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A Street Outreach Manual

Rev. S. Brandt

Rev. S. Brandt

1. Introduction
1.1 Purpose of the Street Outreach Guide
1.2 About Ottawa Innercity Ministries
1.3 Philosophy and Principles
2. Customer service
2.1 Homeless People
2.2 What Homeless People Want from Street Outreach
2.3 How the Service Meets Requests
2.4 Establishing Goodwill
2.5 Building Trust
3. Case management
3.1 What is Team Case Management?
3.2 Level of Service Provided
3.3 Assessment, Monitoring and Review
3.4 Referrals and Managing the Service’s Workload
3.5 Case Closure
4. Shop-front and outreach
4.1 Outreach
4.2 Opening Hours and Office
4.3 Duty Work
5. Professional practice
5.1 Advocacy
5.2 Client Instructions
5.3 Confidentiality
5.4 Duty of Care
5.5 Client Files
5.6 Data and Clerical Systems
5.7 Quality Assurance

1.The examples in this document are not actual events or people. They are based on the experiences of Ottawa Innercity ministries and are used to highlight aspects of the guide.

The Street Outreach Guide is the culmination of over two decades of street outreach service to the homeless on the streets of Canada’s capital.

This guide was written by Rev.Susan Brandt a nurse, a counselor, a chaplain, a friend to the poor and founder of Ottawa Innercity ministries since 1988.

1.1 Purpose of the Guide

Whilst there has been a focus on identifying the needs of homeless people and developing services very little attention has been paid to how services are actually organized and what transpires between street outreach
workers and homeless people on a daily basis. Unfortunately, good practice and the achievement of tangible outcomes for homeless people is more often than not reliant on the skills and effort of individual workers rather than a systematic approach to achieving good practice within an organization.

Good practice stems from a number of sources:
• A philosophical basis for the service that encompasses an understanding of homelessness and disadvantage, a commitment to high standards of professional practice and to respecting and upholding individual rights.
• A clear sense of purpose for the service, including the outcomes to be achieved.
• Knowledge of the characteristics of the people the service is targeting ie. Their life experiences, culture, socio-economic background, value and needs.
• Development of a model of service, service environment and client service which is compatible with, and responsive to, the needs of the homeless community.
• Building in quality assurance processes, which monitor quality and promote reflection and innovation.

This guide provides an overview of a street outreach service to homeless people and in doing so aims to:
• Promote discussion and reflection on practices in working with homeless people;
• Encourage services to adopt flexible and responsive models of service delivery to homeless people;
• Contribute to the orientation, professional development and quality of service delivery to agencies, staff and groups wishing to do street outreach

1.2 About Ottawa Innercity Ministries

OIMs ultimate objective is to eliminate homelessness in the inner city of Ottawa Our more immediate objectives are:
• to provide direct services and individual advocacy to assist homeless people in acquiring decent housing and essential services;
• to provide services in a competent and friendly manner and in accord with each clientís wishes;
• to advocate for change and development to improve services and increase the supply of decent, affordable housing for homeless and disadvantaged people;
• to be accountable for the efficient management of services;
• to monitor and review service delivery and administration to ensure excellence and innovation.

The services of OIM are particularly directed to people with addictions, psychiatric disabilities, dual disabilities and to the frail aged. It has been successful in providing outreach services to people without shelter and/or essential services and to those barred from services. In recent years an increasing number of Aboriginal people have used the service.

1.3 Philosophy and Principles
OIM provides services in the belief that society ought to provide for the fundamental needs of all its members and welcome all members of its community. These needs include decent, affordable housing; employment and educational opportunities; health and other essential services and opportunities for spiritual expression. OIM is committed to assisting people to have their basic needs met as a matter of priority and to addressing the problem of homelessness in as broad a way as the service can manage, given its resources.

The problem of homelessness is not seen as a result of individual failure but as a failure of the society and the spiritual communities to provide adequately for all its members. Consequently, the service seeks to change peoples situations so that they can be empowered to make healthier decisions for their life and this is reflected in its approach to service delivery.

OIM works within a framework, which respects and promotes the individual rights that are afforded citizens of our society These include, equality before the law and the presumption of innocence; freedom of speech and movement; the right to privacy and self-determination; absence of discrimination based on race, religion and sex; and equality of opportunity.

