International Overdose Awareness Day is a global event held annually on August 31st, aiming to raise awareness of overdoses and reduce stigma of drug-related deaths. It also acknowledges the grief of families and friends of those who have suffered a permanent injury or died as a result of drug overdose. The harms associated with the injection of illicit substances have recently been brought into focus with deaths involving fentanyl across Canada. Considered the most potent and addictive painkiller on the market, between 2009 and 2014, some 655 deaths in Canada have been linked to fentanyl, including one involving injection.
Injection drug overdoses from substances such as morphine, heroin, cocaine, amphetamine, and methamphetamine are a public health issue that disproportionally affects marginalized populations, including people experiencing homelessness. Those with a history of abuse, addiction, poverty, incarceration, mental health, low educational attainment, un/underemployment and who lack access to housing and/or appropriate healthcare services are at increased risk of harm from substance use. It is estimated that over 89,000 people inject drugs in Canada, and the issue remains a significant risk factor for premature mortality, suicide, mental health conditions and HIV or hepatitis C infection. Homelessness has consistently been associated with injection drug use and found to be a coping mechanism in dealing with the dangerous and harsh realities of homelessness.
Available health services across Canada tend to focus on prevention, withdrawal management and treatment programs. However, there are also pragmatic treatments and rehabilitation approaches that neither condone nor condemn substance use, but rather focus on harm reduction. Such measures include needle exchange programs, methadone maintenance treatments and supervised injection facilities (SIF). As well, outreach and education programs, as well as cooperation between health and law enforcement officials, can help those who use illicit substances to access health and social services. Harm reduction models are relatively new to Canada with the first SIF in North America, Insite, opening in 2003 in Vancouver’s Downtown Eastside. Harm reduction initiatives have been shown to reduce:
- The sharing of needles and other drug paraphernalia
- The transmission of infections
- Overdose deaths and injuries
- Crime rates
- Costs of health, social, legal and incarceration associated with injection drug use
Insite provides a safe health-focused centre where people can inject illegal drugs under the supervision of nurses. Since opening its doors, fatal overdoses in Vancouver’s Downtown Eastside have decreased by 35% and no deaths have occurred onsite. Because half of Insite’s clients are homeless and/or have mental health conditions, it offers counselling, detox treatment, primary care to treat disease and infection and connects users with other health care services, housing and community agencies. The influence of Insite goes beyond changing behaviour, reducing overdose fatalities and enhancing public safety. Clients create meaningful, trusting and dignified relationships with staff that fosters personal empowerment while raising self-awareness. In turn, substance users become safety and educational ambassadors within their own circles and strengthen their community bond.
The body of scientific evidence emerging out of Insite’s success has been instrumental in making the case to expand supervised injection services to other communities affected by injection drug use. While Montreal is preparing to establish its first SIF, Toronto city council has recently approved three SIFs to open at existing downtown health-care facilities. There has been overwhelming support from city officials, neighbourhood residents and business improvement associations where the sites are being planned to open next year. The three agencies that will provide supervised injection services include: Toronto Public Health (The Works), Queen West-Central Toronto Community Health Centre and the South Riverdale Community Health Centre.
A major concern for the city of Toronto is the 41% jump in overdose deaths from 2004 to 2013 as well as the increase in use of opioids, such as heroin and fentanyl. To address these issues, Toronto SIFs will provide sterile injecting equipment and instructions on safe practices. Users will also receive information and referrals to other health and social support services in the community. However, before establishing the sites, the municipality needs to seek provincial approval and a federal exemption from Section 56 of the Controlled Drugs and Substances Act. By following Vancouver’s SIF model, Toronto and Montreal are making critical steps forward in providing a wider range of programs and strategies to protect its residents, families and communities.
While SIFs and harm reduction programs are essential components in addressing injection drug use, more supports are required to further reduce drug-related harm using the best available evidence. Thus far, the evidence is clear-cut; SIFs, including Insite, save lives.
To join the conversations on social media, you can use the hashtag #OverdoseAwareness2016 and/or follow the awareness campaign on Twitter @overdoseday.
