Preventing Substance Use Problems Among Young People - A Compendium of Best Practices

Section 5 - Exemplary Canadian Programs

Streetworks

Target Population:

Injection drug users; sex trade workers; intimate partners; community agencies and businesses (10% of clientele are youth).

Setting:

Street; Community.

Program Description:

Theoretic Basis

Harm reduction; Health promotion; Transtheoretical Model of Change.

General Desciption

The Streetworks program operates out of five centers in the Boyle Street area of Edmonton. The program also operates out of a van and via outreach workers with backpacks. Streetworks takes a comprehensive program approach. The goals of the program are to prevent the transmission of HIV and other bloodborne pathogens; and to provide and enhance the skills, knowledge, and support for people to live safer and healthier lives. A full-time staff member works with youth.

Components

Pharmacy Program: involves pharmacies that have indicated a willingness to accept dirty needles and to sell back clean needles. They also provide harm reduction information to the target group.

Ride Along Program: is intended to provide an opportunity for other agencies to go out with Streetworks workers and provide information about their services to clients (eg. Student Legal Services).

Health Education: is provided to the target group by nurses and outreach workers. Harm reduction information is provided such as safe injection methods and safe sex. The outreach workers also provide information on how to live safely and protect oneself on the street.

Newsletter: is intended to provide information to the target group. It includes articles about the Streetworks program, as well as contributions from clients.

Prison Outreach: workers regularly visit correctional facilities and provide harm reduction and health information. They emphasize the information is intended for use when the inmates are released.

Nursing Services: provide basic health care such as immunization and dressing changes, as well as appropriate referrals.

Advocacy Services: the intention is to bridge the gap between the mainstream and the street. Workers consult with mainstream services such as social service agencies and medical clinics on ways to respond to street people with respect and understanding. Workers also assist street people by going with them to agencies and clinics, or by providing information on what to expect when visiting a medical clinic, STD clinic, social service agency, etc.

Needle Exchange Tool Provision Program: the program supplies all the tools that are needed for safe injection.

Natural Helpers Program: the program recognizes that there are people who are always helping other people in the community. This program provides additional support and resources to these helpers. The program has developed posters and two handbooks: Vein Care Handbook; and Street First Aid: Cause You Just Never Know.

Referrals Program: the intention of the program is to make referrals that are appropriate to the needs, and level of sophistication of the client. Staff always ensure they are familiar with an agency or service before referring clients.

Research and Evaluation: program evaluation is ongoing. A researcher is currently interviewing clients to identify where specific research needs to be done.

Support Group: is targeted at individuals who are currently injecting but are at the point where they are contemplating change. The Support Group provides a network, information, and resources to assist individuals on moving to a place in their lives where they can stop using, and to deal with being sober.

Messages

Key messages of Streetworks are harm reduction and partnering with clients. Staff ask 'How can we provide clients with what they need to be safer and healthier'. They support 'care-giving, not care taking.' Streetworks is a strength-building program, and a key message is to build on the strengths of the clients (i.e. tell the clients it is great they used an alcohol wipe each time).

Knowledge and Skills Developed

Knowledge of safer injection skills and safer sex techniques. Information on how to protect themselves on the street. Sense of control and influence over their lives. Self-confidence and a vision and hope for the future.

Means of Reaching Individuals Involved in Injection Drug Use

Streetworks reaches clients mainly through reputation. For example, to reach street youth, Streetworks builds trust with current clients (both adult and youth), and finds that when clients trust the program, they will promote the program to youth. As well, Streetworks promotes the program by building partnerships with specific youth agencies.

Contact Time:

Ongoing.

Leader Type and Training Provided:

One-on-one training as opportunities arise.

Results:

Evaluations are ongoing. A recent published study found that the Streetworks program has a cost-effectiveness of $9,500 per HIV infection delayed for one year. Reference: Cost effectiveness of Streetworks' needle exchange program of Edmonton by Jasobs P; Calder P; Taylor M; Houston S; Saunders LD; Albert T. Canadian Journal of Public Health, 90(3): 68-71 1999 May-June.

Prevention Principles Most Reflected:

This program reflects a number of best practice principles. These principles include: addressing protective and risk factors; taking a comprehensive approach; ensuring sufficient program duration; evaluating the program; addressing program sustainability; recognizing youth perceptions of substance use; developing credible messages; combining knowledge and skills development; and attending to training.

Specifically, program strong points include taking a strength-building approach to harm reduction; bridging the gap between the mainstream and the street; providing support and resources to community helpers; and making referrals that are appropriate to the needs and the sophistication-level of the client.

Year Program Established:

1990.

Program Sponsors:

Capital Health Authority; AIberta Health; Alberta Lotteries -- Community Lottery Board grant.

Contact:

• Ms. Theresa Jasperson
  Streetworks
  10116-105 Avenue
  Edmonton, AB
  T5H 0K2
  Tel: (780) 424-4106 ext 210
  Email: tjasperson@boylestcoop.org