Through the experience of working with homeless people, the service is well aware that rights and principles are liable to dwell in the realm of the abstract. It is easy to lose sight of these rights when under pressure, dealing face-to-face with real people,
experiencing distress and behaving in ways that do not accord with one’s own values or background. Nevertheless, this in no way diminishes the need for rights to be respected and upheld. Homeless people have little control over many aspects of their lives; their rights, too, are often and easily breached by those in authority. Respect for people’s rights in a practical sense includes respecting people’s right to live their lives as they see fit. This underpins the practice of OIM


All outreach workers are expected to exercise a high level of competence in carrying out their tasks. This is critical as the people the service assists are amongst the most disadvantaged in the community and are dependent on the service to get their basic needs met.

This competence also extends to ethical practice. Workers are required to keep information held about people in confidence, maintain a duty of care, and act legally and honestly. Workers are also expected to demonstrate respect for individual differences in values and culture. Workers are expected to role model healthy lifestyles and behaviors

2.1 Homeless People
The poorest, most marginalized, least educated and most vulnerable members of society are those at greatest risk of homelessness. Low literacy and numeric skills, a drug or alcohol addiction, chronic health problems, mental illness and eccentricity are common amongst homeless people. These characteristics have obvious implications for service delivery: OIM doesn’t expect alcoholics to be sober, heroin addicts to be straightforward, or the mentally ill to be sane.

The one attribute common to nearly all-homeless people is long term poverty. Long-term poverty has the effect of leaving people without the savings and other material resources that provide a buffer when experiencing a financial crisis. Homeless people often have the further difficulty of being without friends and family to assist in a crisis. Many have slept outside and most have a hand-to-mouth existence. Long term poverty also erodes self-esteem, which can affect expectations and motivation. Young people who feel excluded from the mainstream are likely to turn to street culture for affirmation and a sense of purpose.

While homeless people are not a homogenous group, the experience of homelessness and associated long-term unemployment and marginalisation creates a distinct culture. This culture, like others, is distinguished by its values, behaviour and expectations. Some attributes that are common to it are:
• a quick familiarity with and friendliness towards strangers;
• a ready sharing of information and resources (eg. cigarettes, accommodation);
• a disdain and suspicion of authority;
• a tolerance for personal differences;
• a hand-to-mouth and day-to-day existence, with little or no planning, with a last minute immediacy or urgency about their needs; low expectations of their possibilities; direct language and expectation that conflict be resolved immediately by shouting, swearing, arguing, threatening or (on occasion) using violence.
The language of clients is often direct. Whilst homeless people may sometimes dispense with social niceties this does not mean they are unfriendly or discourteous. Amongst the long term homeless there is little incentive to behave conventionally so what is commonly thought of as being difficult may simply mean unwillingness or inability to behave conventionally. It is important to remember that homeless people have been marginalised. A common and obvious defence against rejection, particularly amongst younger people, is defiance.

2.2 What Homeless People Want from Services
Homeless people request assistance in order to obtain and maintain the basic necessities of life. Their requests are usually very reasonable and modest. Due to their situation, disability or disadvantages, homeless people are often unable to make systems and services work for them in the way that most of us take for granted.

The things that people commonly ask Street Outreach workers for help with are:
* someone to listen to them empathically
* obtaining accommodation and rent monies
* overcoming tenancy problems;
* getting a lawyer and going to court;
* sorting out problems with overdue bills, particularly utility disconnection’s;
* getting treatment for an illness or injury;
* getting a ride or ticket somewhere or paying fares;
* moving or storing belongings;
* banking;
* obtaining food or meals;
* acquiring furniture and other household items;
* obtaining optometry services; footcare services;
* obtaining dental services, nursing services
* spiritual care and facilitation of grieving
* obtaining addiction services
* meaningful activity

