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- 1. 1950 started in a Church Basement Now, professional social service agency Remain affiliated with the United Church in Canada 2013 – Over 200 employees, $8 million worth of services Housing and Homelessness Neighbourhood Development and Newcomer Services Children, Youth and Families DECREASING BARRIERS… INCREASING OPPORTUNITIES www.wesleyurbanministries.ca
- 2. Wesley Urban Ministries believes that harm reduction programs and interventions are vital components of healthy communities. Harm Reduction: Any policy or program designed to reduce substance related-harm without requiring the cessation of substance use-CAMH DECREASING BARRIERS… INCREASING OPPORTUNITIES www.wesleyurbanministries.ca
- 3. Community Need “Back Alley” non-beverage “ETOH” consumers Hamilton mouth wash alley Poly substance users Struggle for urban free space DECREASING BARRIERS… INCREASING OPPORTUNITIES www.wesleyurbanministries.ca
- 4. DECREASING BARRIERS… INCREASING OPPORTUNITIES www.wesleyurbanministries.ca
- 5. Wesley Harm Reduction Continuum 1 2 3 4 5 Abstinence Substance Acknowledged Support Substance Influenced Use Administration Abstinence Non Medical Non Medical Partial Medical Enhanced Comprehensive Medical Medical Custodial Care Outreach Outreach Case Outreach Case Social Care Management Management DECREASING BARRIERS… INCREASING OPPORTUNITIES www.wesleyurbanministries.ca
- 6. Special Care Unit 16 Bed - Level 5 Harm Reduction Program Managed Alcohol Program The intent of the program is to better care for the homeless alcohol dependent individual by meeting their chronic physical, mental health and addiction needs by providing coordinated health care and managed alcohol treatment DECREASING BARRIERS… INCREASING OPPORTUNITIES www.wesleyurbanministries.ca
- 7. Target Population Male Homeless Alcohol dependency Acute mental and physical health problems; Cycle of repeated uses of, emergency rooms, hospitals, detoxification centres and police contacts DECREASING BARRIERS… INCREASING OPPORTUNITIES www.wesleyurbanministries.ca
- 8. Current Staff Director Registered Nurse 2 Registered Practical Nurses 2 Night Shift Coordinators 1 Operational Support Worker 4 Client Care Workers Affiliated Staff Shelter Health Network 2 Primary Care Physicians DECREASING BARRIERS… INCREASING OPPORTUNITIES www.wesleyurbanministries.ca
- 9. Administration of Alcohol Occurs in conjunction with health care and social supports Amount individually determined as a “care team” decision, confirmed by the Director Amounts fall within general guidelines similar to all programs DECREASING BARRIERS… INCREASING OPPORTUNITIES www.wesleyurbanministries.ca
- 10. DECREASING BARRIERS… INCREASING OPPORTUNITIES www.wesleyurbanministries.ca
- 11. Outcomes 100 % of current client group is participating in the harm reduction program 40% are low-risk consumers (includes abstaining) or moving to (reducing etoh consumption) low-risk consumption Medication compliance rate exceeds 90% Flu immunization compliance rate 100% 100% have Primary Health Care provider relationship DECREASING BARRIERS… INCREASING OPPORTUNITIES www.wesleyurbanministries.ca
- 12. Future Niche – Alcohol dependency Moving to a new location that provides expanded and flexible facilities Improve community integration Expand harm reduction services Implementing electronic files and client outcomes data base DECREASING BARRIERS… INCREASING OPPORTUNITIES www.wesleyurbanministries.ca
- 13. DECREASING BARRIERS… INCREASING OPPORTUNITIES www.wesleyurbanministries.ca
Notas del editor
- Our Vision Wesley Urban Ministries has a vision of community, where justice and compassion guide the way we live, where all members are treated with respect and dignity. Our Mission To achieve our vision, we will use our resources to: Decrease Barriers by developing and delivering programs that address the needs of people who are marginalized. Increase Opportunities by providing services that help individuals to achieve their full potential. Be a model and catalyst for social transformation. Our Values Compassion Being aware of the suffering and difficulties of others and wanting to do something about it. Respect Having compassionate consideration of others by listening and trying to understand. Responsiveness Moving to action with an understanding of the needs of our community. Stewardship Using resources wisely to be responsive to the community, to provide maximum value to the people who access our services, and to be accountable to all who support our work.
- Wesley Urban Ministries through harm reduction policies and practises seeks to affirm individual decision-making, responsibility and meet individual needs through compassion, prevention and self-control. Key to this organization’s actions of reducing barriers and increasing opportunities is the respect for individual rights. Wesley strives to provide holistic individual approaches that include harm reduction, health care and supportive relationships. On a program wide perspective Wesley seeks to build in prevention, harm reduction, treatment to all of its programs when appropriate.
