RECOMMENDATION

A. THAT Council approve in principle the continuation of the Carnegie Outreach program for another year at a cost of $300,000, subject to overall 2004 budget priorities.

B. THAT, subject to the program proceeding, staff report back on the progress of the program and the success in securing outside funds in July 2004, in order to allow Council the opportunity to extend the program or have it conclude in December 2004.

CITY MANAGER'S COMMENTS

The City Manager RECOMMENDS approval of the foregoing and notes that while the Carnegie Outreach Program is part of the City's contribution to the DTES, there are also several other significant demands on the 2004 Operating Budget. The City Manager suggests that this program be added to the Community Services Group Contingency Reserve proposals for Council's deliberation as part of the budget process.

GENERAL MANAGER'S COMMENTS

The General Manager of the Community Services Group (CSG) RECOMMENDS the approval of Recommendations A and B as one component of the City's contribution to the Vancouver Agreement Health and Safety Initiative and concurs with the approach recommended by the City Manager. Funding will be found in the CSG Operating Budget to cover staff positions until a Council decision is made.

COUNCIL POLICY

On August 2, 2001, Council approved a two-year trial of the Carnegie - Health Connections Outreach program as part of the City's contribution to the Vancouver Agreement Health and Safety Initiative, starting November 1, 2001.

SUMMARY

This report seeks Council approval for renewed funding for the Carnegie Outreach program as a key component of the Vancouver Agreement Health and Safety Initiative.

The amount of $300,000.00 is requested for 2004, with the stipulation that other funding partners be found during the year to reduce the City's share of the costs in future. A report back on the progress of the program and success in securing outside funds will be presented to Council next summer in order to allow Council the opportunity to extend the program or have it conclude in December 2004.

PURPOSE

The Outreach program's purpose is to provide a measure of safety and assistance to at-risk street people. These are highly marginalized people. Most are addicted to drugs and alcohol. Many are mentally ill. Some are mentally ill and have addictions. They have been isolated or are banned from many community services. All live in poverty.

The partners in the Health and Safety initiative have spent the past two years in planning and introducing the new services of the Health and Safety Initiative such as the Health Contact Centre, the Life Skills Centre and the Supervised Injection Site. As these become fully operational, the work of the Carnegie Outreach is to help people most at-risk have access to these and other services, to provide a "safety" watch for street people, and to advise and where appropriate, initiate new projects to suit the needs of this population.

The current impacts of constrained resources and changes to policies and procedures in social services, mental health, and health are only expected to increase in the next few years, with serious implications for the at-risk street population. Outreach is a front-line component of the Vancouver Agreement service partnerships.

BACKGROUND

The Carnegie Outreach program was first initiated in 1999 as part of a program of Strategic Actions to address issues with the illegal drug trade at Main and Hastings. In November 2001, Council approved two-year funding in the amount of $335,845.00 annually, as part of the City's "Four Pillars Strategy" for addressing addictions.

The Street Outreach program has generally had four responsibilities:

While operating on the corner of Main and Hastings, the program engaged users through triage (first aid, emergency food and shelter, detox and treatment, helping find relatives), and in literacy and recreational activities, and personal care programs (foot baths, haircuts). All these were a means to developing personal relationships which enabled the program to encourage more responsible individual behaviours towards lessening the violence and disorder in the drug market as it then existed.

In 2001, the Carnegie Outreach program partnered with the Vancouver Coastal Health Authority in the new Health Contact Centre (HCC). The Contact Centre provides nursing staff, health care workers, and activity workers for the 16-hour a day, seven days a week operation. This service has proven to be a valuable resource for users and provides an additional range of services to which outreach staff, police and others can refer users, particularly at late hours. Outreach provided programs in the Health Contact Centre and operated a limited "outreach" service in the neighbourhood.

After one year, Carnegie and Vancouver Coastal Health (VCH) revised their relationship. Outreach shifted from sharing operational responsibilities for the Health Contact Centre with VCH to that of providing low-key program services in the HCC, and to other agencies including the Life Skills Centre, Lookout Shelter, the Living Room, WISH, First United Church, DAMS, DES Women's Centre, and the Union Gospel Mission Women's Drop-In. Most significantly, this change enabled Outreach to expand its external work in the alleys and streets of the Downtown Eastside. Outreach's expansion in its street work coincided with the introduction last November of the 24-hour police presence on the corner of Main and Hastings which dispersed the concentration of users and dealers.

Working in teams of two from mid-morning to 11:00 pm at night, Outreach staff are in continuous contact with the street population, performing triage and accompaniment work to shelters, hospitals and other available resources. They are eyes and ears on the street, keeping a look out for the safety and whereabouts of street entrenched people. They facilitate utilization of community resources by people least likely to use them. And when a new service develops like VCH's safe injection site (Insite), Outreach can assist in getting the word out to the street and in helping people get to the site.

