345 October 17, 2013 PHAC : Sheway Project - CHNET

Welcome to Fireside Chat # 345
October 17, 2013 1:00 – 2:30 PM Eastern Time
The Sheway Project:
Improving outcomes
for mothers and babies
in Vancouver’s Downtown Eastside
Advisors on Tap:
Nancy Poole
BC Centre of Excellence for Women's Health
Network Action Team on FASD Prevention from a
Women's Health Determinants Perspective,
CanFASD Research Network
Amy Salmon
Sheway Program , Vancouver Native Health Society
www.chnet-works.ca
Population Health Improvement Research Network
University of Ottawa
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Advisor on Tap
Nancy Poole
Director
Research and Knowledge Translation,
BC Centre of Excellence for Women's Health
Lead,
Network Action Team on FASD Prevention
from a Women's Health Determinants
Perspective,
CanFASD Research Network
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Advisor on Tap
Amy Salmon
Coordinator,
Sheway Program,
Vancouver Native Health Society
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www.cbpp-pcpe.phac-aspc.gc.ca
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www.cbpp-pcpe.phac-aspc.gc.ca
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Sheway
Dr. Amy Salmon
Co-ordinator
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Target Population
• Pregnant and parenting women who live in
Vancouver and struggle with issues such
as poverty, substance use, violence,
homelessness, legal, and in some
instances, mental health issues.
• Self referral, referral from other agencies
• Currently serving 160 women + 150
children each week
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Lives of women at Sheway are
characterized by:
• Poverty and hunger
• Experiences of violence and
sexual exploitation
• Disrupted family lives
• Inadequate, unstable
housing (90% at intake)
• Trouble with the law (nearly
40% have been
incarcerated)
• Unplanned
pregnancies/child removals
• Mental Illness and Cognitive
Impairments
• Substance use problems
• Guilt and shame
• Legacies of residential
schooling and colonization
• Alienation from health and
social service providers
• Limited positive experiences
of being parented (2/3 spent
time in foster care as
children)
• Chronic stress
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Service Philosophy
• Based on the recognition that the health of women and
their children is linked to the conditions of their lives and
their ability to influence these conditions
• Services provided in a flexible, non-judgmental, nurturing
and accepting way
• Use a woman-centered, violence-informed approach
• Respect and understanding of First Nations Culture
• Harm reduction approach
• Safe drop-in environment
• Networking
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Services at Sheway
• Daily hot lunches, daily drop in, weekly
food bags
• Nutrition counseling and prenatal vitamins
• Full service primary health care (including
prenatal and postnatal care)
• Parenting support
• Alcohol and drug counseling
• Mental health services
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Services, cont.
• Contraception counseling and provision
• STD/HIV counseling and testing
• Baby food, formula, diapers, baby clothes
when available
• Housing advocacy and access to benefits
• Advocacy with child welfare and
navigating systems
• Practical support for securing medical care
and other services
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Staff include
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2 Social Workers (MCFD)
2 Infant Development Consultants & 1 IDP Assistant (YWCA)
2 Family and Community Support Workers (VCH & YWCA)
1 Housing Outreach Worker (YWCA)
1 Cook/ Peer Support Worker (VNHS)
1 Client Engagement Worker (VNHS)
1 MOA (VNHS)
4 Community Health Nurses (VCH)
1 A&D Counsellor (VCH)
1 Nutritionist (VCH)
3 Family Physicians, 1 Psychiatrist (VCH) ( & 4 RICHER
Pediatricians)
• 1 MOA (VNHS)
• 1 Program Assistant (VNHS)
• 1 Coordinator (VCH)
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What's new since this
evaluation?
• Significant expansion of harm reduction services in Vancouver,
particularly in the inner city
• Fir Square Combined Care Unit at BC Women's Hospital
provides safe antenatal environment, bringing continuity between
hospital and community services
• New site, co-located with YWCA Crabtree Corner
• More clients: 160 women per week/ 325 women per year, plus
approx 150 children per year
• Fewer children going to foster care
• 70% of children live with their mother or both parents
• 22% are in care, including voluntary placements and apprehensions
• 8% are with fathers or extended family
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Challenges for Sheway clients
• Family friendly services (esp for women
living with mental health and substance
use problems)
• Services for mothers without children
• Health care when leaving Sheway
• Housing, esp. with partners
• Poverty
• Stigma and discrimination
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Evaluation Report for the Sheway Project
for High Risk and Parenting Women
Nancy Poole
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Evaluation approach
Overarching approach Methods be consistent with
program philosophy and
community context
http://bccewh.bc.ca/publicationsresources/download_publications.htm
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The articulation of the program philosophy
(a key aspect of the evaluation process)
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provide services in a flexible, non-judgmental,
nurturing and accepting way,
support women’s self-determination, choices and
empowerment,
offer respect and understanding of First Nations culture,
history and tradition,
take a harm-reduction approach,
offer a safe, accessible, welcoming drop-in
environment, and
link women and their families into a network of healthrelated, social, emotional, cultural and practical
support
Evaluation approach
Three sources of evidence:
 Women’s perspectives – from a focus group and
from creating a collage as to ‘how Sheway helps’
(accounting for differing strengths in expression)
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Service provider perspectives - from close
collaboration with staff, and from inviting
perspectives of those surrounding Sheway
Document/database review
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At intake . . .
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Income - 15% of women had no source of income at intake, and 73%
were on social assistance,
Housing - 27% had no fixed address or were living in a hotel or
shelter at the time of intake. For many of those with housing, there
were housing concerns due to the size of the housing, poor
location, overcrowding, and/or safety/health/structural problems.
In total, 65% of women had identified housing concerns of some
type at the time of intake
Social Support - 9% had no friends or family support in Vancouver
Food security - 79% had nutritional concerns (less than three meals
a day, lack of financial resources to buy adequate food, lack of
knowledge of food resources and nutrition, and/or no kitchen
facilities)
Prenatal care - 23% did not have a health care number and 30% had
no medical/prenatal care at intake
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Affirmation of the program philosophy
women’s perspectives

