Research Matters Blog
Addictions programs consists of self-help (i.e. 12 step programs such as Alcoholics Anonymous or Narcotics Anonymous), residential or outpatient treatment facilities, harm reduction programs (including needle exchange programs, safe injection sites and ‘wet’ shelters), individual or group counselling, abstinence-only housing and support from community programs. People dealing with addictions issues may also seek mental health support or services from their primary care physician.
Management and treatment of addictions issues is best provided in a holistic context as there are often concurrent issues at play including mental health diagnosis, past abuse/trauma or physical health concerns. Client-centered support that allows for a partnership or collaboration between the client and practitioners can both empower and support people to make the necessary changes to achieve their treatment goals. Treatment may also be designed to help individual users as well as families, peer groups, communities, and society.
Housing First as a program is predicated on a belief that housing can be provided without any housing readiness requirements. Physical or mental health or addictions issues are often easier addressed once housed. As such, Housing First has a “recovery orientation” which supports individual well-being. Clients may chose to be placed in an abstinence-only housing setting to support their recovery but sobriety is not a requirement for housing.
Many programs that serve people experiencing homelessness who also face addictions challenges are embedded in the harm reduction model. This philosophy is designed to “meet people where they are at” and providing services and supports that best meet their needs. The goal is to reduce the risks and harmful effects of the individual’s addictive behaviours and substance use.
Megan H. asked us about the implications of Toronto’s upcoming fare system changes on people experiencing homelessness.
This week, news reports surfaced about the Toronto Transit Comission (TTC)’s decision to phase out tickets and tokens. Presto, a Metrolinx smartcard system – one that has cost $700 million to develop, according to the auditor general – will be fully integrated across the TTC by the end of 2016, with tokens and tickets being accepted into mid-2017. While this may be a welcome change for some of us, Presto raises a few concerns for people living in poverty and/or experiencing homelessness.
Public transit is very important for this population, as it is usually the only means of transportation available to them. Many are forced to choose between basic costs (like buying food) or a few tokens. The benefits of public transit can go beyond simply getting from point A to point B – providing transportation to people experiencing homelessness often opens up opportunities that weren’t there before. For example, an Edmonton study found that by providing youth with monthly transit passes, their encounters with police and the criminal justice system were reduced. Even so, it appears that people living in poverty or experiencing homelessness are not being fully considered in the TTC changes.
How Presto will work is mostly unknown
Presto, in its current form, charges $6 for new cards, which can be purchased in-person or by mail (takes 7-10 days to arrive). Users must load at least $10 onto each card. Debit, credit and cash can be used. It is unclear how this will change during its rollout, but as it stands, Presto does not make it easy for social agencies – who previously purchased tickets and tokens to distribute – to provide transportation passes to the people they serve. At $6 per card, that’s a hefty markup for handing out TTC rides.
Smartcard systems like Presto assume that people can pay via debit card, credit card or mobile device. That is, indeed, the biggest draw for people like me, who have these things. But what about people who don't have access to these cards? Many people without a fixed address don’t get the luxury of a bank account or a credit card. For these people, who then have to use change to load a card, the Presto process could be more of a hassle than handing over change, tickets or tokens.
Another concern is increased surveillance. Not only does Presto have access to people’s financial accounts, it also tracks our movements – something many people may not be comfortable with. Who has access to this information, and how will it be used?
According to The Toronto Star, there will be a report in November that makes recommendations on how Presto integration (including buying rides in bulk) will work for riders. Hopefully, some of these issues will be addressed.
Public transit in Toronto and other Canadian cities
In Toronto, fares are high and discounted transit plans are dismal. The 12-month pre-authorized plan offers passes to adults for $129.75, and $102.75 for seniors/students – which is as low as monthly passes get.
Most available discounts in the city – via preauthorized plans or Presto – are implicitly most beneficial to people who already have more money. If people get rewarded for loading more money onto a card (ie. buying transit rides in bulk), then they are really being rewarded for having more money to spend upfront. This is a luxury afforded by a minority of transit riders. In 2006, commuters with the lowest income (less than $20,000 a year) were 1.6 times more likely to use transit.
The city and the TTC claim Presto will make discount fares more possible, writing in a joint report:
Smartcard technology will allow for a wide range of fare-pricing options that could not be accommodated previously…For example, fare prices may be linked to travel time, peak/off hours, distance, or vehicle type. Moreover, the Presto cards could also be linked to a low-income rider’s registration in a discount transit fare program funded by the city or through a partnership with an external organization.
Of course, this would be great – if card signup fees were waived and there actually was a low-income program in Toronto. According to numbers compiled by The Toronto Star, Toronto has the second-highest ridership in North America, but receives the least amount of government subsidies – meaning it relies mostly on riders for funding. Because of this, Toronto riders see plenty of fare increases but few financial breaks. In 2014, city council voted to look into creating a low-income transit pass, but have not made any statements yet this year. The following infographic from Toronto Public Health, though somewhat dated, shows just how expensive transit can be in Toronto for people with low incomes:
Other Canadian cities are leading the way when it comes to creating low-income transit programs. Recognizing the relationship between poverty, transit and social isolation, Calgary implemented a low-income monthly transit pass. Edmonton Transit is considering a similar program. Other examples include the British Columbia buss pass discount (seniors and people receiving disability benefits) and Saskatchewan’s discounted public transit program (people receiving social assistance).
