What It Means To ...

What It Means to Struggle with Drug & Alcohol Use

Life for street kids in Toronto – especially those who use drugs and alcohol – is precarious. In Drug Use in Toronto (City of Toronto, 2004), findings included:

• Rates of drug use reported by street youth in Toronto are far greater than those of their housed counterparts.
• The lack of any residential treatment facilities for youth, in general, renders effective treatment for homeless youth with serious addictions highly unlikely.

Another factor which complicates drug abuse treatment for homeless youth is the high prevalence of concurrent disorders – mental illness along with problems of substance abuse.

• Crack cocaine continues to be the most popular drug among homeless and marginalized populations.
• The transmission of Hepatitis C and HIV are two of the most serious public health risks associated with injection drug use.
• Approximately one quarter of homeless individuals are diagnosed as Hepatitis C positive, 29 times the Canadian average (Street Health, 2007)
• HIV rates among homeless individuals are 300 times the average Canadian rates.
  
  • 2% of homeless individuals in the Street Health Report reported being HIV positive compared to 0.8% of the Canadian general population (Street Health, 2007)
    
  • 59% of Street Health Report respondents report using illicit drugs at least once a week (Street Health, 2007)

What It Means to Be Young & Homeless

Almost 70% of homeless youth report leaving home because of physical, emotional or sexual abuse. Family breakdown is a significant contributing factor. As well, difficulty in accessing income assistance, the decline in community social services after youth reach age 16 and shortage of affordable rental housing force them to live on the streets – streets that somehow seem less threatening than living at home.

An ongoing challenge is the increased number of homeless youth with mental health issues – concurrent disorders, dual diagnosis, self-harming behaviours, depression, substance use and anger issues. There is a lack of resources across the shelter system in Canada to cope with these troubling issues.

Eva’s Initiatives first opened its doors almost 15 years ago and it has become evident through these years of experience that homeless and at-risk youth require more than food and shelter – they need a supportive living environment in which to gain independent living skills, tackle substance use issues and training and employment opportunities that provide above minimum wage and career path progression. With these supports, they are better able to live productive, financially independent lives and leave the shelter system permanently.

A New Solution – Eva’s Satellite

In 1997, homeless adults were dying on Toronto streets in sub-zero winter temperatures. The City of Toronto was concerned homeless youth, barred from accessing youth shelters because of drug and alcohol use, would be next to succumb. The City approached Eva’s Initiatives to provide emergency shelter for these hard-to-serve youth at a winter-only facility in an unused subway area. The cold weather disappeared – our clients did not. We were moved to another temporary facility – inadequate for our needs, but an improvement on the subway bunker.

At the request of the City of Toronto, Eva’s Initiatives opened the first youth shelter in Canada for homeless/at-risk youth who use drugs and alcohol.

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Operating from a Harm Reduction perspective, Eva’s Satellite provides emergency shelter for up to 28 youth each night in addition to drop-in services for additional youth averaging approximately 8 a night who may have lost access to other shelters and services due to behavioural problems or substance use.

Looking Forward to Our New Satellite Facility

Eva’s Satellite, currently housed in a woefully inadequate living space/building, will finally move into a new 24-hour purpose-built facility in 2009. We look forward to the array of programming and support we will be able to offer homeless/at-risk youth struggling with drug and alcohol use. The new building has programming space specifically designated for recreation and drop-in which will provide alternatives to youth looking to decrease their substance use by engaging in healthy alternate activities.

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This exciting prospect will include a new roster of programming supports for our youth, including:

• Harm Reduction Program that includes case management, counseling, groups and workshops, safer supply distribution program, resources and referrals;
• Health and Wellness Program that includes counseling, workshops, case management, health supports, healthy sexuality information, nutrition, resources and referrals;
• Recreation that provides athletic and creative options for youth;
• Independent Living Program that provides workshops, counseling and case management supports that provide youth with the skills needed to live independently;
• Community Outreach and Advocacy Program that provides legal supports to youth including workshops, referrals, advocacy, accompaniment and resources.

All programs are implemented from a low threshold approach to minimize barriers to youth and increase accessibility and options for youth.

At Eva’s Satellite, we help our clients re-engage with the community while providing advocacy and support. Eva’s Satellite can be a pivotal turning point in the lives of a hard-to-serve street youth population. Without positive change, they may experience serious addiction, trouble with the law, severe (and other deadly) health consequences and, most certainly, isolation.

We attempt to reduce the harm that comes with substance use and risky behaviours by creating a credible and trusting relationship with each youth. We do not judge, preach or reject. Our goal is to make a difference one youth at a time!

Harm Reduction

Eva’s Harm Reduction Program – a pragmatic approach addressing health, social and economic harm caused to individuals and communities by substance use – is central to our client service model and encompasses all our residential and programming services.

Central to all programming is information and easy access to appropriate referrals and resources for youth on the issues that most affect them. Workshops and drop-in programming focus on alcohol and substance use, safer sex, HIV/AIDS, healthy relationships, family dynamics, and anger and conflict management issues.

Measuring Success

Success is measured differently for each youth client at Eva’s Satellite.

For some, it can simply be reducing potential harms associated with their substance use. For others, it means the start of a new life with independent housing and career possibilities. Success of our programs is demonstrated by our youth’s accomplishments and experiences. We effectively pursue the following outcomes:

Increase in number of youth moving into independent housing, engaging in programming, engaging in employment or education pursuits, experiencing stable housing for longer periods Increase in number of youth accessing services for health, mental health support, identification replacement, counseling, detox and treatment.