2.3 How the Service Meets Requests
OIM helps people acquire and maintain housing and basic services by providing a range of services including:
• making the office and office equipment available to clients (telephones, fax, photocopier) in order that they may transact their own business;
• providing a temporary mailing address;
• providing for the safekeeping of papers and documents;
• providing information and advice; negotiating and advocating;
• phoning around to find accommodation vacancies;
• accompanying clients to court;
• making appointments, reminding clients of appointments and transporting them to these appointments;
• filling out applications (for example, public housing applications) and filing them with the appropriate agency;
• accompanying clients who are looking for rental accommodation;
• providing and arranging advocacy;
• providing bus fares and transport;
• locating services and making referrals;
• writing letters;
• assisting with cleaning;
• assisting with moving.
The service attempts to be flexible in responding to requests rather than having a list of predetermined services it provides to clients. Priority is given to assisting with spiritual care and basic needs.
OIM acts as a go-between for its clients with services, landlords and other authorities. It actively links people to services and works to ensure that services and housing are maintained.

2.4 Establishing Goodwill
OIM staff aim to establish good will and encourage people to return to the service through good customer service. This is achieved by a commitment to good customer service and tailoring services in response to the particular characteristics of homeless people:

OIMs practice is to:
• greet new clients immediately and convey by our manner to them that we are pleased to be in a position to offer assistance;
• offer tea, coffee or a cold drink;
• use plain English and not assume people can read and write;
• use an informal and relaxed approach in talking to people;
• ask for personal details when they are required for reasons that are obvious to the client, (for example, date of birth, health care card number etc are required for a Housing application. Requesting highly personal information from a stranger about their disabilities or addictions is usually not necessary and may be seen as offensive);
• respond to immediate needs on the spot;
• be alert to the distress that people may be experiencing;
• make sure that the client is not given the impression that his or her problem is too difficult to deal with while being careful he or she is clear about the sorts of assistance OIM provides. For example ‘We don’t provide accommodation but we’ll help you find somewhere else to live’;
• refrain from asking people what they have done with their money as this is humiliating and pointless. All OIM clients are poor and many have addictions so it is likely that the small amount of income they receive will quickly disappear;
• assume that people are honest, reasonable and decent and remember that if people lie, it is usually out of desperation;
• assume that people have come to ask for assistance because they need it; that they have, or would have, contacted family if help could be expected from that source;
• make every effort to see that couples are accommodated as couples, and not independently. It cannot help their situation if they are told that they will have to separate for a night, or a week.
OIMs policy is to take people as they come without expecting them to be different from what they are. Its emphasis is on changing people’s situations and helping folks help themselves. Individuals will change themselves in their own time according to their own decisions

2.5 Disarming People
OIM does not permanently bar people from using the service or expect that everybody will be pleasant, well mannered and easy to get along with. In the office, workers maintain a balance between maintaining order so that business can be conducted with all clients who use the service, and being tolerant of a wide range of behaviour and language. OIM aims to prevent volatile situations arising by disarming people with good service. In the office this could mean offering cups of tea and coffee, letting people blow off a bit of steam, generally making a fuss of the person and sympathising with his or her difficulties. Most people find it hard to be awful to someone who is being decent to them.

This approach is not always successful and other means may need to be tried. This requires the ability to make a rapid assessment of the situation and to respond accordingly. The most experienced workers on the staff team, are required to take the lead. If a person is well known to the service, there may be enough goodwill established to be able to be direct with them about their behaviour without much risk. Sometimes people know they’re out of control but can’t do anything about it and respond well to someone taking charge.

The service does not require clients to be sober or straight. However, a client will be asked to leave if he or she is too drunk or drugged to do any business, or is being a nuisance. Often the person will be told to come back the next day when he or she is (more) sober. Workers try to deal with hostility or drunkenness, without making the client feel that he or she is unwanted or unwelcome forever. It is important to separate the individual from his or her behaviour. It is important to see a `bad day’ or destructive incident in context, and give people the chance to come back the next day.

Sometimes it may be necessary for a worker to follow up with a visit to a client who has been told to leave, or with whom there has been some conflict, in order to settle the matter, so that person feels comfortable to continue using the service.

Clients are not permitted to abuse other clients or members of staff. At the same time, people who swear, raise their voices or in other ways let off steam are not automatically chastised. If a client has a complaint it is expected that it will be expressed in a fairly direct and heated manner, so it is incumbent on staff to listen and respond to the content of the complaint rather than the manner in which it is put.

