local primary health service, STAR Health. Our guiding principle was that the vulnerable community members who attend each day for meals would benefit from culturally familiar and convenient access to on site vaccination, along with a tailored health promotion approach.
To help support this program we received funding from the Community Engagement Grants – Ambassador Program funding through the Department of Health.
The vaccination clinic is positioned alongside the meals take away service at the front of our property. Every day there are people we have not seen before, there are also regulars and the pattern of use is varied. There are those who come once or twice a month, right up to people who attend almost daily.
The clinic ran twice a week for three hours per session from a large white marquee in the middle of our front courtyard.
We have privileged a consistent, single worker to act as a vaccine ambassador. This has enabled consistent messaging and allowed the worker to become a familiar and trusted source of information.
This worker does a range of things including meeting and greeting arrivals, inviting people to have a vaccination, answering questions, and providing written information. A major part of the role has been listening to people’s fears and concerns. Having a single worker present for each session has been a key part of this project’s success.
I’d like to also acknowledge the work of STAR Health and particularly the team who have been coming to our service, who have demonstrated great flexibility and patience and an openness to working in a spontaneous way.
We know that in our four residential services, vaccination uptake has been high (above 80%). This is primarily because workers have increased opportunities and time to engage with residents. At a drop-in service like ours, with an ever-renewing community of transient and marginalised people, the fully vaccinated rate remains low and (at the time of writing) is still under 50%.
While many people in the homeless community are mindful of their health, we know that homelessness itself has a diversity of presentations. There are groups of people within this community who do not often engage with services. Experiences of trauma are probably at the heart of this.
We generally see between 12 to 25 people attending for each 3-hour session.
There was a lag in numbers at the end of 2021 where we had only 3 or 4 people, but that was unusual.
Across the year l, we provided:
In all of this, it might be useful to remember that our engagement hub is a high-volume, open access service – we do not keep files on everyone who comes in, and we don’t know everyone’s name. If someone seeks specific help then we get consent and open a file. Our model is to encourage people who may not be help seeking to come to us, with as few barriers to access as is possible.
It should be noted that in recent weeks the need for booster shots has been received with some suspicion and irritation, even from fully vaccinated people. “When is this going to end? Is this really necessary?” have been a common reactions. Enhancing the messaging about why boosters are needed must be a key part of vaccination communication going forward.
We have identified 4 cohorts of people:
Central to our approach has been having one dedicated worker whose job it is to educate, answer questions and provide clarification. Sometimes this has included being yelled at.
It’s not always the bad thing when someone loses their temper. I can think of several occasions where a client has been very angry about vaccinations, and about the pandemic in general, has vented and this has eventually led to a fruitful conversation.
A number of people have actually made the decision to be vaccinated from an initial position of verbal resistance, but it takes time and a nuanced response.
There have been many reactions to on-site vaccinations. One man, Peter, is a 55 year-old who identifies as an Aboriginal community member. Nine months after he was eligible, he decided to have his first shot.
We had a chat about why he finally agreed to go ahead after weeks of hesitation. Peter said that he came to our site for several weeks and watched the people coming in and out for their shots. In Peter’s words, “I saw no one was taken away on a stretcher, no one seemed to get sick. I saw the same workers here each time. People were friendly. I decided, based on what I could see it was probably safe.”
This goes to the heart of predictability and consistency.
I’m aware that other vaccination clinics have also been set up alongside vulnerable communities and that they have not always had a significant uptake of vaccinations. Perhaps what was missing was an element of predictability and a dedicated worker to provide that important transfer of trust, to act as a conduit.
We think there are 8 key lessons that are worth sharing.
This article was first published in Parity Magazine, Australia’s national homelessness publication. The outcome statistics mentioned in this article were updated in October 2022.
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