Photo Credit: Penington Institute International Overdose Awareness Day
From time to time, voluntary sector leaders—and advocates in general—come up with ideas for new spending and new social programs. When they do this, they often focus too much on influencing elected officials, and too little on influencing senior public servants. What’s more, it’s important that their proposals be supported by good research, in part because exaggerated claims about the benefits of their proposals may hurt them in the end. With all of this in mind, here are 10 things to know about central agencies in Canada.
- Even after a minister tells you they support your idea, there will often be further government approvals required. At the federal level, this process is run by three central agencies; they are Privy Council Office (PCO), Finance Canada and Treasury Board Secretariat (TBS). Their respective roles will be discussed below. There are broadly similar functions for provincial and territorial governments (but details may vary).
- For your idea to become a new program, cabinet will need to give “policy authority” and PCO supports this cabinet decision-making process. PCO coordinates the meetings of cabinet and cabinet committees, provides advice to the prime minister on cabinet business and briefs the chair of committees on agenda items. During this process, PCO analysts play a “challenge function role” (this will be a recurring theme), meaning they critically assess and examine proposals as they come forward. Questions that might get asked by PCO officials in Ottawa include: Is this an area of federal jurisdiction? Does this initiative have intergovernmental implications? Have you consulted on this with other departments within the federal government? (If no such consultation has taken place, PCO officials will coordinate a meeting among staff from various federal departments.) PCO officials might call into question the rationale or evidence used to support the proposal and if a similar program exists elsewhere, PCO officials will point this out. PCO will also ensure that the political implications are spelled out.
- Once you have policy authority from cabinet, a new program will still need budgetary approval through Finance if it involves new money. Finance provides funding authority or a “source of funds” for new proposals through the budget process. Departments and Ministers generally make a request to the Minister of Finance and it gets assessed by public servants in the Department of Finance, who also play a challenge function. The underlying question asked by Finance officials is “Does this initiative really require new money?” My sources in Ottawa have three unofficial mottos that Finance officials can almost always be expected to say. The first is “How much will that cost?” The second is “Why can’t you do that from your existing budgetary allotment?” And the third is “No” (hopefully, the last one is not so consistent). It’s also important to note that the budget process doesn’t just assess the merit of spending money on your idea on a yes-or-no basis, but also the comparative merit of different proposals. You’re competing against other ideas for scarce resources. Finance officials are suspicious of lofty promises that a proposal will save large sums of money somewhere else; they hear this often. If the proposal has the potential to save money elsewhere, be prepared to demonstrate this with precision and nuance.
- Treasury Board, a committee of cabinet, provides implementation authority for proposals and this approval process gets into the details of how the program will be run. Cabinet policy authority is sometimes thought of as “agreement in principle”, while Treasury Board is where the details get discussed. TBS officials play a challenge function that is focused on how the proposal will be implemented rather than challenging the basic idea. They will want to know the risks inherent in the proposed initiative and how they are addressed. They’ll also want to know if the proposal is compliant with other federal policies and they’ll want to know if the details of the proposal are logistically sound and realistic. For example, if a complex program is proposed with a plan for three staff persons to run it, TBS officials will call this into question. In Ottawa these days, treasury board officials are also very focused on the measurement of outcomes.
- There is typically some overlap between what the different central agencies do. For example, in Ottawa, PCO officials might ask how results for a new program might be measured (even though that’s more typically thought of as a question asked by TBS officials). Likewise, PCO officials might also scrutinize a cost-benefit analysis that is supporting a pitch (even though similar scrutiny might be provided by finance officials). And the central agencies work closely together.
- At the end of the day, if cabinet really wants a new program or new spending, central agencies won’t stop the initiative. An inherent principle underlying representative, executive government is that ministers are ultimately the decision-makers. Public servants, meanwhile, operate with the principle of “fearless advice, faithful implementation.”
- In Ottawa, even the Minister typically has to wait until Budget Day to know if each proposal has been accepted. That’s because the final decision on every budget item is made between the Prime Minister and the Finance Minister, and their decision is usually kept secret—even from the rest of cabinet—until the budget is released. (In Ottawa, proposals for a new program or new spending are typically made months before.)