Some American cities with homeless populations have similar transit systems:
- New York City’s system, MTA, offers mixed fares available at booths, on buses and in vending machines. Metrocard users get an 11% bonus and various discounts, while others can use cash to pay fares. MTA only charges $1 for new cards, and they can otherwise be refilled and reused. Like Toronto, MTA only offers discounts for seniors and people with disabilities.
- In San Diego, MTS offers discounted fares and passes for seniors, people with disabilities, and people receiving Medicare/social assistance. MTS uses a smartcard system called Compass, which charges a $2 administration fee for new cards. People with discounted passes and fares can only reload their cards in person.
- In San Francisco, the SFMTA uses a multi-pass system like the TTC currently does, with single-rides, smartcards (called Clipper cards). The system offers discounts to seniors, students and people with disabilities/who receive Medicare; as well as those who are considered low income. Clipper cards cost $3, which is waived for discount fares/passes and for adults who opt to use the autoload feature.
What can be done?
While the city of Toronto and the TTC both seem committed to full Presto integration, there are still many unanswered questions, including:
- How will rider details (finances, travel information) be used and/or protected?
- Will card fees be waived for bulk purchases (by social agencies) or for people designated as low income?
- Can multiple cards be easily loaded? (Is there a way to reproduce the simple act of handing out tokens and tickets?)
- How can people without debit/credit cards and cell phones going to receive and maintain cards? Will this option be available at all stations/points of access, or just a few?
- Will a low-income transit pass program be implemented after all?
Write your local councillors! Let them know that these questions are important to you and that you expect the city of Toronto and the TTC to take poverty and homelessness into account while integrating Presto.
This post is part of our Friday "Ask the Hub" blog series. Have a homeless-related question you want answered? E-mail us at firstname.lastname@example.org and we will provide a research-based answer.
The health and well-being of children is strongly related to the environmental conditions that they grow up in. A growing body of research has found strong links between adverse childhood experiences and long-term negative effects on children across the lifespan. The term adverse childhood experiences (ACEs) is used to refer to potentially traumatic events that can have lasting negative effects on health and well-being. The term ACE originates from an ongoing research project that looks at what impact traumatic events in childhood have on future social and health outcomes. The below infographic, published by the Robert Wood Johnson Foundation as part of their series on ACEs, provides some details on the prevalence of ACEs and their impact.
The three types of ACEs include abuse, neglect and household dysfunction. A large U.S. study has revealed that a significant portion of its study participants have a history of ACEs. Over a quarter of all participants reported physical abuse, and 20% of participants reported sexual abuse. Under the household dysfunction header, 27% of participants reported the presence of household substance abuse and 12.7% of participants reported domestic violence against their mother. Over 60% of all participants reported at least one ACE. These are startling figures.
An increase in the number of ACEs corresponds with increased risk for several negative outcomes, meaning an individual with three ACEs is significantly more likely to experience poor health outcomes than an individual with no ACEs. These risk outcomes can be broken up into two main categories: risks to behavioural trends and risk to physical and mental health. Behavioural risks include things like low physical activity, smoking, alcoholism and drug use. Poor behavioural outcomes can function in causal pathways leading to poor physical and mental health outcomes. Physical health outcomes that have shown strong correlations with ACEs include severe obesity, diabetes, contracting STDs or heath disease, and even getting cancer. Mental health outcomes associated with ACEs include depression, as well as affective and anxiety disorders.
In 1997, researchers working with the New York State Psychiatric Institute conducted a study to see if adverse childhood experiences were risk factors for homelessness. 92 individuals who had previously experienced homelessness were compared with a control group of 395 individuals who had no prior homelessness. Telephone surveys, designed with a focus on childhood physical and sexual abuse and inadequate parental care, were administered to participants. Researchers found that a lack of parental care significantly increased subsequent homelessness. The same trend was observed for individuals who had experienced physical abuse; these individuals were 16 times more likely to have experienced homelessness than their counterparts who had not experienced physical abuse. Researchers concluded that adverse childhood experiences are “powerful risk factors for adult homelessness”.
The ACEs study provides a great platform for discussions on the importance of healthy childhood development on the lifespan. Increasing awareness about the link between negative health outcomes can help develop innovative prevention and treatment approaches that can help reduce risks associated with ACEs.
"I can't say who I am unless you agree I'm real." - Amiri Baraka
Is there some part of you that has been denied or ignored? A fundamental part of you that you've been asked or forced to hide, or that someone has refused to see? Have you ever tried to access health care or housing services only to be told that your needs cannot be accommodated and that you in fact do not exist? If you are lesbian, gay, bisexual, transgender, queer, or two-spirit (LGBTQ2S), the answer to at least one of these questions is likely YES.
The month of Pride is a time for LGBTQ2S individuals to not only say who we are; but to also celebrate and be proud of who we are. Pride month is meant to remind us that we are real and that we matter, however, not all members of our community are seen; not all are celebrated; many are silenced and marginalized, made to feel that they are not real and that they do not belong.
