News & Events

Harm Reduction

Shaundra Bruvall | February 2, 2024

Harm Reduction

The social services sector evolves with the needs of the people that it serves; harm reduction has become a leading framework for those working with individuals facing homelessness and substance use challenges because of its effectiveness in minimizing risk in situations involving physical health, mental health, and/or substance use.

Understanding Harm Reduction

First off, what is harm reduction? Harm reduction is a non-judgmental approach that seeks to reduce the health and social harms associated with an action that is inherently risky. In the social services and addiction sector, we seek to reduce the harm associated with substance use, without requiring individuals that use substances to immediately abstain. We often refer to this as ‘meeting people where they are at’ instead of placing a moral judgement on their behaviour i. The goal is to reduce harm in the immediate while supporting conversations and options around what reducing harm can look like long-term.

Why Not Abstinence?

For many people, substance use is part of recreational activities, and risk of long-term substance use disorders is minimal, but for others it can develop into an addiction that significantly impacts all other areas of that individual’s life iii. A common misconception about harm reduction is that it is an enabling action and that abstinence isn’t an option within a harm reduction model. Harm reduction is about giving individuals the power to make decisions for themselves, and that can mean anything from continuing to use substances, reduced substance use, choosing abstinence, and everything in-between. This framework is here to support individuals in improving their circumstances over time with a non-judgmental approach, and, ultimately, to help people lay the foundation for lasting change in their lives.

Harm Reduction in Practice

Harm reduction in practice can look very different depending on its application and doesn’t only apply to situations involving substance use. People engage in harm reduction practices every day, often without realizing it; for example, putting on sunscreen to reduce the harm of sun exposure, wearing a seatbelt when driving a car to reduce the risk of serious injury in the event of a car accident, and using oven mitts when cooking are all examples of harm reduction measures.

In the realm of substance use, overdose prevention sites are part of reducing harm due to toxicity or quantity. Overdose prevention sites have considerable positive impacts on those in active addiction. These sites reduce the harm of illicit drugs by providing a safe and clean environment where people are monitored by medical professionals to ensure quick, life-saving action in the event of an overdose. These sites are known to reduce costs for the healthcare system, prevent illnesses, and most importantly prevent overdose fatalities ii. Other examples of harm reduction practices and services relating to substance use might be:

  • Outreach programs
  • Safe supply
  • Needle exchange programs
  • Opioid replacement therapies
  • Drug testing kits/services
  • Use of naloxone kits

 

Harm Reduction and Homelessness

Alongside the need for shelter, unhoused individuals face many challenges that compound experiences of homelessness. We know that individuals living on the street are at a higher risk of mental illness, physical health issues, and basic hygiene challenges; in some cases we see substance use become a coping mechanism for individuals on the street as a response to struggling with the challenges (and trauma) of experiencing homelessness. Unhoused individuals often experience barriers to health care on top of not having access to basic hygiene supplies, resulting in a higher number of negative health outcomes such as infections, Hepatitis B and C, and HIV. This is why ensuring unhoused individuals have access to safe supply like sterile water, needles, and glass pipes is essential to ensuring the safety of unhoused folks.

Harm reduction is a practice related to substance use as one example, but other health interventions are harm reduction practices that are equally important. Access to clean clothing, for example, reduces harm by removing dirt, bacteria, fleas, and other irritants which helps reduce the occurrence of infections, rashes, and disease. Access to showers, as another example, reduces the harm of infestations like scabies, fleas, and head lice which individuals on the street are at a higher risk of due to infrequency of washing supplies iv. Once the immediate safety of the individual is addressed, there is room for support, referrals, and goal setting towards other improved circumstances.

The overall goal of harm reduction is to minimize the negative consequences involved with an inherently risky action (such as substance use) while recognizing that each individual’s circumstances are different and require a unique, non-judgmental approach.

If you want to learn more about the root causes of homelessness, harm reduction, and practical strategies on how you can better navigate interactions with this population, we offer a free 90-minute workshop twice a month at the carya Village Commons. You can learn more about the workshop and available dates here.