- A key take-away from all of this is that, when voluntary sector organizations advocate for a new program or new spending, they should think about both elected officials and senior public servants. Indeed, it’s important to engage senior public servants early and often. If an elected official likes your proposal, do not assume that members of the senior public service won’t eventually give it the third degree. Ideally, as many senior public servants as possible should hear about your proposal directly from your organization before it arrives to them via official channels.
- New proposals should be supported by sound research. Just because an elected official doesn’t scrutinize your cost-benefit analysis or your long-term savings calculations, doesn’t mean senior public servants won’t. Staff in both central agencies and line departments will appreciate intellectually honest analysis, the humble presentation of information and well-referenced propositions. The challenge function at the central agencies will involve dozens of very smart people reviewing and assessing the proposal; your proposal (sponsored by the department and minister) will stand up much better if it has a strong problem definition (a.k.a. the rationale for why action is needed) and recommendations supported by evidence.
- Exaggerated claims about your proposal will probably burn you in the end. Consider a statement such as: “This proposed program will revolutionize this sector because nothing this great has ever been done before.” That might get you traction in the media and with some elected officials; but always consider the roles of central agencies discussed above. Senior public servants have heard such statements before and will likely scrutinize every aspect of such a claim.
The author wishes to thank Francesco Falvo, Louise Gallagher, Darcy Halber, Kayle Hatt, Alex Himelfarb, Kevin McNichol, Michael Mendelson, Leslie Pal, John Stapleton, Katherine White and one anonymous reviewer for invaluable assistance with this. Any errors are his. [Author: Nick Falvo, Ph.D., Director, Research and Data, Calgary Homeless Foundation]
 An important exception is in the case where your idea happens to be within the minister’s existing authority and, more importantly, within the existing department/ministry budget and not especially politically contentious.
This blog post was originally posted on the Calgary Homeless Foundation website.
I recently heard a young person with lived experience of homelessness offering recommendations to A Way Home America and senior policy makers. He said that funding more services and supports for youth experiencing homelessness is great, but it’s not good enough. He talked about the damage to his life caused by his experiences in foster care and then later with homelessness. He came back again and again to the role of schools in preventing youth homelessness. He asked why we aren’t putting more effort and emphasis on school-based early intervention. Point taken, but what does that look like?
A Way Home Canada is partnered with the Canadian Observatory on Homelessness and Raising the Roof (lead partner) on The Upstream Project. Some visionary organizations in Niagara and York Regions are piloting this Canadian adaptation of Australia’s Geelong Project. The Raft and 360 Kids are laying the foundation for a potential provincial and national scaling of this innovative school-based model for early identification and support for young people at risk of homelessness. We will work together in the coming months to develop the knowledge and evidence base that will allow other communities, provinces and territories to implement this model so we can ensure better outcomes for young people.
Why schools? Our response to that is because virtually every young person who becomes homeless was in school at one point, and most likely an adult in that school (teacher, coach, etc.) knew something was wrong, but didn’t know how to help. This model identifies and assesses students at risk and then connects them to community services that will support the young person and their family
One person who understands the importance of working upstream to support young people before they ever experience homelessness is Joe Roberts, a former homeless youth who began pushing a shopping cart across Canada on May 1st of this year to raise awareness about youth homelessness, but also to elevate the importance of prevention. This national trek will culminate in Vancouver on September 30, 2017. Part of the funds raised will go to support The Upstream Project and our efforts to scale this work. The other funds will stay in the community to support local services. Joe is stopping in over 300 secondary schools and will be involved in over 200 community events across the country. I checked The Push for Change website just this morning and Joe has already walked 1,751 km (and here I thought I was having a productive summer).
Will The Upstream Project end youth homelessness? Well no, not on its own, but this model combined with other models of prevention and appropriate housing and supports can. In the coming months we’ll continue to update you on how we are working together as a coalition to hit this issue from every angle. In the meantime, give a shout out to Joe and The Push for Change on social media. Let him know we’re with him on this. #pushforchange #endyouthhomelessness
This post is part of a monthly series that follows A Way Home's progress as we create real change on the issue of youth homelessness. On the second Wednesday of every month, join us for an update from A Way Home's Executive Director, Melanie Redman.