It is our obligation and should be our privilege to work alongside our LGBTQ2S youth community members experiencing homelessness.
LGBTQ2S youth homelessness has been acknowledged as an emergent crisis for over a decade. While there have recently been increased efforts to support LGBTQ2S youth experiencing homelessness and to learn more about the barriers and challenges experienced by this population of young people; still there is minimal investigation into these issues and large-scale data collection remains limited. For example, national measurements on LGBTQ2S youth homelessness in Canada and the United States are often based on older data. The hazards of relying on this old data is that there is an under-estimate of the real prevalence, and that without an accurate count it is difficult to confirm crucial characteristics of the population or to secure necessary increases in funding, or to build a policy case for the delivery of more targeted services. This gap in data inevitably impairs service delivery.
A high proportion of LGBTQ2S youth report feeling safer on the streets than in shelters, due to homophobic and transphobic violence that occurs in shelters and youth serving organizations. Although LGBTQ2S youth often avoid shelters and may describe the streets as safer in certain circumstances, it is important to note that the streets are not safe and sleeping outside is not safe. LGBTQ2S youth in particular are at high risk of violence and discrimination.
We have heard numerous young people talk about homophobic and transphobic violence on the streets and how for LGBTQ2S youth, staying awake all night is sometimes the only strategy to increase safety. Here is how one young trans man interviewed by Abramovich (2014) described sleeping rough in Toronto:
"Nothing's really safe. That's the biggest issue. There's no such thing as safe. You just got to have your wits about you, you sleep during the day and you're up walking around all night. Daytime is your safe time because there are more people around."
(M, 28 years old)
LGBTQ2S youth are especially vulnerable to mental health concerns, and face increased risk of physical and sexual exploitation, substance use, suicide, and family rejection. In a recent report issued by the True Colors Fund and the Williams Institute, U.S. based homeless youth service providers report that LGBTQ2S youth experience homelessness for longer periods than non-LGBTQ2S youth, and that identity based family rejection is one of the most frequently cited precipitators of their homelessness. For these reasons, focused responses are needed if we are to meet the needs of queer and trans youth experiencing homelessness. Focused responses include targeted prevention tactics, specialized housing programs, as well as building the capacity of existing housing programs to serve LGBTQ2S youth in a safe and affirming manner. Everyone deserves a safe place to sleep at night.
Over the past year we have seen lots of positive changes in Canada and the U.S. For example, Toronto will open its first transitional housing program for LGBTQ2S youth this summer and Canada's first LGBTQ2S host homes program was recently announced in Alberta. Additionally, Eva's National Learning Community developed a National LGBTQ2S Toolkit to provide services with the resources they need to better support LGBTQ2S youth, and the Government of Alberta has recognized that ending youth homelessness will require prioritizing specific subpopulations of young people, including LGBTQ2S youth. This involves the development of a strategy to meet the unique needs of this population, which will be implemented by youth serving organizations across the province of Alberta.
In the U.S., efforts to identify strategies to prevent LGBTQ2S youth homelessness are underway through the LGBTQ Youth Homelessness Prevention Initiative. This initiative, taking place in Cincinnati, OH and Houston, TX, was developed by and is supported by five federal partners - the U.S. departments of Housing and Urban Development, Education, Health and Human Services, and Justice, and USICH - in partnership with the True Colors Fund, a nonprofit organization dedicated to ending LGBTQ2S youth homelessness.
We certainly have a lot to celebrate this Pride, but the fight is far from over.
As we celebrate all of the progress that we have made this past year, and as we give thanks to our queer and trans elders who paved the way for our coming out and acceptance, let us remember that the work is not done.
As we march the streets and celebrate who we are, let us remember all of the young people who will still be without a home and who are still pushed to margins on a daily basis. May we continue the fight for equal rights, and may we do whatever it takes to ensure that all of our youth can be their full authentic selves and still have a place to call home, because: "I can't say who I am unless you agree I'm real."
Homecare and continuing care refers to a wide range of inpatient and outpatient services that may be offered in the home, in the community or in a hospital or medical setting. These programs can include: counselling, psychotherapy, individual and group therapy, day treatment programs, wound care, visiting/home nurses, meal support programs (i.e. Meals on Wheels), adult day care and homemakers services.
In the past, continuing care services for people who require support services focused on facility-based programs such as nursing homes and auxiliary hospitals. In recent years, there has been significant development in the delivery of services to support individuals to remain in their homes, or in community-based supportive living residences.
An individual that is aging or is experiencing mental or physical illness, for example, often faces unsupportive and stressful circumstances – poverty and unemployment. If discharged from formal care without continuing or home care they are likely to experience more setbacks, crises and hospital readmissions than a person with a strong support system.
Continuing care and home care is typically delivered by voluntary organizations to vulnerable groups such as the elderly, the mentally ill, the physically disabled and individuals that have been discharged from corrections facilities. They provide supports and services such as: transitional residences, counselling services, links to affordable apartments, home health care services, case management, psychiatric rehabilitation, family care for adults, respite programs, employment programs, boarding homes and group homes.
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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.