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The STRENGTH Project Community Report on Outreach Activities Bungay, Vicky Jan 31, 2019

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J A N U A R Y  2 0 1 9The STRENGTH Project Community Report on Outreach ActivitiesThe Project TeamAcademic Co-Lead Vicky Bungay Co-Investigators Adrian Guta, Kasari Govender, Wendy Bungay, Colleen Varcoe, Cecilia Benoit, & Greta Pauls  Community Co-Lead Linda Dewar Project Staff   (alphabetical order)Community AdvisorsJulia Araujo, Sharon David (part-time), Kat Dockrill, Lana Kootney-David, Janina Krabbe, Briony Metcalfe, Liz Moss, Sara Sebti, Paisly Symenuk, & Sandra WalkerTo access this report online, visit: http://hdl.handle.net/2429/68472 © Victoria B ungay, 2019Please cite this report as follows:The STRENGTH Team (2019). The STRENGTH Project Community Report. University of British Columbia School of Nursing, Vancouver, BC. Funding for this project is provided by the Social Sciences & Humanities Research Council and the Vancouver Foundation. Additional funding support includes Dr. Vicky Bungay's Canada Research Chair in Gender, Equity and Community Engagement and the Michael Smith Foundation for Health Research Scholar Program.S T R E N G T H :  D T E S  |  J A N U A R Y  2 0 1 9 0 2Mary Schoening, Jade Cosa, & Chase Engh  Table of Contents1   Title Page 2   The Project Team 3   Table of Contents 4   Acknowledgments 5   Glossary 7   STRENGTH Project Overview 8   Philosophy & Approach 10   Data - Gender 11   Age 12   Time Spent With Women 13   Outreach Activities  14   Referrals  15   Well-Being 16   Location of Outreach Activities 17   Mode of Contact 18   Summary 19   Next Steps 20   Appendix - Project Summary 22  - Brochure24  - Poster S T R E N G T H :  D T E S  |  J A N U A R Y  2 0 1 9 0 3Acknowledgements This work would not be possible without the dedication and wisdomof the Community Advisory Committee. We are grateful to thosewomen who gave of their time and expertise on this committee in thepast as well as for the current Community Advisors:  Mary Schoening, Jade Cosa, & Chase Engh who have and continue toguide and shape the project.   The STRENGTH team is appreciative of all the partnerships andengagement with service organizations as well as the hard work anddedication of our project staff.     We especially want to acknowledge the fantastic artwork of localIndigenous artist John for his stunning design of the butterfly in thelogo. Thank you also to Justin Liu for his graphic design skills to makea digital version of the butterfly logo.  S T R E N G T H :  D T E S  |  J A N U A R Y  2 0 1 9 0 4GlossaryCommunity-basedparticipatory  approach  Community HealthWorkers (CHWs)   Community member    Contact   Cultural safety      Equity     Gender   Location   Mode of contact    This section outlines how terms commonly used in theSTRENGTH Project are defined within the context of thestudy. refers to a shared governance structure for design,implementation, and decision-making   refers to an individual with lived experience in thecommunity working in an outreach capacity with aResearch Outreach Worker   refers to any individual who lives, accesses services, orspends a considerable amount of time in the DowntownEastside of Vancouver (DTES)  refers to each individual interaction between an outreachworker and a community member   refers  to actively attending to and addressinginequitable power relations, discrimination, racism, andthe ongoing impacts of historical and present-dayinjustices on all facet's of people's quality of life, well-being, and their access and receipt of human services  refers to a commitment to justice and fairness, andorients the work to the systemic, social and remedialinequities and power differentials that limit women'sautonomy and overall quality of life  refers to how people self-identify their gender identity   refers to the setting where an interaction takes place   refers to the platform an interaction is facilitated by     (e.g. over the phone versus in person)   S T R E N G T H :  D T E S  |  J A N U A R Y  2 0 1 9 0 5Glossary continuedS T R E N G T H :  D T E S  |  J A N U A R Y  2 0 1 9 0 6Outreach     Outreach  activities   Referrals     Research OutreachWorker (ROW)   Trauma and violence-informed    Violence     Wellbeing   Woman  Women-led  refers to the process of building relationship with women tosupport service access and receipt. It involves locating andmaking connections with women within their localcommunity in times and places convenient for women   refers to the work that our outreach workers engage induring their interactions with individuals in the community  refers to any connection made with or on behalf of anindividual in the community to support the priorities theyhave identified. Please note, it does not include individualswho are referred into the project  refers to the individuals working in the dual role of outreachworker and research assistant. It is their work that is thesource of data in this report.   