While there is a level of violence that occurs within the homeless community it is very rare for this to be directed externally. It is also important to refrain from equating verbal aggression with physical violence. In the rare case of someone being genuinely physically threatening it may be necessary for workers to remove themselves and others. It may become necessary, as a last resort, to call the police. In the 15 years OIM has operated, a couple of people have been barred from coming to the dropin centre for a period of time but have been provided services on an outreach basis, OIM is finding this a more manageable way of dealing with the person’s behaviour.

More serious problems with a client’s condition can occur at times. If someone appears to be psychotic and at risk of injury or injuring another person, every effort is made to get the client to stay in the office while the emergency mental health team or police are called.

3.1 What is Team Case Management?
Case management at OIM ranges from the provision of practical assistance to the coordination of a range of services to clients. In utilising a case management approach, OIM takes responsibility for ensuring service delivery and coordination. Strategies used in case management include: practical assistance, referral and linking, advocacy, assessment, monitoring and review.

OIM employs an innovative team case management model of service provision, drawing on ideas from a range of service industries. The service is designed to operate at high volume yet respond quickly and reliably to the needs of any one of its clients. All service commitments to clients will be met irrespective of staff absences, providing continuity of service over 52 weeks of the year. For example, the service itself will make a commitment to a client to accompany him or her to court rather than make this the responsibility of any one worker.

Team case management brings together the skills of the staff team in assisting each client. The Executive Director allocates tasks to particular workers on a daily basis from the service’s central diary of client commitments and oversees the day-to-day work of the service. Workers confer with the Executive Director throughout each day to ensure that they are up-to-date with events. Work is also frequently re-assigned by the Executive Director in response to crises and the needs of clients on any given day.
Weekly case management meetings are held during which the situation of all current clients is reviewed, possible needs identified and strategies for assisting the person discussed.

The team case management model at OIM focuses resources on achieving tangible outcomes for clients: on obtaining and maintaining accommodation for them; helping them stay out of jail; obtaining medical and allied health services. It encourages clients to rely on the service rather than on a particular worker. The success of the model is very reliant on staff being flexible enough to be able to pick up where someone else left off with the minimum of briefing, good communication between staff

3.2 Level of Service Provided
OIM is flexible in the type and level of service provision. Assistance may take the form of arranging emergency accommodation on a once-off basis or providing intensive assistance and case management services over several years.

A small proportion of clients have a long history of using the service. They have complex needs and their behaviour at times may be described as volatile. They are typically people with a history of being barred from services, with frequent arrests and often high use of accident and emergency services. They may have a mental illness and/or have a history of childhood trauma or extreme neglect.

These clients endure a pattern of frequent crises and the service is well placed to respond to their needs. The nature of the relationship of staff with long-term clients is familiar. OIM offers stability, consistency,a spiritual presence and regularity to this group of people. They know the service will be there to help when things get out of hand and will accept the direction of OIM staff in these circumstances given the nature of the relationship. The team case management model assists the service in working with this client group through the staff sharing responsibility for providing assistance rather than any one worker taking sole responsibility for service provision.

3.3 Assessment, Monitoring and Review
Assessment is a judgement or opinion on the needs of a person. It derives from what the person tells you or asks you, what you know about this person and what knowledge the organization has acquired over the years about the needs of homeless people. In addition to the person’s immediate request of the service, workers will make some assessment of a client’s needs and offer services that may be of use.

Given the characteristics of homeless people and the culture of homelessness an informal, ongoing and unobtrusive approach to assessment is required. Workers
accumulating knowledge about clients in the course of providing assistance will also be thinking of what other needs the person may have and considering other services that may be of value to the person.

This type of assessment is more successful than a formal assessment because:
• it is likely to put people at ease and encourage them to talk freely about their situation;
• people are in crisis and their life may be chaotic so that their needs can change very rapidly;
• people may need to develop confidence in the service’s capacity to deliver results over time before revealing more about themselves and their needs;
• as a person’s situation improves they may begin to think of things that they need or would like – things that may not have occurred to them when they were facing a crisis.
It is important not to overload people. People generally have a sense of priority that sees them asking for assistance with their most urgent problems. An experienced worker will make a note of needs that should not be ignored, but cannot sensibly be addressed until a later date. The worker may note these for follow-up in the Office Diary, discuss them with the Coordinator or bring them up at a Team meeting.