As communities around the world prepare to celebrate International Youth Day on August 12, this blog entry discusses child, youth and family programs available to homeless youth and families across Canada. A Way Home Canada, a national coalition dedicated to preventing, reducing and ending youth homelessness, estimates that approximately 20% of the homeless population are between the ages of 13 and 24. Without any clear indication that the situation is improving, A Way Home Canada facilitates partnerships among communities and governments to organize, plan and implement measurable and impactful strategies to eliminate youth homelessness. By strengthening families and addressing their needs, youth can make healthy transitions to adulthood by avoiding life on the street.
- School-based interventions
- Family reconnection
- Support for LGBTQ2S Youth
- Support for youth transitioning from care
- Employment, training and education
- Youth transitional housing and Housing First
While the homeless youth population is incredibly diverse, what marks this group is their lack of experience living independently and their developmental needs. The transitional period from childhood to adulthood can be difficult, and youth services are necessary to best support the developmental needs of homeless youth and those at-risk. Without these critical support systems, at-risk youth can fall victim to the dangerous street life that carries a number of long-term consequences, including chronic homelessness, violence, exploitation, mental health, substance use, dropping out of school and criminality.
For homeless families with children, programs are just as essential, and often the lifeline that keeps them afloat. With 37% of Canadian households struggling to maintain housing, more and more families are relying on emergency shelters. Between 2005 and 2009, the number of families with children using shelters increased by 50%. Some of the causes of family homelessness include family violence, a lack of affordable housing, low-wages, un/underemployment and low rates of social assistance. Thus, programming and services must support parents overcome a number of personal challenges (i.e. family break up, mental health, substance use, loss of employment) as well structural factors (i.e. growing income inequality, lack of affordable housing, discrimination, low social assistance rates) while promoting an enriching and secure environment for their children.
Initiatives include food programs, housing stability programs and housing retention, as well as other community services such as employment centres, health services, family support programs, as well as many other services that are not necessarily focused on the homeless population. However, solving family homelessness requires strategies with focuses beyond basic needs. Raising the Roof’s study Putting an End to Child and Family Homelessness in Canada lists a number of recommendations for community agencies and all levels of government, stressing the importance of cooperation, overlap and extensive investments.
In addition to developing integrated programs, service providers and governments must also understand the distinct challenges of sub-populations in order to meet their specific needs and develop solutions to ending homelessness. Below are a few youth and family-focused initiatives:
- Youth Reconnect is an early interventions shelter diversion program developed by RAFT Niagara Resource Service for youth in Ontario. The initiative helps homeless and at-risk youth access resources, increase their self-sufficiency, assist to maintain school attendance and secure housing.
- Link, delivered by Aunt Leah’s House in British Columbia, provides a series of services and programs for youth in transition from foster care. Link offers life skills workshops, drop-in, outreach, and one-on-one support to work on challenges identified by youth.
- Aura Host Homes is a program established by the Boys and Girls Clubs of Calgary that provides LGBTQ2S youth experiencing homelessness a safe place with host parents where their sexual orientation and gender identity is respected and celebrated.
- Parenting After Violence, offered by YWCA Agvvik Nunavut in Iqaluit, provides weekly life-skills workshops for homeless mothers and those at-risk of homelessness who have experienced violence. In addition, participants have access to counseling, child care and referrals.
- The Healthy, Empowered and Resilient (H.E.R) Pregnancy Program in Edmonton works with street-involved women to access healthcare services before and throughout their pregnancy, and addresses issues such as addiction, poverty and family violence.
With quality programming and appropriate prevention strategies and solutions to homelessness, we can ensure that no child or youth becomes entrenched in a lifelong struggle with chronic homelessness. As the world discusses International Youth Day and poverty eradication, Canada must strengthen its social safety net to take care of its most vulnerable citizens; children and youth.
To join the conversations on social media marking International Youth Day, use #YouthDay and/or follow the UN programme on Youth-Focal Point on Twitter @UN4Youth.
Photo Credit: United Nations International Youth Day
On May 4, 2016, approximately 40 people attended the First Annual Canadian Homelessness Data Sharing Initiative, sponsored in Calgary by the Calgary Homeless Foundation and the University of Calgary’s School of Public Policy. Those attending included government officials, researchers and students. Here are 10 things to know about the event.