refers to the recognition that interpersonal and systemicviolence cause trauma that is directly linked to historical,political, social, and economic structures, influences, andcontexts  refers to both interpersonal violence, such as violentpartners, as well as structural violence, such as living inpoverty or experiencing discrimination or racism  refers to the state of wellness of an individual during anindividual interaction  refers to any individual who self-identifies as a woman  refers to the direction, priorities, and work being led bywomen. STRENGTH Project OverviewMany women experience limited access to services necessary to preventinterpersonal and systemic violence and reduce its harmful effects. Barriersinclude isolation, control by partners, knowledge gaps about services, andnegative encounters in support service settings. This project explores outreachactivities to build lasting relationships between outreach workers and women toenhance quality of life and overall well-being. S T R E N G T H :  D T E S  |  J A N U A R Y  2 0 1 9 0 7The STRENGTH PROJECT is a 3-year, community-based pilotresearch project exploring women-led, trauma- and- violence-informed outreach with women in the Downtown Eastsideneighbourhood in Vancouver, BC. The goal is to reduce barriersin accessing support services among women affected byviolence by building lasting relationships that promoteautonomy and enhance overall quality of life.The project is led by a team of researchers, service leaders/staff and experientialexperts (i.e., women affected by violence), and builds on current services’ capacitiesto learn if and how integrating a women-led and trauma-and-violence informedapproach to outreach facilitates women’s connections with services and improvesservice coordination. Project Model Philosophy & ApproachS T R E N G T H :  D T E S  |  J A N U A R Y  2 0 1 9 0 8Philosophy Being women-led is at the heart of this project. Nowhere is this more clearthan in the design of the team. The Community Advisory Committee wasestablished to be central to the decision-making and operations of theproject as a whole. In the spring of 2017, Linda Dewar asked several keywomen with lived experience if they would be willing to serve on thecommittee. They began meeting in July 2017, taking 3 months to establishtheir code of conduct and rhythms of practice before inviting the researchersto a meeting. This dynamic acknowledged and respected the strengths andcapacities of the Advisors and meant the researchers entered as guests andlearners. Sharing from their expertise, the Advisors ensure that women'ssafety is upheld at all times.  Approach The Outreach teams were also created tobe women-led. The teams include oneResearch Outreach Worker workingtogether with one Community HealthWorker. At any point, there are 1 or 2outreach teams out and about in thecommunity. Intensive training wasprovided at the beginning and ongoingtraining is organized throughout to meetspecific needs as they arise. For example,most recently all the staff were trained inNonviolent Crisis Intervention.        S T R E N G T H :  D T E S  |  J A N U A R Y  2 0 1 9 0 9 Every day the outreach workers record the interactions they have as “daily stats.”No personal information is recorded here. It also does not require the person toanswer questions. It is a way of seeing how the outreach workers spend theirtime to better understand how to meet the needs of women in the community.For example, an outreach worker meets a woman for the first time in an alley.The woman appears to be in her 20s and in the course of conversation identifiesherself as a woman.  After the interaction, the outreach worker fills out the daily stats that she metwith a woman in her 20s in the community, it was an in-person interaction, thewoman was looking for harm reduction supplies, it was about a 3-minuteinteraction and the woman appeared relatively stable.    In the next several pages, we summarize all of their records using graphs and piecharts. The pie charts reflect the cumulative 6-month data and the line graphs orbar charts show each month by category.  As you’re looking at the graphs, please note that the numbers do not refer toindividual people but rather to individual interactions. That means that oneperson could appear multiple times. For example, an outreach worker might seethe same woman 5 times in one month. That would be counted as fiveinteractions.  The total number of interactions with individuals over 6 months was 717.  Over the past 6 months, Julia and Sara - our two research  outreach workers (ROWs) - have recorded all their interactions and work. Their first three months focused on relationship building and making connections in the community. After that, the focus broadened toinclude building linkages between women and local services according to thepriorities set by women.  This report outlines the most recent and up to dateinformation on their outreach activities in order to see trends over time andinform decision making. Source & Background of DataPresentation of DataThe majority of people the outreach workers interactedwith present as women (99%).This is not surprising given that the focus of our project iswomen.S T R E N G T H :  D T E S  |  J A N U A R Y  2 0 1 9 1 0GENDER6-MonthTotalsByMonthS T R E N G T H :  D T E S  |  J A N U A R Y  2 0 1 9 1 1AGEThe majority of people are between the ages of 26-40 years old.6-MonthTotalsByMonthS T R E N G T H :  D T E S  |  J A N U A R Y  2 0 1 9 1 2T IME SP ENTW I THWOMENDuring the first three months, the outreach workers weremeeting lots of people for shorter periods of time. Asthey built relationships withinthe community, the time theyspent with individuals increased.6-MonthTotalsByMonthS T R E N G T H :  D T E S  |  J A N U A R Y  2 0 1 9 1 3OUTREACH  ACT I V I T I E SRelationship building continues to be the main aspect of the