For two years the Outreach program has also done pioneering work in low threshold employment training (LTE). Objectives of this training are based on the life styles and actual circumstances of street people. Through the Historic Markers project (funded by Western Economic Diversification), Outreach has involved approximately 200 street people in a program of literacy, health care, life skills, and the construction of 31 mosaic historic markers in the sidewalks of the Downtown Eastside. The Historic Markers project has demonstrated the value of LTE as a "ladder" of increasing opportunities and responsibilities for people to leave the street scene. The Historic Markers project has now concluded as a program demonstration. Plans are underway for it to be developed as a permanent training and employment organization under other auspices.

Throughout all these activities, the purpose of the Outreach work has remained the same: to offer services and programs which provide respite from the drug scene which in turn provides opportunities for addicts to move into more stable activities such as healthier addictions management, proper shelter, detoxification, counselling, treatment, life-skills and pre-employment training.

DISCUSSION

An outline of services provided through the Outreach program and evaluation highlights of the program's role in the street drug scene include:

Program Service

The Carnegie Outreach program recorded 2444 contacts, involving 925 separate individuals from March-September 2003. 47% of all contacts range between the ages of 30-44, and 82% reported residing in the Downtown Eastside (program statistics - Appendix 1). On individual contacts recorded, the Outreach team details 53% are female and 70% are repeat contacts and are familiar to the Outreach workers.

The Carnegie Outreach program workers are accepted by the "street" because they have no statutory or controlling authority over people's lives. This is in keeping with the literature which describes effective outreach agencies as being characterized by users as non-judgemental and sensitive to street culture (see literature sources at the conclusion). These agencies usually involve street people in the development of their programs. Many recruit staff that previously lived on the street. Carnegie Outreach does both.

There are over 50 agencies serving the Downtown Eastside with outreach as part of their mandate. Four involve direct street level contact: BC Centre for Disease Control (BCCDC) Street Nurses, Vancouver Area Network of Drug Users (VANDU) alley patrol, DEYAS Health Van, and the Carnegie Outreach Program. Each makes an important contribution according to their mandate which, with the exception of Carnegie Outreach, is associated with a specific service interest, or in the case of VANDU, service and advocacy interest.

Evaluation Method

Carnegie contracted with the Strathcona Research Group to carry out this work. The primary methods of data collection included:

The key respondents interviewed were from the Vancouver and Area Network of Drug Users (VANDU) City of Vancouver (Drug Policy Coordination, DTES Revitalization Program, and Engineering Services), Vancouver Coastal Health Authority, Health Contact Centre, Lifeskills Centre, Supervised Injection Site, and the Vancouver Police Department. In addition, interviews were held with project staff and Carnegie management. Key respondents were selected to represent diverse views in the community and in Carnegie about Outreach.

Participants that were surveyed were randomly selected by the interviewer at three sites: Oppenheimer Park, along the Street Outreach route, and at outreach programs at other agencies. Selection of participants presented some research challenges because the researcher could not interview a participant who was shooting up or who was not lucid. Data was collected at three different site visits over three days: the women's drop-in program at the Union Gospel Mission, the music program at the Health Contact Centre, and Oppenheimer Park.

Evaluation Findings

The results confirm that the Outreach program is reaching the intended target group of highly marginalized people in alleys and on the streets; that it is consistent with the Carnegie mandate; that it does not unnecessarily duplicate other services; and, that it is consistent with outreach programs in major cities across North America.

The question of duplication is especially important. There is a degree of overlap with the other three street level outreach agencies with respect to needle pick-ups and first aid work. However, none are present in the community for the same length of time, and the volume of need is significant. There are periods when Outreach is the only group providing these services. In sum, there is no other outreach program with the generic mandate of Carnegie Outreach in the Downtown Eastside.

The Carnegie Outreach program is well supported by respondents and participants and is seen as more flexible than other programs. Key respondents and participants rate the program highly with the average score assigned ranging from 3.3 to 3.7 on a 4 point scale where 1 is poor and 4 is excellent. 79% of key respondents and 94% of participants think the program should continue. 71% of key respondents and 93% of participants agree or strongly agree that staff are effective and respectful. 83% of key respondents agree or strongly agree that the program is appropriate to the people served while 53% of participants agree or strongly agree. A higher number of participants argued that the program needed to run all night.