It was basically the free food for me. They (other programs) didn’t
give you enough to live on during the months that you’re pregnant,
and the milk and stuff really helped out in case you ran out and if
you had other children. They don’t give you enough to live on,
right, so you need that extra support.

When I first came to Sheway they told me that it was like a drop-in
centre and will help you through your pregnancy with milk and
stuff like that, and that was fine. And then all of a sudden they
introduced me to a social worker for the ministry and she’d kind of
help you out a little bit instead of being a worker when you’re in
her office. And it was choice, to participate in the program at
Sheway, but they also wanted you to do your part of being
responsible for yourself too while you’re there, instead of always
them supporting you all the time. So that’s why I came to Sheway.
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Affirmation of the program philosophy
service providers’ perspectives

If they didn't have that approach then a lot of women wouldn't go
there. Women feel safe when allowed to be who they are, even when
they are high, and there is no judgment
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Their philosophy fits perfectly with their client

Their philosophy is very supportive . . . They are just fantastic at
going the mile with women on practical support.

With this kind of client it is the only way you can get an effective
relationship – if you become more directive they are not going to
come back. It’s about empowering people and giving them a sense of
self.

The abstinence model takes away services from women in the DTES
and forces them to live with the shame and the blame that they're
already experiencing and doesn't offer them services to improve their
situation or where they're at. Being non-judgmental and letting them
change at the rate they're able is more empowering.
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Overarching theme
You could come here
and not be judged
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Sheway services in 9 key areas
Support to build networks
- both friendship and
ongoing service support
Healthy Babies,
networks
Pre and postnatal
Infant/Child
Medical Care and
Drop In
Development
Nursing Services
Advocacy and
Out Reach
Support on Access,
Nutritional Support
Crisis Intervention
Custody and other
and Services
Legal issues
Advocacy
Support
Advocacy and
Support/ Counselling
Connecting with other services Support on Housing
on Substance
& Parenting issues
Use/Misuse issues
Support in reducing
Support on HIV,
exposure to violence
Hepatitis C and
and building supportive
STD issues
relationships
Reducing barriers to care
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What services did women choose to
access?
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All of it!
The clothes for the kids.
The nurses to get the shots.
The alcohol and drug counsellor to work out your problems with trying to
get off drugs.
The social workers, settlement workers, you know.
The nutritionist.
Everything, yeah, all of it.
I took different stuff – I (got referred to) a parenting program, a native
awareness one – and for me that’s what really helped me, because, like, I
didn’t even know how to parent. I was too tied in to when I lost my three
children, so I had a lot of issues to deal with.
The doctor that came here every Thursday.
Lynn’s (the Infant Development Worker) sewing machine. Lynn has stuff on
loan for babies and helps you work through the development stages of the
children
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Translating program services into desired
outcomes
Example: Support/Counselling on substance use/misuse
A key aspect of this evaluation was creating criteria for success for a
program with a harm reduction philosophy. The staff and the
evaluator settled on these indicators of improvement related to
substance use:

