Published March 2025
Our Specialized Outreach Services (SOS) is a mobile multidisciplinary team that supports individuals who are experiencing homelessness or are precariously housed and who are experiencing medical, mental health and/or substance use concerns. SOS is designed to provide low barrier clinical care to individuals who may have difficultly accessing other traditional supports. The SOS team is comprised of social workers, nurses and outreach workers who work alongside physicians, nurse practitioners, hospitals, police, and the court/probation system.
- SOS works with close to 1000 people in a year – offering direct support to encampments, motels, drop-ins where people are accessing services. Team members, including nurses can see 10-20 people a day in different locations, providing vital community connections and access to health care.
- The team provides clinical care on the street; including primary care, medical assessment, coordinating with medical care providers, wound care, medication administration, counselling, and support coordination. We offer accompaniment to appointments, so that they are kept in a timely way and we provide support/follow-through for the medical provider.
- The Emergency Department diversion is significant – the team treats people where they are, in a responsive way that prevents presentations to hospitals.
- The team works collaboratively with Emergency Departments, medical floors, and mental health wards around admission and discharge planning; we receive many requests for wound care following discharge from hospital and following long acting anti-psychotic injections. We also coordinate with Freeport Specialized Mental Health.
- The Impact team contacts our team when working with people who are homeless for ongoing community based support to reduce calls for service to WRPS.
- We are receiving 3-5 new referrals per week which is high given our ongoing caseload. In one week we supported 8 different people out of hospital who had nowhere to go, providing follow-up care in community once we found them an often inadequate place to be sheltered.
- The Point in Time Count reported that 75% of people homeless (over 2,371 people) are living unsheltered – we provide ongoing care to people experiencing homelessness who are unable to navigate the system – these numbers are growing.
The work of SOS happens every day, behind the scenes, supporting people in important ways as they deal with homelessness, addictions, mental health, and the frustrations of being marginalized. The work is all about caring for the other, showing up for each person even when we don’t have solutions to the main challenges. These photos show how real this work is. They were all taken on a Friday in January.
SOS and Street Outreach workers gather outside at Queen and Charles where each Friday morning the Waterloo Region Foodbank delivers food to Maurita’s Kitchen. The delivery includes 80 food hampers packaged specifically to be distributed to people living in motels and precarious situations.
A great deal of effort and good will goes into distributing the food hampers and they are a way to connect weekly, to check in on people’s wellbeing, and from which to coordinate follow-up. Later in the day, the work continues and includes going to encampments and to various housing, shelter, and drop-in spaces, checking in on medical and other support issues. In the photo above, one of the SOS nurses tends a wound at our 87 Victoria Street drop-in, located directly across the street from the 100 Victoria St. encampment. SOS provides important connecting services that support people dealing with complex health, mental health, legal issues and basic needs that are constantly a part of living unsheltered or precariously housed.
