New Innovations

At CUPS, we continuously evolve as we strive to better meet the needs of clients and staff. The following highlights some of the new initiatives that have occurred over the past year.

  • Last year, CUPS launched the Integrated Care Tool (ICT), an internal tool developed to better support the work being done alongside our clients to create and achieve their goals. The ICT aligns with CUPS’ focus on Integrated Care, which uses a collaborative, coordinated, and trauma-informed approach, and is based on individuals’ strengths and needs. Using a brain science lens, the ICT was developed to support care planning and coordination processes. The ICT tracks relevant client, program, and agency-level data to show clients their progress over time while allowing the organization to look at program improvement, quality improvement, and demonstrating program and organizational impact.

  • Over the past year, CUPS has been undergoing renovations to expand and repurpose undeveloped spaces in our building. Much of the renovation was focused on creating a safe, accessible, and more trauma-informed space for clients, including introducing an improved Welcome to CUPS area, dedicated space for clients to meet with their workers or staff, the creation of a Ceremony Space, combining CUPS’ Child and Family Development Centres into one space, and creating space for collaboration. Additionally, CUPS was able to expand both our mental health space and health clinic space to meet the ongoing demand for services. Renovations were completed in April 2023, with many staff and clients beginning to enjoy the new physical spaces.

  • Homes for Health (H4H) is a housing program that was established in 2022 to provide support regarding physical and mental health, addiction supports, wellness and community engagement, and housing. The program serves youth and adults with complex physical health needs that prevent them from maintaining housing stability independently. This program provides client-centered care and intensive case management for clients, with individuals graduating into less intensive supportive housing or independent housing. The team consists of nurses to address and care plan for physical health needs, a Mental Health Counsellor focusing on addictions and mental health, a Graduation Navigator to strengthen wellness and community engagement, and a Housing Liaison to support housing compatibility. A multidisciplinary team offers clients intensive wrap-around care in community health, housing, and social supports.

  • CUPS’ Street Outreach Addictions Team (STOAT) is a mobile peer-led program that began in 2022. STOAT outreach services collaborate and complement the existing CUPS’ Opioid Agonist Treatment (OAT) Team which provides on-site treatment and services for individuals who use substances. The combination of these services includes assessment, education, connection to medication coverage, treatment for individuals managing addictions, and access to addiction counselling services both onsite at CUPS and in the community. Throughout the past fiscal year, 65 individuals were registered specifically through outreach and connected to CUPS’ integrated services.

  • In early 2023, CUPS created a Client Advisory Committee to inform CUPS’ strategic work and to incorporate clients’ voices throughout the organization. This work was described by a member of the committee as work “to make good things better.” Consultations and discussions with similar groups across Alberta informed the creation and structure of this committee and was further refined by the committee members. The primary purpose of the Client Advisory Committee is to inform policies, programming, and practices, and work in partnership with staff and leadership at CUPS to create positive change within the organization. This includes addressing gaps in services, improving existing programs, and informing future organizational direction. The committee meets monthly and will continue to be involved in strategic initiatives, program planning, and events.

Informed Program Changes

CUPS values the opportunity to review client data in order to inform program changes and identify areas for improvement.

  • The introduction of a Peer Navigator to the C2C team provides additional services for clients after their immediate needs have been stabilized and addressed by the team. A Peer Navigator is a role filled by someone with lived experience who utilizes their past experiences to understand and support others with housing insecurity, complex medical needs, or substance use to navigate the systems of service. The Peer Navigator assists C2C clients in exploring longer-term goals and works with them in accessing the resources they need to pursue these goals. The Connect 2 Care team worked with an external developmental evaluator to help facilitate ongoing strategic planning and identify possible areas for program improvement and opportunity.

  • Through ongoing strategic planning and program development, CAMPP was rebranded to Community Allied Mobile Palliative Partnership. This name change is to align CAMPP’s commitment in growing and nurturing collaborations with Palliative Care Physicians, AHS, public systems, service agencies, individual and corporate champions, governments, and community members. Like C2C, part of the strategic planning involved working with an external developmental evaluator to determine areas of improvement. In 2023, a palliative homecare clinical nurse specialist (CNS) began working part-time with the frontline CAMPP team. With the addition of the CNS role, the CAMPP team is better supported with client care needs, as well as through building a stronger relationship with palliative homecare and navigation of acute care services.

  • This is the first full year of the Twelve-Session Counselling Model. This model provides a more deliberate, timely, and focused opportunity for counseling interactions which can be more supportive of client goal setting. The change to a 12-session model helps CUPS align with community partners providing similar services by offering improved access and reduced wait time to counseling services. The MHS team also provided virtual group programming consisting of Women’s Trauma, Men & Gender Diverse Trauma, and Shame & Resiliency groups. These groups are implemented by members of the MHS team in addition to the individual counselling and consultation services they provide.

  • This is the 2nd year of collaboration for this program through partnership with Kindred which focuses on providing rapid access to mental health services for individuals within the Homeless Serving System of Care. Lessons learned from the pilot enabled focus of services shifting to placed-based housing sites to provide a more seamless provision of counseling options (single and multiple session) to enable continuity of care. In order to improve access to counseling services, the Dream Centre, Rainbow Lodge and the SORCe were added as locations that individuals can access for other services and demonstrated a convenient location for some to access counseling.

Successes and Areas for Improvement

Over the past year, there have been notable successes in the work we do with clients. Some examples are:

The number of new clients enrolled into the Opioid Agonist Team (OAT) program increased this year. OAT was able to support 546 unique individuals through in-person and remote visits, which is a 44% increase in the number of clients accessing OAT compared to last year. The proportion of clients supported who were new clients also rose this year, increasing from 49% in 2021-22 to 71% in 2022-23. By providing same-day enrollment into the program, clients were able to access treatment when they needed it. CUPS recognizes the importance of same-day enrollment to ensure barriers to accessing treatment are minimized and continues to prioritize access to timely health care.

The number of specialist visits has increased by 16% overall, with specialist visits accounting for 1,639 direct client visits during the year. Obstetrics and Gynecology increased by 29%, psychiatry visits increased by 59%, and pediatrician visits increased by 12%. These are just a few of the specialty physician services that individuals are able to access at CUPS. This increase in specialty service access demonstrates a return to pre-pandemic levels of service.

The Nurturing Parenting program saw a notable increase in the number of enrolled caregivers. Of the 206 individuals who engaged with our Family Development Centre, about 87 were caregivers that engaged in this educational programming to improve their parenting skills. This speaks to more clients who have been able to increase their parenting knowledge and their ability to apply practical skills, thus building stronger families in our community. 

This report also highlights areas for improvement that can inform program work and advocacy moving forward.

CUPS has seen a slight decrease in the housing stability of clients in our housing programs (Graduated Rent Subsidy (GRS), Community Development, and Key Case Management). External factors such as the cost-of-living crisis, inflation, and wage stagnation are widely understood to disproportionately impact individuals living in poverty. While clients and the staff working alongside them at CUPS continue to find ways to navigate the current challenges in the housing market, we have seen other successes, such as increased community connection, continued relationship building with landlords, and clients accessing income supports they are eligible for. For example, 27% of newly housed clients enrolled in our Key Case Management program increased their income after three months of being housed primarily through accessing income support such as Alberta Works, AISH, etc. (compared to 14% the previous year). While housing stability is an ongoing challenge with the rising costs of housing, CUPS continues to work with clients to build the foundations for housing stability and to increase their well-being in other ways.