1. Developing a Peer-led and Peer- driven Substance Use Support Program for LGBTTQQ2SIA Youth ages 16 to 29 years old in Toronto.

2. Overview of Presentation Project Background Needs assessment Initial proposed program Phase 2: –Interviews with peer agencies –Peer working group –Pilot groups Moving forward

3. Background, Focus & Staffing How the project came into being Personal experience from Geoff and Tim Breakaway Addiction Services sponsoring organization Project focus: to conduct the steps necessary to build the framework for a proposed program for transitional aged LGBTTQQ2SIA substance abusing youth

4. Needs Assessment

5. Service Provider Interviews 60 agencies contacted – 28 interviewed Main point: “We think it is, but clients may have a different opinion”

6. Population Survey Wanted to find out: –Self-perception of alcohol and other drug use –Previous experiences of service access –Barriers to service access –Service Preferences –Demographics Promotion: online and in person Time frame Screening questions 640 valid entries

7. Demographics 44% (n=180) of respondents espoused some form of trans identity 48% (n=226) of respondents identified as exclusively white 91.2% (n=279) of respondents identified as having a formal/self-diagnosed disability, mental health and/ or medical condition

8. Self-Perception of Alcohol & Drug Use 44.3% of respondents wish/are trying to either reduce or eliminate their drug use 36.8% of respondents wish/are trying to either reduce or eliminate their alcohol use

9. Experience and Barriers of Services 43.9% had previously accessed services Of these, 65.1% said that provider and/or client orientation towards their LGBTTQQ2SIA identity negatively impacted their service use experiences

10. Service Preferences The overwhelming majority of participants indicated a preference for queer and trans specific services Nearly 75% of respondents identified mental health support and more than 45% identified trauma support as services that they need in order to support their drug and alcohol goals

11. Alcohol and Other Drug Use Prevalence

12. Proposed Program Based on the findings from all the work conducted Framework and Model Focus on all recovery goals, embracing harm reduction and abstinence equally Based on the principles of respect, empathy and empowerment Safe separate space for participants to create a positive community for themselves in which they can recover and thrive Staffed by peer workers, who are both members of the LGBTTQQ2SIA population and in recovery

13. Proposed Program, cont’d Elements/Content Services: both individual and group-based Hours of service: prioritize afternoon and evenings Each participant will have a peer staff to work with them, providing both case management and counselling Group work: module based Primary focus: the topic, with all programming grounded in reducing and/or eliminating substance use

14. Groups, Cont’d. Two groups to be offered each week, one for those practising harm reduction and one for those practicing abstinence Drop-in group will be offered, which will include food Support and education group will be established for family members (representing participants’ chosen family members, whoever these may be), with links to more intensive family counselling services for those who require this Training for other organizations

15. Phase 2 Second funding opportunity from TC LHIN Phase 2 plan Service provider meetings Peer working group Pilot groups and exit interviews

16. Phase 2: September 2015 to March 2016 Initial program development –Meet with service providers –Peer working group –Pilot groups

17. Interview with Peer Service Providers Information and Perspectives we Wanted to Learn About: The role(s) peers fulfill within the structure of your program How to support peers when challenging events arise or when conflict occurs How to manage personal and professional boundaries with participants and other peers Types of qualifications expected of peers How to support the professional development of peers Challenges consistently faced while delivering services Key lessons learned

18. Interview with Peer Service Providers Recommendations, Lessons Learned and Considerations: Peer Workers must have lived experience The title “Peer” can affect pay structure Boundaries Defining limitations in the sharing of lived experience Roles and expectations Provide debriefing/mentoring and combat stigma against peers Be educational not punitive about boundaries Absenteeism ( have a pool of relief workers) Community advisory committees and the development of policies with peers

20. Peer Working Group Developed peer working group Topics about previous experiences, program space, harm reduction and abstinence, differences between lived experience and peer roles, program content

21. Peer Working Group Observations and Themes: Spaces are inaccessible. Marginalized people don’t have access to funds. Expected to utilize tools that are harmful and inaccessible Lack of evidence based treatment; (“one size fits all” mentality) Queer sexual/gender identities are medically pathologized (in terms of mental health) Substance use is the tip of the iceberg. Queer addiction is intersectional; and systemic. It is not always a negative.

23. Pilot Groups Recruitment –Engaged with 32 people in 1 month –Registration included evaluations using Contemplation Ladder and Self-Efficacy Scale –10 people for HR group, 5 people for Abstinence group Groups –Process group with cumulative content –Motivational interviewing Case management

24. Early Insights from September 2015 to March 2016 Preliminary insights and observations: –Harm-reduction groups –Abstinence groups

25. Feedback from Exit Interviews Abstinence Stream Themes and Observations: Hopes: to connect w other Q/T people, alternative to 12 step, non-heteronormative space, explore intersections Impacts: sharing experiences, structure, accountability, rebuilding relationships Changes: population specific groups ie. BIPOC, Drop in/Walk in, more detailed group content- focus on Q/T experience more

26. Feedback from Exit Interviews Harm Reduction Stream Themes and Observations: Hopes: community, goal setting, learning techniques & skills, access to other resources Impacts: felt supported, mindfulness of substance use patterns, goal settings, skills, accountability, problem solving Changes: build cohesion, more specific, volunteers from group, prioritize antioppression, don’t compartmentalize experiences

27. Refined P2P program model “Walk-in” space and individual client support as primary focus Groups as secondary focus for support

28. Moving Forward… Report to TC LHIN in April 2016 Developing policy and procedures Develop new terminology

29. P2P In the Media

30. Stay Connected Website: –www.piecestopathways.comwww.piecestopathways.com Social Media: - Facebook: Pieces to Pathways - Twitter: @p2p_toronto - Tumblr: Pieces to PathwaysPieces to Pathways@p2p_torontoPieces to Pathways