- Public, homeless addicts putting considerable demand on, emergency shelters, police services, EMS, emergency rooms and the broader health care system, Severity of the addictions meant individuals chronically disconnected Alcohol risk is lowest when mental, physical and social demands on the consumer are at a minimum Context of Use – Patterns of Use – Volume of Use Acute Health effects – Chronic Health Effects – Acute Social Effects Chronically Disconnected – the giving up of, non-maintenance of, loss of: social, occupational and recreational activities; supportive family relationships; home and income; supportive relationships for physical and/or mental health
- Risk of injury at low levels of risk increases when the context of drinking is not controlled (ie. back alley, non beverage etoh) Risk is reduced by using good judgement about settings and associated activities as well limiting consumption The harm reduction pyramid is from HAMS-Harm Reduction Network – New York, NY. – harm reduction is hierarchical-some risks are worse than others.
- The Wesley Harm Reduction continuum is described in the handout. This continuum describes a level of harm reduction service and the corresponding health care and program interventions that are required in order to support the level of harm reduction service. In building harm reduction into programs, the Wesley experience has been that effective harm reduction is dependent on integrating preventative options with supportive alliances with staff, connections to treatment and collaborating with enforcement agencies. While providing harm reduction services Wesley will not allow for harmful drug seeking activities, violence or predatory substance exchanges to take place at any Wesley program site. Professional good judgement is used when working with the HPS in all matters related to, violence and risky-disruptive behaviours, illegal activities and the selling of illegal substances. Depending on the situation, HPS involvement is activated by Wesley staff through the local crime unit, the social navigator or through the Crisis Outreach and Support Team (COAST) depending on the nature of the incident.
- 2004 – 2007 Supporting Community Partnerships Initiative Homelessness Funding 2007-08 Ministry of Health and Long-term Care 2009 – 2013 - Hamilton, Niagara, Haldimand, Brant Local Health Integration Network - Aging at Home Claremont is one of three permanent managed alcohol programs in Ontario; – Ottawa: Shepherds of Good Hope – Ottawa Inner City Health; Toronto: Seaton House – St Michael’s Hospital Inner City Health Team One of four permanent program in Canada, recently Vancouver established a program Thunder Bay has a two year trial program Kenora conducting a study Programs are collaborating with University of Victoria to get funding for a nation wide research-evaluation project The essence of this model is the pragmatic recognition that treatment must meet active substance users ‘‘where they are’’ in terms of their needs and personal goals. Thus, harm reduction approaches embrace the full range of harm-reducing goals including, but not limited to, abstinence-Andrew Tatarsky
- 20% of Claremont population over 60 Youngest – 40 yrs. Oldest– 68 Population often presents onset fragile medical conditions in early fifties Context of Use – Patterns of Use – Volume of Use Acute Health effects – Chronic Health Effects – Acute Social Effects
- CCAC is a direct partner with the team providing health care supports St. Josephs Emergency Psych services provide assessment supports Cost effective -$142/bed - Congregant Living Exploring means to improve case management and aftercare supports
- Administration of alcohol amount designed to meet the persons level of etoh tolerance-dependency so that withdrawal symptoms do not occur, while remaining below a level where signs of etoh intoxication would occur Individual choice within the range, but individual may not choose an amount that produces signs-symptoms of etoh intoxication The Claremont program administers a morning “serve’ of up to 7 ounces of white wine (or equivalent) at 7am and then serves up to 5 ounces of white wine (or equivalent) every 60 minutes until 10pm. Client care workers administer etoh – provide perpetual screening assessment for physical-behavioral signs of etoh withdrawal or intoxication Claremont brews beer off-site, and purchases wine directly from wineries. Allow individual participants to substitute a preference of spirits, sherry ,beer or wine but ensure that consumption is strictly controlled. If individual prefers spirits then they purchase this themselves and hand it into the program for administration “ House rule” - alcohol consumption takes place in the program, not in the community. Experience is that we are working with individuals who are poly substance users where alcohol dependency is one of multiple addictions.
- Harm reduction plays an important role in stabilizing homeless people with addictions, Current group of patient-clients, 30% new admissions since November 2012 100% have ceased consuming unsafe ETOH and rubbing alcohol, police contacts have stopped, improper use of ER eliminated, emergency shelter use stopped Back alley drinking not the public issue it was 8 years ago Police work actively with us, social navigator, to direct eligible individuals to the Special Care Unit