outreach workers' day. In recent months, however, referrals, advocacy, and accompaniment have increased substantially.6-Month TotalsBy MonthS T R E N G T H :  D T E S  |  J A N U A R Y  2 0 1 9 1 4RE F ERRAL SThe types of referrals made most frequently by the outreach workers are for health care (including mental health) and/or housing. Referrals to legal services and addictions services have increased over time. By Month6-Month TotalsS T R E N G T H :  D T E S  |  J A N U A R Y  2 0 1 8 1 5WELLBE I NGThe majority of wellbeing designations were deemed 'neutral' by the outreach workers. Looking at those women who were not  'neutral', the majority of women were quite unstable or in crisis. Considerably fewer women were reasonably stable or stable.18-25 years oldBy Month6-Month Totals*Neutral designations are not included in this chart.S T R E N G T H :  D T E S  |  J A N U A R Y  2 0 1 9 1 6LOCAT I ON  OF  S ERV I C E SInteractions with individual women most frequently took place either in the community or in women's homes. By Month6-Month TotalsS T R E N G T H :  D T E S  |  J A N U A R Y  2 0 1 9 1 7MODE  OF  CONTACTThe majority of interactions with individual women are in person.18-25 years old6-Month TotalsBy MonthSummaryS T R E N G T H :  D T E S  |  J A N U A R Y  2 0 1 9 1 8717 contacts with individuals1282 outreach activities    253 referrals made2.8x increase in referrals inthe last 3 months comparedto the first 3 monthsIn the 6-months the outreach teams have been out and aboutin the community, there have been... 3.7x increase in interactions thatlasted over 60 minutes in thelast 3 months comparedto the first 3 monthsThe information collected over the past 6-months highlights someimportant points:  > There has been considerable engagement with community members.> Overall, the majority of individuals are between the ages of 26-40years old.> Most of the interactions occurred in-person in the community or inindividual's homes.> Outreach activities provided were most frequently includedrelationship building, referrals, or accompaniment.> Over time, individual interactions with women have increased inlength.What's happening nowS T R E N G T H :  D T E S  |  J A N U A R Y  2 0 1 9 1 91. The Research Outreach Workers (ROWs) are currentlyworking in more intense one-on-one relationships with manywomen in the community to meet specific and more long-term needs.  2. The Community Advisory Committee and research team areworking on resources that can be used by other projects andcommunity members to set up and support effectiveCommunity Advisory Committee's as partners in research.  3. Ongoing training for ROWs and Community HealthWorkers is being planned based on identified goals andneeds. We are grateful to PACE Society (http://www.pace-society.org/) and Rise Women's Legal Centre(https://womenslegalcentre.ca/) for their support in trainingto date.   4. Preliminary data from the first six months is being analysedto identify strengths and gaps in the program to help informthe next steps.  5. We are applying for ongoing funds to continue this work inthe Downtown Eastside and have been invited to supportother communities in Canada interested in doing similarwork.   Appendix - Project SummaryS T R E N G T H :  D T E S  |  J A N U A R Y  2 0 1 9 2 0STRENGTH Project Description The STRENGTH PROJECT is a 3-year, community-based pilot research project exploring trauma and violence informed outreach with women in the Downtown Eastside neighbourhood in Vancouver, BC. The project is led by a team of researchers, service leaders/staff and experiential experts (i.e., women experiencing violence), and builds on current services’ capacities to learn if and how integrating a women-led and trauma-and-violence informed approach to outreach facilitates women’s connections with services and improves service coordination to address their needs.  BACKGROUND Many women experience limited access to services necessary to prevent interpersonal and systemic violence and reduce its harmful effects. Barriers include isolation, control by partners, knowledge gaps about services, and negative encounters in support service settings. Outreach activities can build lasting relationships between support workers and women in ways that enhance quality of life and overall wellbeing, and are not harmful or re- traumatizing.  AIM To reduce barriers in accessing support services among women affected by violence by building lasting relationships that promote autonomy and enhance overall quality of life.  TEAM Project Co-leads: Dr. Vicky Bungay, Associate Professor at the UBC School of Nursing and Director, Capacity Research Unit; Ms. Linda Dewar, Director, Inner City Women’s Initiatives Society (ICWIS); and Dr. Adrian Guta, Assistant Professor, University of Windsor School of Social Work. National partners:  Nova Scotia Department of Community Services, West Coast Women’s Legal Education and Action Fund (LEAF). A local Community Advisory Committee comprised of experiential experts guide and provide input on everything from intervention design to recruitment of participants, from how and what questions we ask women to how lessons learned are shared. The community advisors, research team and the project steering committee collaboratively hold the vision, exercise leadership and respect the expertise of all involved in this project.  