L’action intersectorielle clinique : l’expérience d’EMRII, une équipe mixte pour les personnes en situation d’itinérance

A research team of sociologists conducted a descriptive case study of the Mobile Reference and Intervention Team for Homeless Individuals (EMRII), an inter-professional and inter-sectional team created by Montreal Police Service (SPVM) and a Health and Social Services Center (CSSS – Jeanne-Mance). The mixed team is an inter-organizational team composed of health workers, social workers, and police officer, who work with chronically homeless people, providing a close follow-up on the streets and case management on a mid- and long-term basis.  Inspired by teams instigated in the United States (Compton & al., 2008), the aim of this second-response team is to increase the effectiveness of community response, enhance collaboration, and find alternatives to criminalization of homeless people who are the cause for a large number of calls to the police by the public.  Following this team for over six months, gave the researchers the opportunity to examine the ways in which, different and at times divergent, professional cultures were dealt with within the team (the police’s ways of collaborating with the health and social workers and health workers working with the police). From this professional “cultural shock” emerges a new practice, giving space to original ways of looking at chronically homeless people (Rose, Baillergeau, Hurtubise & McAll, 2012).

In addition to the mandate of ensuring a safe and harmonious coexistence in the public spaces, the focus of this team is to explore solutions for improving the wellbeing of homeless people.  This unusual collaboration is set to fill in the “cracks” where homeless people too often fall in, ending up with no access to services or in a “revolving doors” situation.  In this paper we will present the approach used by the EMRII team to analyse different situations, moving from their traditional professional belief systems and practices, and searching for a new understanding. We show how the team comes up with a continuum of interventions elaborated on a common understanding about a person, his condition, and the context. Apart from circumstances where there is an “obligation to act”, most of the collaboration between policemen, social workers, and health workers will consist of improving the team’s capacity to evaluate situations and intervene in creative ways, based on the expertise of each professional and institution. The cross-sector clinical work of the EMRII team goes much further than is usually seen in inter-institutional collaborations (Van Dusseldorp & Wigboldus, 1994). It is not only about administrative collaborations and drawing protocols between sectors; the results are a reformulation of professional frontiers in the actions of health workers, social workers, and police officer. 

Numerous studies demonstrate that police officers are often the frontline workers with homeless people (Alderman, 2003; Bellot & Sylvestre, 2012; Boivin & Billette, 2012; Teller, 2006). The EMRII team represents an innovative approach to working with people in the streets, whose living conditions are difficult and whose needs are complex. The cross-sector clinical work of the EMRII team goes much further than is usually seen in inter-institutional collaborations (Van Dusseldorp & Wigboldus, 1994). It is not only about administrative collaborations and drawing protocols between sectors; the results are a reformulation of professional frontiers in the actions of health workers, social workers, and police officers.