Women can discuss the impact of alcohol and other drug
use on their lives and the development of their babies

Women reduce or stop their use of alcohol and other
drugs (including tobacco) during pregnancy

Women access the treatment and self help services they
need, to reach their goals for reducing/stopping use
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Seeing change
Prenatal/delivery care
30% of women had no
medical/prenatal care at
intake
Food security
79% had nutritional concerns
at intake
(Nutritional concerns were
defined as less than three
meals a day, lack of financial
resources to buy adequate
food, lack of knowledge of
food resources and nutrition,
and/or no kitchen facilities.)
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At the time of the birth of
their children 91% of
women were connected to
a physician or midwife to
support their deliveries
(for the other 9% it was
not known).
4% had nutritional
concerns at six months
postnatal
Seeing change
Housing
At intake,
65% had housing concerns
(Housing concerns were defined
as having no housing, or
inadequate housing due to the
size of the housing, poor
location, overcrowding and or
safety/health/structural
problems)
Mothering and custody
Initially custody was an issue
for all new mothers who used
substances
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6 months post partum
6% had housing concerns
For 56% of mothers custody
did not become an issue
26% of babies were
apprehended at birth and
16% at later points
37% were later returned to
their mothers or immediate
family members
Seeing change
Connection to
social supports
Children’s
outcomes
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At discharge close to half of the
women who accessed services at
Sheway for longer than one
month were positively connected
to services such as parenting
programs, health care providers,
and social workers
86% of infants had healthy birth
weights
Fir Square Combined Care Unit
not in place at the time, so while
specialized care was required at
delivery for 33% of infants, this
would be normal for withdrawal
management.
Seeing change
Substance misuse
Experience of
violence
Supportive partner
relationships
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24% met one of the 3
indicators of a positive
outcome in relation to
substance misuse (had
accessed treatment while
also accessing services at
Sheway, were not using
substances, and/or were
stabilized on methadone
Most important change made while at Sheway
women’s perspectives

The self-esteem I guess, like, you know, when you’re first coming off the street for the first
year, it’s kind of rough and Sheway’s there to support you and you start getting some of your
self-esteem back.

like we didn’t have the patience, we didn’t have the understanding of calming the baby, you
know, instead of getting angry, or just trying to work through, you know, them teething and
things like you just needed to learn patience for them, you know . . . So for me the most
important thing that I’ve learned around here is patience.

And them talking through things with you instead of going, “Oh, well, just, don’t worry
about it and blah blah blah” or something – like they asked me how to work through the
situation and they got you to do most of the work on it, you know, like the talking of whatever
was going on and how to work through it, rather than just giving you answers. And that helped,
right? Because of course by doing that, you keep it inside, right?
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To stop using drugs was the most important change.
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To respect yourself.
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I learned to value myself as a person other than just as an object, an object to go out and
use men to get whatever I needed – so that’s why being around all these women you know, I
realized that’s not all there is to life.
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Sheway’s influence

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Herway Home
(Victoria), Maxxine
Wright (Surrey), HER
Program (Edmonton)
Manito Ikwe Kagiikwe
(Winnipeg) have all
drawn from Sheway’s
model
In this report from the
CanFASD Research
Network they identify
the following program
strengths of Sheway as
“why these programs
work”
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Outreach
Practical
support
Harm
reduction
Integration
Mother-child
unit respected
Trauma
informed
Cultural safety
www.canfasd.ca/researchteams/prevention/preventi
on-from-a-womens-healthdeterminants-perspective/
Building on the evaluation model used
Current project entitled Towards
an Evaluation Framework for
Community Based FASD
Prevention Programs funded by
the Public Health Agency of Canada
is designed to:
 support the capacity of
community-based organizations
delivering FASD prevention
programs to undertake
evaluation
 identify promising evaluation
methods, tools, indicators of
success
www.fasdevaluation.ca
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