References

  1. Thomas, G. (2005) Harm Reduction Policies and Programs Involved for Persons Involved in the Criminal Justice System. Ottawa: Canadian Centre on Substance Use.
  2. Mental health. CMHA Ontario. (n.d.). https://ontario.cmha.ca/harm-reduction/#:~:text=What%20are%20some%20examples%20of,for%20people%20who%20inject%20drugs.
  • Harm reduction. Harm Reduction | The Homeless Hub. (n.d.). https://www.homelesshub.ca/about-homelessness/substance-use-addiction/harm-reduction
  1. Thelwell, K. (2020, October 24). Struggles obtaining convenient access to showers. The Borgen Project. https://borgenproject.org/access-to-showers/

 


National Housing Day 2023

Shaundra Bruvall | November 21, 2023

National Housing day exists in Canada to remind each of us of the importance of affordable housing for all. If you are lucky enough to never have had to worry about shelter for you and your family, it can be easy to overlook the barriers faced by so many and the critical nature of having safe, affordable housing.

 

National Housing Day aims to provide more advocacy for people experiencing homelessness within Canada, and serves to remind us that there is much to be done to make sure that all Canadians have access to affordable and safe housing. Current estimations suggest 235,000 Canadians may experience homelessness in a given year. Many people experiencing homelessness have multiple barriers to gaining affordable housing, such as lack of consistent or adequate income, mental or physical health issues or substance use addictions.

 

It has become more and more clear over the past decade that Canada is facing a housing crisis. Growing costs of housing and a strong demand with insufficient supply has led many Canadians, unable to afford market prices, to become entrenched in unsafe or inadequate housing units, or to become unhoused. In Calgary, the average house price is $553,300, and market prices for apartment rentals are currently averaging $2,178. These prices are often unaffordable for so many and, as a result, it becomes more and more likely that individuals, couples, and families will be forced to stay in unsafe housing situations, places that don’t meet their needs, or risk becoming unhoused.

 

Alpha House Society works alongside other homeless-serving and housing agencies in Calgary and within the Calgary Homeless Foundation’s Housing Strategist programs to transition people experiencing homelessness into housing. Alpha House offers two different types of housing programs: permanent supportive housing (PSH) sometimes called Place-Based Housing (PBH) and Community (Scattered-Site) housing. Alpha House’s PSH program is made up of seven different apartment buildings throughout Calgary. Each offers individual case management and goal setting, as well as group programming case, supporting each resident to improve their circumstances by learning new skills, reducing harm related to substance use, and establishing and creating community for everyone.

 

Alpha House’s Community Housing program supports clients to transition towards independent living. Clients in the program are housed within the community with their own units and sign their own leases. Caseworkers support clients with intensive case management to help with basic short and long-term needs and reduce the likelihood of re-entry into homelessness.

 

There is a vast array of needs when it comes to housing and, to ensure stability, it is critical to meet those needs with a spectrum of housing options; matching needs with services. In the homeless-serving sector, housing options are critical to reducing barriers for individuals who are rough-sleeping, struggling with mental or physical health challenges, and dealing with substance use addiction

 

Alpha House believes foremost in a Housing First approach to solving homelessness –  without barriers and without exception – providing housing regardless of an individual’s personal circumstances and, as an agency, our continuum of programs work to meet individuals where they are at, determine what type of housing would suit them best, and support them in transition.

 

National Housing Day exists to remind Canadians that every person deserves a home, four walls and a roof. Many Calgarians are feeling firsthand the impacts of the housing crisis. aware of how the housing crisis. The City of Calgary Council recently passed a strategy with the goal of ensuring every Calgarian has an affordable place to call home. This strategy has five main points: 1) increase the supply of housing, 2) support affordable housing providers, 3) enable the City’s housing subsidiaries to improve service delivery, 4) ensure diverse housing choice, and 5) address the affordable housing needs of Indigenous people. This strategy was adopted on September 16, 2023 with implementation plans stretched out over 2024-2030.

 

Federally, Canada has also implemented a national housing strategy which includes investing 40 billion dollars into different housing strategy targets, such as a 50% reduction of emergency shelter stays by those chronically homeless, 385,000 community housing units protected, and another 50,000 units created through an expansion of community housing. Alpha House knows the importance of safe, supportive, and affordable housing and we stand with all agencies, government bodies, and developers who are working towards Housing for All.