Assessment is not static; it is continuous and constantly changing in response to altered circumstances and information. Consequently, OIM does not have a written assessment form; rather, assessment is the shared ideas and knowledge about a client developed from our knowledge of the person: what they tell us about themselves, what they ask of us and our professional judgement about their needs.

Important tools for assessment, monitoring and review are the weekly case management meeting, documentation, staff collaboration and discussion and the hands on role of the Executive Director in service delivery. At the weekly case management meeting clients situations and work on their behalf is reviewed, monitored and plans adjusted accordingly. Work on behalf of clients is recorded in their cfile along with future plans.

3.4 Referrals and Managing the Service’s Workload
OIM does not maintain a waiting list and is always willing to assist new clients. It is a high volume service, which attempts to address the problem of homelessness in its community rather than limits itself to a set number of clients. The persistence of the problems faced by homeless and disadvantaged people guarantees that some clients may require assistance over a long period of time. Others will require intermittent or once only assistance.

The strategy of OIM for managing the workload entailed in providing an immediate and regional response to homelessness can be itemised as follows:
• re-ordering work and priorities in response to fluctuations in demand and crises;
• emphasizing crisis resolution, providing long term or more intensive assistance to a small minority of very high-needs clients;
• providing a friendly but professional service, with an emphasis on spiritual care and practical assistance;
• referring out people seeking services that are beyond the parameters of OIM and would reduce its ability to respond to crises;
• respecting people and their right to make their own decisions about their life and thus refraining from making them overly dependent on OIM;
• allowing people to use the service in a flexible, often episodic way;
• withdrawing services as clients become less reliant on assistance through gaining stable housing and becoming linked to mainstream services.
Workers approach people in local rooming houses, drop-in centres, the streets and other settings to explain the work of OIM and offer services.

When referrals are received from other agencies OIM requires the client to directly request our involvement.

Referrals made by OIM to other agencies are initiated with a client’s permission and with the minimum necessary information passed on to the organization with specific client consent.

3.5 Case Closure
Closing files is not always straightforward or easily defined as many clients use the service spasmodically for years. The service is primarily a local service but is flexible about boundaries, often assisting old clients who may be living out of the area or assisting someone who comes to the office who is out of area when there isn’t an appropriate local service available.

The files of some clients who have a history of using the service intermittently and who are living in the service’s catchment area are kept open. A small proportion of clients have had active files over almost the whole time of the service’s operation. These people may require frequent or ongoing services due to:
* tenancy problems and/or evictions relating to non-payment of rent or to what is seen as disruptive behaviour;
* problems with bill payments;
* difficulties obtaining mainstream services;
* spiritual or mental health crisis
* addiction problems
* illness or frailty;
* legal problems.
A decision to close a file may be made by workers at the weekly team case management meeting when work for all current clients is reviewed. A decision about closing a file is made on the basis of:
* work being completed for the client, his or her situation being stabilised and a judgement made that he or she is unlikely to have need for the service in the near future;
* a client having moved out of the area;
* a client dies
* a client being referred to another support agency offering case management services.
*all files are stored for 7 years

4.1 Street Outreach
OIM uses street outreach as a way of making contact with people who are isolated, new to the area or unlikely to get access to services. Street Outreach involves assertively approaching people who may be in need, in parks, on the streets, rooming houses or the dropin centres. Street Outreach Workers keep a look-out for people who may be destitute, possibly with all possessions with them (bags, etc); people sitting in the street, in parks, in foyers or corridors of hotels or shops or rooming houses and at drop-in centres.

One opportunity for meeting new people occurs when workers come across existing clients on the street or in the course of assisting a client. Workers, then use existing clients to introduce themselves to new people; also someone may ask for assistance once they know you are a street outreach worker.

Over time, street outreach workers become known to the inner-city community These people are familiar with the service, the worker and the sort of assistance that we offer. Street outreach Workers become familiar and accepted in the community.

Street outreach Workers wear clearly identifiable name tags and carry cards that display a map showing how to get to OIM services, as well as opening times and a list of the types of services offered. The sort of initial assistance provided might be information about meals services, where to get food, help with an applications, spiritual resources, information on local doctors, information on local rooming houses, etc.