PRIMARY RESEARCH QUESTION What are the effects of a women-led and trauma-and-violence-informed outreach intervention on access to and receipt of support services among a highly vulnerable group of women experiencing interpersonal and systemic violence? Appendix - Project Summary cont.PRINCIPLES THAT GUIDE THE WORK The following principles guide all aspects of this project. Women-led: The direction, priorities and work are led by women. Each person and their actions are shaped by multiple influences including, but not limited to situations, emotions, context, experience, and relations with others. Trauma-and-violence informed: Recognizing that interpersonal and systemic violence cause trauma that is directly linked to historical, political, social, and economic contexts. Cultural safety: Attend to actively addressing inequitable power relations, discrimination and racism and the ongoing impacts of historical injustices on all facets of people’s quality of life, wellbeing and their access and receipt of human services. Equity and justice: Meeting women “where they are at” vs. a provider-centered approach, with an emphasis and recognition of social inequities. Community-based participatory approaches: Shared governance structure for design, implementation and decision making. Integrated service delivery models: Community engagement, collaboration and integration of human services, and social inclusion.  CURRENT STATUS OF THE PROJECT The intervention is currently being piloted in Vancouver’s Downtown Eastside. We are in year two of the project, and actively engaged with women experiencing or at risk for violence. A robust Community Advisory Committee has been created and was vital in co- developing the survey. Interviews have been conducted with Outreach Workers from a variety of local community organizations to understand how the intervention can best be tailored to this community. Outreach workers have been hired and trained. Data collection is currently underway.  S T R E N G T H :  D T E S  |  J A N U A R Y  2 0 1 9 2 1 S.T.R.E.N.G.T.H. aims to reduce barriers in accessing support services by building lasting relationships that promote health and healing.  We work from a trauma- and-violence-informed model that empowers women’s experiences. We strive to listen and learn as we understand that women are the experts in their own lives. We hope to build on the resilience and strength of each woman to better meet her goals.      STRENGTH Project:   Downtown Eastside  Sisters Together Reaching Every New Goal Towards Healing          STRENGTH Project is a trauma-and-violence-informed outreach/research project. We foster engagement with women through an innovative partnership between the Inner-City Women’s Initiatives Society and the UBC School of Nursing.  Our Goal We aim to work together to facilitate and support women in the DTES to access services and engage spirit, heart, and mind in activities promoting healing. By connecting and collaborating with community members we hope to build empowering relationships.  We fundamentally believe that all women are the experts in their own lives. Services Provided Our program is shaped by trauma and violence informed care, non-judgmental & culturally safe approaches, and a harm reduction philosophy framed within a feminist lens. We offer:   Support for women in reachingtheir goals Care and compassion for women To meet women wherever they aremost comfortable Support with housing Support with access to primary-care services Support with access to mentalhealth services Accompaniment to appointments Advocacy Harm-reduction supplies One-on-one confidential andreliable supportTeams Our outreach teams include members of the community with a variety of lived experiences.  Research project Part of our work is conducting community-based, collaborative research that seeks to develop a model of outreach that promotes health and healing while improving access to services. Enrolling in the project is not mandatory to receive immediate support. The research is led by the experiences and knowledge of women in the Downtown Eastside who have engaged with support services. We hope to better understand how to apply a trauma and violence informed model to improve access to services necessary for healing. Contact Us S.T.R.E.N.G.T.H. Outreach Teams Julia & team 778-988-7950 Sara | Briony 778-988-9350 STRENGTH Project: Downtown Eastside Sisters Together Reaching Every New Goal Towards Healing We aim to work together to facilitate and encourage women in the DTES to access services and engage spirit, heart, and mind in activities promoting healing. Through connecting and collaborating with community members we hope to build empowering relationships with women. Our program is trauma and violence informed. We provide support that is non-judgmental and culturally safe. We are committed to principles of social justice and take a harm reduction approach. We work as part of a reseach project examing how to better support women to meet their needs and desired goals.  Support women in reaching their goals ──── Meet women wherever they are most comfortable ──── Support with housing ──── Support with primary care and mental health service access ──── Getting ID/Welfare ──── Accompaniment to appointments ──── One-on-one confidential and reliable support Contact Us Julia & team 778-988-7950 Sara | Briony 778-988-9350 www.capacitycentre.ubc.caI F YOU HAVE QUEST IONSFEEL FREE TO CONTACTTHE STRENGTH TEAM :strengthproject@ubc.ca

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