 

Written by Alpha House Staff (Amy Sutherland)

 

Government of Canada. (2017). Canada’s National Housing Strategy: A place to call home. https://eppdscrmssa01.blob.core.windows.net/cmhcprodcontainer/sf/project/ placetocallhome/pdfs/canada-national-housing-strategy.pdf

 

City of Calgary. (2023). Home is here, the City of Calgary’s housing strategy 2024-2030. https://www.calgary.ca/communities/housing-in-calgary/housing- strategy.html#:~:text=Home%20is%20Here%2C%20The%20City%20of%20Calgary’s%20 Housing%20Strategy%20was,office%20conversions%20to%20support%20students

 

Alpha House. (2023). Housing Program. https://alphahousecalgary.com/how-we-help/housing- program/

 

Homeless Hub. (2021) How many people are homeless in Canada. https://www.homelesshub.ca/ about-homelessness/homelessness-101/how-many-people-are-homeless-canada

 

Average house price in Calgary. (2023, October 16) The Canadian Magazine of Immigration. https://canadaimmigrants.com/average-house-price-in-calgary/ #:~:text=The%20average%20house%20price%20in,over%20year%20in%20September%2 02023


Housing First; What Comes Second?

Shaundra Bruvall | June 16, 2021

In the homeless-serving sector, we operate on a principle of Housing First. Housing First means providing affordable, supportive housing to individuals/families experiencing homelessness as quickly as possible without expecting them to meet certain requirements (such as ‘sobriety’) before being allowed a home. In our experience, housing gives people the opportunity to work on other aspects of their lives without being constantly displaced. But housing is not the only solution or supports that people need. We sat down with some of Alpha House’s Community Housing Caseworkers to hear their thoughts on what comes next after ‘Housing First.’

 

We know about some of the barriers individuals face when trying to transition from homelessness to housing – lack of income, issues with obtaining ID/bank accounts, unmet medical needs etc. What are some of the barriers you see when it comes to someone newly housed remaining housed?

Most newly housed folks need to learn/relearn basic household and hygiene skills. Emergency Shelters do not always have the capacity to allow clients to learn how to perform these tasks so it can be a struggle when someone is newly housed.

Many folks also struggle with feeling as though they don’t fit into their new community, they may feel they are being targeted due to their appearance or behaviors and rarely feel comfortable asking for support from neighborhood support systems. It often takes months or years for a client to build a sense of community and belonging. This can lead to struggling with boundaries around things like guest management with clients inviting their (still unhoused) friends to stay, as that group of people is where they feel most comfortable.

 

What do Alpha House’s caseworkers do to reduce these barriers for clients?

From the perspective of learning/relearning basic household and hygiene skills, caseworkers are able to assist with basic chores, provide insight and information, and work off their rapport with clients to support skill building and overall confidence.

For community integration, caseworkers are able to do tours of the community, provide lists of community supports and events, and provide encouragement and supports to help clients reintegrate within their community.

The importance of having someone you trust cannot be overstated here. Rapport with clients is critical to supporting their needs and helping them gain confidence and feel more comfortable.

 

How big of a part does a neighbourhood/community play in helping individuals stay housed? Are there things we can do better as a community to prevent re-entry into homelessness?

The neighbourhood and community play a big part in a client’s successful housing. When clients feel like they are part of a community, we often see greater success in housing stability. We all play a part in our communities to help people feel welcome and that is no different when it comes to those we house. Simple things like smiling and saying hello or introducing yourself make a huge difference. More involved engagement like having a coffee with the individual and taking the time to get to know them is very beneficial to the success of housing programs. Those we serve have often been experiencing homelessness for a long period of time and feel alienated from society, so reintegration and kindness are key.

If our clients feel welcomed and understood by their neighbors, they are more likely to integrate quickly and to show a sense of pride in their housing, which promotes hope and is crucial to long-term housing stability and overall wellbeing.

As a community, we can help prevent re-entry into homelessness by understanding that everyone deserves a chance and has a unique story. Greet your neighbours regardless of their past or appearance.

Society as a whole could be more open to seeing unhoused individuals as people that are worthy of interaction and compassion.

Anecdote: I live in the deep SW and one day stopped to fill up with gas, an Alpha House client was in the parking lot asking for money to get on the bus. When he asked me, I showed him my employee ID badge and he immediately held out his hand to show me a possible broken hand with cuts all over it. He only needed to get on the bus to go get medical attention and had no money to do so. Everyone else that he approached walked away from him as fast as possible when he really just needed help and support.