An active street outreach component has the benefit of promoting the service to its target group. It supports the overall aim of the service in eliminating homelessness in its area of operation by targeting and assisting people who are not in receipt of essential services and may be sleeping out or have very inadequate accommodation.

Workers employ a number of strategies in undertaking outreach work, including:
• being on the look-out for new clients while assisting current ones;
• being able to identify possible clients and walk up and say hello and start talking;
• using the name of another worker or client eg. ‘I work at OIM with Anne’ or ‘Mike said you may need our help’ or `Julie asked me to drop round’;
• using an existing client to make an introduction in a group situation in a park to existing clients;
• staying mindful of being a visitor and leaving if it appears that people aren’t interested or feel intruded upon;
• doing as much work as possible on foot to facilitate approaches to new clients.
Over time, clients who have been assisted in a street outreach capacity will be encouraged to come to our other services, and are then introduced to other workers. Some clients may need to be accompanied to the office by an OIM worker before they feel comfortable coming by themselves or can find it by themselves

4.3 Greeters
Greeters are utilized to staff the office, providing service to clients who come to, or phone the office. The Greeter is responsible for the efficient functioning of the office. As OIM works with people in crisis, clients are not necessarily assisted in order of arrival but according to their need, state of mind and the length of time they require with a worker. With experience, workers learn to juggle the workload, making their way around the room, and assisting more than one client at a time.

Managing the office when busy requires a good deal of skill and a number of strategies are employed to manage the workload and provide good customer

As soon as people arrive at the office, the greeter excuses himself or herself from the person he or she is talking to, greet the newcomers and informs them they will be attended to soon. Offering tea, coffee or munchies is often a good way to make people welcome and more comfortable with waiting a while.

If the worker is currently assisting someone who will take more than a few minutes to finish off helping he or she will try to gain some idea of the newcomer’s needs and state of mind at this point. If the person is familiar with the service, or merely requires some information or use of the phone they can be assisted immediately.

Sometimes a client may have a request that is very time-consuming. Details may be taken and a plan of action proposed. A time may be made to follow up with the client at a later date, or the Greeter may undertake to do some work now and ask the client ask to drop back the next day.

If a client has a request that is time-consuming and needs to be dealt with immediately, the greeter will start the work off, getting the person himself or herself to do as much as he or she is able. The greeter may have to excuse him or herself from time to time to assist other clients.

The greeter often makes arrangements to follow-up other needs while dealing with the most pressing problem within the office.

The greeter will politely encourage clients whose requests have been met to move on, so that the office is kept as clear as possible.

Workers other than the greeter who happen to be in the office are expected to help out at busy times and the Executive Director provides a back up to the greeter when the office is busy.

5.1 Advocacy
A homeless person’s basic needs are not being met. They may be barred from services, made to feel unwelcome or have received inadequate service. The behaviour of the person concerned may not accord with the accepted norms of the service or professional involved, and he or she has been refused service. Sometimes the requirements for gaining a service may be too great for the person to negotiate on his or her own.

OIM staff will assist people to gain services. A client focus entails being prepared to act on a client’s behalf against other services in seeking assistance or in making a complaint.
OIM also refers clients to established advocacy services, such as the Tenants and legal services. Advocacy also extends to raising issues that concern homeless people (harm reduction; police harassment; public drinking; public housing availability) at spiritual, local and provincial forums.

5.2 Client Instructions
Our clients generally give clear instructions and rarely make unreasonable requests. They understand the limitations of the service, appreciating that we cannot do anything illegal nor address matters beyond our capacity and must give priority to urgent work.

Homeless people receive lots of advice on what to do when to do it and how to do it, but are rarely given the opportunity to direct the service. At OIM, we take the view from the outset that each person best knows how to live his or her life if they are aware of their choices.

5.3 Confidentiality
Homeless people generally have little influence in the wider world, minimal purchasing power and limited control over even their immediate environment. Personal autonomy and privacy is one of the few things they have even theoretical control over. To take away people’s privacy by freely discussing them and their lives with other professionals without their consent is an act of fundamental disrespect and a breach of human rights.