Gaps in services to the street entrenched population which were identified in the research are consistent with other surveys and issues raised consistently in community meetings and other reports. Specifically, the gaps identified most frequently were:

Addressing these gaps through direct services is clearly not the role of a Carnegie Outreach program. However, Outreach can play an important part in collecting reliable data regarding conditions affecting street involved people. This information can support the development or expansion of low threshold harm reduction services such as needle exchanges, detox, counselling, methadone, peer support, and employment training. This is consistent with one of the goals of the Vancouver Agreement - to develop a continuum of care for people in addictions.

Performance Management Plan - Future Directions

With the assistance of the Strathcona Research Group a three-year work plan has been prepared, and is being organized into a performance management framework with an accompanying evaluation framework.

Given the experience of these two introductory years the plan:

Special programs such as literacy, helping make family contacts, social and cultural activities, and nutrition, will continue in collaboration with other components of Carnegie and community agencies.

It should be noted that the ability of the program to contribute to the overall amelioration of addictions for marginalized people will be influenced by other external factors such as more restrictive conditions for disability and welfare eligibility. Should these continue, then the Outreach program will have an especially critical role in immediate triage work and individual advocacy.

DRUG POLICY COORDINATOR'S COMMENTS

The Carnegie Outreach program has provided a critical function in the Downtown Eastside community since its inception in 1999 as a response to the open drug scene on the corner of Main and Hastings. Currently the Outreach program is one of a handful of programs that provide consistent outreach efforts seven days per week to a highly marginalized and difficult to reach population. This next year, 2004,  is an important transition year for the Downtown Eastside as there are several variables in the environment that will have an impact on the population reached by the Carnegie Outreach program including, the importance of outreach in the first year of the operation of the Supervised Injection Site, the uncertainty as to the impact at the street level of changes to welfare eligibility, increased numbers of crack cocaine users who will not be adequately served by the supervised injection site, and the continuing presence of significant numbers of mentally ill individuals on the street. Operation of the Carnegie Outreach program through 2004 will be important in addressing these issues. The implementation of the Vancouver Agreement strategic plan will provide opportunities to explore partnerships for future funding of this program.

FINANCIAL IMPLICATIONS

Funding in the amount of $300,000 is needed in 2004, compared with $335,845 in the current budget, which was based on providing a 24-hour staffing service at the Health Contact Centre (this expansion to 24 hours did not occur, resulting in a budget surplus). The reduction permits a modest cost saving while reorganizing some core elements of the program and adding others. This funding enables seven days week coverage for one shift during the most important times in a 24 hour period. It provides sufficient supervision time to enable the program to continue its development work in peer-based, low-threshold employment projects, including the honoraria to go with these projects. Finally, it covers the rental cost for the Outreach office and some administrative and program supplies.

Outreach is to report back to Council in July 2004 on progress in finding other funding partners in the future.

See Appendix A for budget breakdown.

CONCLUSION

The introduction of the key components of the Vancouver Agreement Health and Safety Initiative is now underway: expanded, re-organized and relocated community health services on Pender and Powell Streets, the opening of the Health Contact and Life Skills Centres, the inauguration of the Supervised Injection Site and a local enforcement plan for the Downtown Eastside. At the same time, the conditions affecting marginalized street people are deteriorating and the numbers are growing due to economic conditions and changes in public policies and regulations. The experience of the Carnegie Outreach program's first two years as part of the Health and Safety Initiative confirms that this form of front-line service assists with the utilization of the other service components, contributes to the health and safety of addicts and is uniquely experienced to assist in the development of low threshold employment programs for this population. Finally, the program is a source of primary information about social conditions on the street, and about the characteristics of the population which can aid planning and policy-making.

SOURCES

Health Canada - Review: Peer Helper Initiatives; For Out-of-the-Main Stream Youth in Canada
Carnegie Outreach Program Evaluation: Kathy Coyne, Strathcona Research Group
Carnegie Outreach Program Statistics: March 2003 - September 2003

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APPENDIX A
PAGE 1 OF 1

CARNEGIE OUTREACH PROGRAM BUDGET

SALARIES

Programmer (50%) $ 22,000

Activity Coordinator $ 37,350

Fringe @20% $ 11,850

Auxiliary Wages $ 133,400

Auxiliary Fringe $ 34,400

Total Wages $239,000

OPERATING

Rent $ 8,000

Program Supplies $ 4,500

Office Supplies $ 3,000

First Aid Supplies $ 2,000

Photocopy $ 500

Telephone $ 4,000

Training $ 1,000

Honoraria $2,000

Special Events $2,000

Program Evaluation $2,500

Operating Total $ 29,500

Agency Peer Training and Support $ 25,000

Publication - "Help in the Downtown Eastside" $ 6,500

TOTAL: ALL COSTS $300,000

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