 

Can you share some thoughts on the importance of landlord relationships when it comes to housing stability for clients? How do you go about building those relationships and reducing stigma that can come with housing previously homeless individuals?

Landlord relations are incredibly important as not all individuals have an easy or seamless transition to independent housing.  With a patient and understanding landlord/lady, it is easier for individuals to be successful in their housing. One critical piece is establishing a landlord-tenant relationship where the landlord addresses concerns they are having with a client themselves in a direct and gentle approach. If a landlord/lady requests Alpha House discuss all concerns with a client it does not build a client’s capacity to have these discussions and overall, it reduces their accountability. All of our clients are their own lease holders and need to attend the lease signing with the landlord; we also encourage clients to call their landlord for small fixes and concerns just like a non-program tenant would. This builds capacity and self-advocacy as well as relationships. Forming a relationship helps the property owner see a client as a person who deserves housing, and not just someone who used to be homeless or has an addiction.

 

What about neighbour relations? How do you encourage clients to integrate into their community?

In inner city areas it is easier to integrate and not feel so targeted as opposed to in suburban communities.  Alpha House never wants to make a client feel bad about their appearance or experience so when working with clients we tend to focus more on being a good neighbor and what that means. We talk about not having a lot of guests over at any one time, using appropriate garbage cans, keeping the apartment a good level of cleanliness etc. Overall, integration into community is not something that can be easily achieved without society as a whole becoming more open minded towards our clients.

 

Where are there gaps (both in the homeless-serving sector and overall as a society) when it comes to housing stability? What things are we missing as a collective group to prevent someone losing their housing or to be more inclusive and well rounded in general?

To help the client succeed and maintain housing stability, communication is key. When housing someone from homelessness into housing, the transition period is very hard for the client. We often see clients who sleep on their balconies, or have their bed in the living room. As a collective, we all need to be patient and communicate the struggles that the client is facing at the time and work together to ensure adequate supports are provided.

Additionally, the Homeless Serving sector could do a better job at educating society about the variety of reasons individuals become homeless. So many non-aware people assume that it is just based on drugs and alcohol, rather than seeing the trauma that so often leads to substance use as a coping mechanism.

 

We typically see studies that show prevention is more cost effective than reactionary programs – this is true in terms of crime prevention, injury prevention etc. Besides the humanitarian reasons to provide affordable housing to all and prevent homelessness, what do you see as the economic benefits of housing stability? (i.e. client interacts with police less often, fewer medical issues, less substance use etc.)

We often see a reduction in overall emergency services use, such as CPS and EMS interactions, as clients are housed and able to attend general medical appointments on a regular basis and address underlying health concerns.

Often times we see a reduction is substance use as a result of decompression. When clients are homeless their bodies go into a fight or flight mode. When they are housed we often see them decompress and they are able to relax, not having to constantly be looking over their shoulders.

We also often see mental health concerns stabilize as individuals are able to take care of themselves, stick to a medication regime, get better sleep and eat better, which all contributes to a positive state of mental health

 

Alpha House operates from a Housing First perspective meaning individuals are better able to work on other aspects of their lives if they have shelter security and a place to call home. In the context of “housing first, what’s second?” – what would you say comes second after housing?

Some of the most common ‘seconds’ we see are mental health, overcoming trauma, reconnecting with family or dealing with physical health concerns.

In addition to the above pieces, community reintegration and purpose, along with a sense of dignity and self-worth for the client are important. We help clients set goals and support their plans for the future. Having something to work towards and having hope for the future is critical.

Overall, we know that support needs to come second; it is about supporting clients in whatever way they need so they can find stability.

 

What types of philosophies do you follow as caseworkers to support your clients? Do you have any rules of thumb or best practices?

  1. Be honest to yourself and to the client
  2. Everyone deserves to be treated with dignity and respect. We work with people and not just numbers. Client choice is also very important. Every client has their own unique story, with underlying trauma as a big factor in why they were homeless. We support clients, no matter the choices that they make. As long as they are safe, and given the tools to remain safe in their homes.
  3. Harm reduction principals and to meet a client where they are at. We cannot move faster than them and for individuals who have been homeless or institutionalized most of their lives, it takes longer to feel comfortable being housed than someone who has been only episodically homeless.
  4. Celebrate the small successes with your clients and encourage self-sufficiency