Reduction in number of serious community incidents, evictions youth experience once they leave the shelter

Decrease in unsafe substance use practices by our youth clients

Fewer clients reporting significant health issues including communicable diseases such as HIV and Hepatitis C, infections due to unsafe injecting and smoking practices, overdose and overuse, and general illnesses due to lowered immune systems.

Current Data on Client Drug Use, Impacts and Needs

Surveys conducted in 2007 asked youth at Eva’s Satellite to identify perceived knowledge and resource awareness of HIV/AIDS, sexually transmitted diseases, Hepatitis C and safer drug/alcohol use. Clients were also surveyed about perceived risks for disease contraction and drug overdose, disease testing history, substance use patterns and awareness of safer use practices.

Survey Results

• An overwhelming76% of clients surveyed use drugs/alcohol frequently. The majority identified using multiple drugs and/or alcohol simultaneously.
• 93% of clients surveyed feel they are at no or low risk for getting HIV/AIDS.
• 89% of clients surveyed feel they are at no or low risk for getting Hepatitis C virus.
• 86% of clients surveyed feel they are at no or low risk for getting a sexually transmitted disease (STD).

These self-perceptions of low to no risk are in stark contrast to the reality of the risky behaviours in which clients engage.

• Only 38% of clients surveyed have been tested for HIV/AIDS.
• 25% of clients surveyed have been tested for Hepatitis C virus.
• 66% have been tested for sexually transmitted diseases, although it is unlikely continued testing and sexual health follow-up occurs.
• 93% of clients surveyed feel they are at no or low risk for a drug overdose.

There appears to be an enormous and alarming knowledge gap. The need to increase supports and provide harm reduction education for these youth is paramount.

Homeless youth who use substances are further criminalized and marginalized from the general population because of their situation and actions. They do not have a safe, comfortable place where they can use or relax. Ongoing harassment generally encourages them to adopt behaviours focused on avoiding harassment rather than self-care.

Youth at Eva’s Satellite are usually unemployed with few financial resources to access appropriate care. This often translates into serious substance use issues and unsafe use of drug paraphernalia, including binge drinking, drinking harmful substances, sharing drug use equipment and/or using unsanitary/non-sterile equipment, and unsafe disposal of used (biohazard) equipment. There may also be a failure to engage in safer sex practices because judgment is often impaired by drug/alcohol use.

Youthful attitudes often translate into approaches that rely on the strength of youth – and deny vulnerabilities presented by continued or prolonged drug use or mixing drugs. Young women, in particular, may be pressured to engage in unsafe practices to “survive” on the streets and avoid losing credibility by exposing themselves to more violence or intimidation.

Youth with mental health issues also may engage in high risk drug use behaviours; they focus typically on self-medication to reduce adverse or unwanted mental health symptoms.

Youth’s priority is to establish coping mechanisms to alleviate confusing or negative psychological issues – not the risks associated with their drug use.

Background – Eva’s Initiatives

Eva’s Initiatives operates three unique shelters in Toronto – Eva’s Phoenix, Eva’s Place and Eva’s Satellite – which house and feed 112 youth aged 16-24 each night. With cutting-edge services and distinctive programming, we provide a continuum of service not available anywhere else in Canada.

Many homeless youth report leaving home due to family breakdown. We created the Family Reconnect Program at Eva’s Place to help homeless youth and their families rebuild relationships. It serves almost 600 people each year and now includes an overwhelmingly successful prevention component – aimed at keeping youth from leaving home in the first place. From April 06 to March 07, this program saved the shelter system almost $550,000 (based on an average three-month stay).

At the request of the City of Toronto, we opened Eva’s Satellite – the first youth shelter in Canada for homeless and at-risk youth who may have lost access to other shelters and services due to behavioural problems or substance use. We pioneered a Harm Reduction Program which includes counselling on alcohol and drug dependency, safe sex, healthy relationships and family dynamics – in keeping with City of Toronto Drug Strategy recommendations.

Eva’s Phoenix provides focused career training and supports essential for long-term self-sufficiency in employment and housing. It the home of our Technology Training Program, Phoenix Print Shop (social enterprise) and the Buzz Hargrove Training Supports Program, made possible by a unique partnership between Gerry Schwartz of Onex Corp. and the Canadian Auto Workers. In 2006, Eva’s Phoenix was awarded the Service Canada contract to be the principal organization to deliver employment programming for homeless/at-risk youth in the City of Toronto.

The Mentorship Program connects youth with community and peer role models who help build their self-esteem and support them on the road to self-sufficiency. In 2006, mentors donated more than 930 volunteer hours.

The Independent Living Program at Eva’s Place, one of our newest programs, provides youth with life-skills training in budgeting, cooking, housing searches, community integration and educational support – all essential skills to becoming self-sufficient. Through the National Initiative Program, Eva’s Initiatives shares its integrated service delivery model with dozens of Canadian organizations enabling them to help homeless and at-risk youth develop self-sufficiency in their own communities. The latest success story is the Eva’s-based model breaking ground soon in St. John’s, NL.

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Do you think harm reduction is an effective approach to working with street involved youth with substance and mental health issues? Why? - Maria Crawford