- The Data Sharing Initiative was jointly organized by the Calgary Homeless Foundation (CHF) and the University of Calgary’s School of Public Policy. A major goal was to bring together persons with access to various forms of homelessness data for a one-day event for the first time. Both CHF and SPP provided cash and in-kind support to make this inaugural event happen.
- When researchers want to access data on homeless persons in Canada, there isn’t a single point of access. Rather, data is both collected and accessed in a variety of ways. When it comes to data collected about persons experiencing homelessness, there are three main types of data to understand. First, there is administrative data (such as the data presented at the May 4 event by officials from Calgary, Ottawa and Toronto); this is collected on an ongoing basis by front-line professionals and often used by social workers. Second, there is data gathered from Point-in-Time (PiT) counts (such as the data presented at the event from Montreal). Third, there is survey data collected by researchers (such as the data presented at the event on Managed Alcohol Programs, and data presented at the event that was gathered from a study on homelessness in Northern Ontario). The May 4 data-sharing event included discussions about all three types of data.
- Canada’s federal government has data on homeless persons from roughly half of the country’s homeless shelters. This includes data gathered via theHomeless Individuals and Families Information System (HIFIS) software; it also includes data gathered via data sharing agreements (which it has with the City of Toronto, the Province of Alberta, and BC Housing). The federal government then uses this data for policy development, measurement and program evaluation. The federal government uses some of the data for its Community Progress Indicators Reports, which it shares with its 61 Designated Communities. (Most of these reports aren’t publicly available, but the one for St. John’s can be found here.) The federal government uses some of the data for public documents (e.g. the National Shelter Study).
- All municipally-funded Toronto homeless shelters are required to use the Shelter Management Information System (SMIS) database system. This is a web-based software that tells administrators when people enter homeless shelters and when they leave. It must be used by all 60 of Toronto’s city-funded homeless shelters. Among other things, it helps administrators tell where there are empty beds. It also helps front-line staff to manage beds in their own programs. And it helps staff in Toronto’s central access services to refer people in need to available beds. In the future, city officials hope to use the SMIS system to assess how much ‘social work’ support a person will likely need once they’re referred to housing; they also hope to use the system to track how people do after they’re referred from emergency shelters to housing. (It’s also thanks to the SMIS system that municipal officials in Toronto know that, on a typical night, there are more than 4,000 persons staying in Toronto shelters, and that in a typical year, more than 17,000 persons sleep in a Toronto shelter for at least once night.) More information on Toronto’s SMIS system can be found here.
- The City of Montreal has no centrally-coordinated database system for homeless shelters. However, the three main men’s shelters are using HIFIS, and other individual shelters in Montreal do keep data on their clients. But those data are not coordinated or kept by one central body. Likewise, Montreal-based programs that receive funding from the Homeless Partnering Strategy all keep data (which they have to provide to the federal government), though not necessarily using HIFIS. Readers should be mindful that the homeless file in Quebec is first and foremost a provincial file; municipalities play only a minor formal role in program administration (e.g. the municipal government provides some funding to various social programs—such as day centres—that serve homeless persons). All of Montreal’s homeless shelters are private, non-profit entities; in general, 60-70% of their budgets come from private sources (and those private funders have very few stipulations in terms of what kind of data must be kept). Montreal did conduct its first PiT Count last year, and municipal officials have access to the dataset. What’s more, in the summer of 2015, the City of Montreal commissioned a more detailed survey of homeless people; it was administered by four teams of paid professionals. (Officials with both the City of Montreal and the Douglas Institute have access to data from both of these studies).
- Ottawa homeless shelters have an open system. Ottawa homeless shelters must use the HIFIS system as a condition of receiving funding from the City of Ottawa; and the centralized database is hosted by the City of Ottawa. It is anopen system in that staff at one shelter can see client records elsewhere in their respective sector—that is, staff in a men’s shelter can see information gathered on one of their clients by another men’s shelter. Data, once collected, is shared on request by municipal staff with a variety of external actors, including University of Ottawa researchers and the Alliance to End Homelessness Ottawa. (Note: municipal staff only release aggregate data—that is, no personally identifiable information.) This open system has been in existence for almost 10 years. Ottawa has never conducted a PiT Count.