Respecting people’s privacy and autonomy is the cornerstone of OIM practice. At times this can be very difficult; we as professional people may be inclined to look more to fellow professionals for acceptance and approval rather than to our client group. Additionally, certain information is often more readily available from another professional than a client, due to an agreement of priorities and a shared familiarity of terms. We take the view that dealing directly with the client establishes trust, increase our knowledge of the person and is ultimately a more fruitful avenue to assisting people to improve their circumstances.

Information about clients is kept in confidence within the service. It is not provided to other agencies, friends or family without the client’s specific permission. In the case of police a warrant for the information is required.

Translating the policy of confidentiality into practice is not always straightforward. Some reflection and thought is required when faced with the inevitable dilemmas over confidentiality. In a general sense workers are required to refrain from stating or implying moral or other personal judgement of clients when talking to workers from other services or organizations. Workers are encouraged to be mindful of the feelings and sensitivities of the client in what is discussed and to be prepared to repeat what is said about the client to the client.
• The particular client views need to be taken into account in liaison with a third party. Some people may use the service as a postal address, use the phones and even seek information and advice but don’t wish to have OIM act on their behalf and would not wish for OIM to discuss any arrangements with a third party. Others are happy for the service to liaise with other services.
• In most cases, workers will pass on general information to advocates known to be engaged by the client to act on their behalf (eg. workers will discuss arrangements for court with a client’s lawyer. Workers would generally tell the person next time they were seen that a worker had spoken to their lawyer).
• Specific permission is gained before a referral is made. If the organisation to which the referral is being made is known to require background information, this is explained to the client before proceeding. As much as possible when this sort of information is required, the client is encouraged to speak for him or herself.
• Permission to pass on information or represent a client is required, particularly in regard to personal details like address, disability, health problems, legal matters or addiction.
The service’s legal mandate may, in extraordinary circumstances, override confidentiality requirements when that person or other’s safety is at risk due to their actions or state of mind. For example a person who is mentally disturbed and requires an immediate assessment may compel us to breach confidentiality. In this case OIM is conscientious in following up to ensure the person concerned is informed as to what was done and why.

5.4 Legal Mandate
In regards to disclosure of confidential information OIMs legal mandate informs the practices of OIM. In extraordinary circumstances it may require the service to divulge information about clients or act against the instructions of a client. An example of this would be the divulgence of an intention by a client to do harm to another person (usually physical harm). Often, this dilemma would not require any breaking of confidentiality: the client would simply be talked out of it. However, if absolutely necessary, the OIM worker will seek external assistance eg. call the police or local psychiatric crisis assessment team.

5.5 Client Files
A file is opened and maintained for each client once he or she has been seen more than once and work has been carried out on his or her behalf. All work undertaken on behalf of clients is recorded.

All files , file notes, documentation and correspondence are held in a locked filing cabinet The file except for health information is open only to OIM workers and to the client. A warrant would be required to provide information about a client without his or her permission.

Reliable information is vital to the efficient running of the service and workers make brief, factual case notes at the end of each day, recording such details as work undertaken with or for a client, changes in circumstance and needs. Client addresses and other basic information are recorded as soon as they are obtained.

Clients are always granted access to their particular files, and Photo copies are available to them. File notes, once entered, cannot be altered.

Clients can record objections to anything entered on a file or provide additional comments, and these notes are entered in the client’s own words. Clients are also free to use their file to store cards, photographs and personal papers for safekeeping.

5.6 Data and Clerical Systems
Workers are responsible for completing the following tasks:
• recording of file notes and data;
• typing of letters;
• entering all client appointments, court dates, meetings,
• completion of application forms;
• photocopying of all correspondence and applications leaving the office;
• dating of outgoing and incoming correspondence;
• redirection of mail for clients who have moved out of the service area, or who will not be visited, nor expected at the office;
• delivering mail to clients who are being visited.

5.7 Quality Assurance
The service aims to systematically monitor and improve its service delivery to homeless people. It regularly develops and reviews policies, practices and procedures. Additionally, OIM develops and refines systems to monitor the quality of service delivery and service accountability. These systems are to:
• review active client files on a weekly basis;
• up-date information resources;
• maintain paper files and an effective archiving system;
• staff development addressing particular aspects of the service’ practice, out of which may be developed procedures or other systems to improve service delivery;
• checking accuracy of data reporting and client files