- Throughout Canada, there are many examples of data repositories in the natural sciences and some in the social sciences, but very few in social policy. A trusted digital repository is another term for a certified digital archive (and an archive is a place you can deposit data for the long term, where it will be managed across space and time, and where it’s backed up and has a sustainable financial plan and technology transition plan). One example in the natural sciences is the repository created for International Polar Year (IPY) data archives. Another example with social science data is the Irish Qualitative Research Data (IQDA) archive. With homelessness data, since there’s no central place to deposit them, such a data repository to consolidate data resources from all sectors and levels of government would be helpful. In addition to the actual data, the repository would include information on who collected the data, methodological guides and a data dictionary with definitions; and these would all be kept together. This could allow for a one stop shop of shared data—some data could be kept private, with restricted access for researchers only and other datasets could be open data. For such an initiative to get started, someone would have to do the collecting, data, curating and cataloguing of the data. They’d also have to contact sources of the data. Librarians and archivists are experts in this area; they would need to be very involved in the early phases of the project. Such an initiative would require resources (i.e. time, expertise and money) but in the long run could provide the sector with data for national, provincial and local planning.
- Canada’s major funding body for social sciences research has started mandating data management plans. Indeed, the Social Sciences Research Council of Canada (SSHRC) will soon start mandating data management plans. They will also start mandating the preservation of data. This will apply to research projects collecting large amounts of data; but it will not apply to municipal governments simply collecting administrative data, as these are not SSHRC funded research projects. When research proposals go to SSHRC, SSHRC will expect to see money budgeted for data management; SSHRC will also ask researchers for data management plans. Other national funding bodies may follow suit.
- The one-day event allowed for some invaluable networking. Canada is a big country, and there are staff in major cities who administer homelessness data who have never met their counterparts in other cities. This event helped us to overcome some of those silos. For example, one provincial official discussed HIFIS with a federal official during the event, and exploratory conversations have since begun about the possibility of that province introducing the HIFIS system into its homelessness sector.
- The Data Sharing Initiative will become an annual event.
The author wishes to thank the following individuals for invaluable assistance with this blog post: Britany Ardelli, Steven Bulgin, Francesco Falvo, Louise Gallagher, Darcy Halber, Ron Kneebone, Eric Latimer, Tracey Lauriault, James McGregor, Kevin McNichol, Laural Raine, Aaron Segaert, Madison Smith and Shelley Vanbuskirk. Any errors lie with the author.
 Ottawa’s homeless shelter system has four sectors: men’s, women’s, family and youth. Family shelter staff are allowed to see client data in all of the sectors because family shelters are the ‘overflow sector’ (meaning they sometimes take in clients from the other sectors).
Below are links to the minutes of the full day’s event, as well as the slide presentations. Next year’s event will also be held in Calgary.
MINUTES May 4, 2016 Colloquium
The At Home / Chez Soi Demonstration Project Tim Aubry, PhD., C.Psych
The Health and Housing in Transition (HHiT) Study Tim Aubry, PhD., C. Psych.
2016 Coordinated PiT Count – Overview and Data, HPS Dr. Patrick Hunter, Policy Analyst, HPS, ESDC
Dataset Description HPS 2016 Coordinated Point-in-Time Count
Data Description, The Mustard Seed Calgary John Rook, PhD, Samantha Sexsmith
Patterns and Determinants of Housing Utilization and “Graduation” in Calgary Ali Jadidzadeh, PhD and Nick Falvo, PhD
Homelessness Data Discussion Tracey Lauriault
Using Data for Evidence-Based Service Planning Laural Raine, City of Toronto
Homelessness as a public issue Aaron Segaert
Managed Alcohol Programs (MAPS): Implementation and Effectiveness Bernie Pauly RN, PhD, Tim Stockwell PhD, Clifton Chow, MA, Kate Vallance MA, Ashley Wettlaufer, MA
This blog post was originally posted on the Calgary Homeless Foundation website.
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The analysis and interpretations contained in the blog posts are those of the individual contributors and do not necessarily represent the views of the Canadian Observatory on Homelessness.