+ Youth Wellness Project (YWP) Vancouver, Canada

+ Program Introduction and Description Angela Sanchez-Pope 2

+ Vancouver Street Youth Wellness Program Angela Sanchez-Pope

+ Presentation Overview Mission/ Stakeholders / Descriptive Developmen t of Participative Health Promotion Program Methodology /Program Evaluation/ Collaborator s Focus Group results/ YWP/VYVC/ UBC Health Science Students Key Findings with Health Promotion Program/Stre et Involved Youth Conclusions/ Implications/ Limitations Angela Joseph Abby AnthonyCarlottaOliva 4 Angela Sanchez-Pope

+ MISSION : To improve the wellbeing of inner city street youth. Research: Evaluation of Program Education: Health Program Advocacy: Expose Health Science Students to Street-involved youth Health Promotion Program for Inner-City Street Youth 5 Angela Sanchez-Pope

+ Community Street- Involved Youth Program Professionals Youth Shelters Vancouver Youth Visions Coal. (VYVC) UBC Health Science Students Stakeholders and Participants 6 Angela Sanchez-Pope

+ Street Involved Homelessness School Parental Substance Abuse Unstable Housing Sexual / Physical Abuse Mental Health Problems Risk Factors 7 Angela Sanchez-Pope

+ Street involved Homophobia Parental Spousal Abuse Emotional Abuse Foster Care Home Violence Family Substance Use Risk Factors (Concluded) 8 Angela Sanchez-Pope

+ Candidates for the Street (Panhandling/Binning but Still live at home) Children on the Street (Inadequate Support from Families –Seek basic needs) Children of the Street (function without family support – seek basic needs) Street-Involved Youth Categories 9 Angela Sanchez-Pope

+ Demographics 10 Angela Sanchez-Pope

+ Services Needed By Youth 11 Angela Sanchez-Pope

+ Skills Required Service Access Consequences of Street Problem Solving Communication/Advocacy Mentorship/Empowerment Transitioning off the Streets 12

+ Program Development and Promotion Joseph Harris 13

+ The Youth Wellness Project was initiated with the primary goal of providing effective and culturally sensitive health promotion for street-involved youth in Vancouver. Once these youth leave the home, they lack basic necessities: Shelter Proper Clothing Nutrition Access to Health Care Safety Social Aptitude Basic Survival THE PROJECT EVOLVED… Rationale 14 Joseph Harris

+ Collaborators Because of the awareness and necessity, organizations committed themselves to the Youth Wellness Project in an attempt to blanket all the needs of Street-Involved Youth. 15 Joseph Harris

+ Division of Inner City Medicine, Faculty of Medicine Improve the health status Community Health Initiative by University Students Focused on bridging the gap (5 principles): service, learning, inter-professionalism, reflection, and student leadership Vancouver Youth Visions Coalition Prevention of homeless and sexually exploited youth Crystal Clear Support for youth addicted to drugs – specifically meth Covenant House 24-hour youth shelter Directions Youth Services Center Helps youth reclaim their lives Health Promotion Center for Population and Public Health 16 Joseph Harris

+ Areas of Coverage Easier access to health care; Mentoring and friendship; Street education (avoidance); Addiction support; 24-hour shelter; Goal setting First-Aid education Not only did these opportunities become available, but it because easier for the youth to access these programs through collaborative effort. 17 Joseph Harris

+ Youth Wellness Project Assumptions Health literacy is a barrier to health and quality of life among street-involved youth Many different interest groups (e.g., Health- Science Students; Volunteers, and Community Members) would be willing and able to participate in a health-literacy education program Financial support from different organizations would be willing and available to fund a health- literacy program. 18 Joseph Harris

+ Proposal and Promotion 19 Strategies Create a health-literacy program for street-involved youth Influential Factors Documented need for street-involved youth Strong support academically and organizationally Problem/Issue Poor health and quality of life among Vancouver street- involved youth Community Needs/Assets Approximately 500 street-involved youth residing in Vancouver. Joseph Harris

+ Desired Results Provide 150 hours of health literacy education to 120 street-involved youth Engage street-involved youth in project planning and implementation Empower and improve health literacy among street- involved youth Provide health-science students with experience working with marginalized youth Increase health and quality of life among street-involved youth 20 Joseph Harris

+ Logic Model Inputs Personnel (e.g., staff, mentors, etc.) Supplies (e.g., space) Activities Regular Meetings Workshops Outputs 150 hours of instruction Involve 40 youth in programming Outcomes Change health-related behavior Increase awareness 21 Joseph Harris

+ Impact Improve the health and quality of life of street-involved youth 22 Joseph Harris

+ Contributors to the Program Paulo Friere – Participatory Education Theory The full participation and empowerment of the people affected by a problem is essential in order to enact change Albert Bandura – Social Learning Theory People learn through direct experience as well as through the observation of role models. 23 Joseph Harris

+ Program Methodology and Evaluation Abby Maestas 24

+ An Evaluation Grounded in Theory The process of creating and managing a collaborative research project that includes parties such as: academics, physicians, community based organizations, and other street- involved youth partners. Collaborative research with communities increases the collective research capacity of the group and contributes to the overall functioning of the evaluation process. Abby Maestas

+ A Front Line Perspective on Participatory Evaluatin September of 2007, Partnership in Community Health Research (PCHR) learners identified an opportunity to conduct an evaluation of the YWP in partnership with the YWP’s street-involved youth partners. YWP’s reputation as a youth operated organization allowed us to take advantage of facilitating factors. Abby Maestas

+ Focus Groups Participants Two major collaborators in development and facilitation of the YWP, VYVC and CHIUS, both participated as subjects in focus groups. Street-involved youth who participated in the YWP workshop series at Covenant House, the Directions Youth Services Centre were also invited to participate in focus groups. Abby Maestas

+ Procedures and Ethics Focus group participants were eligible to participate in the evaluation process only if they had self-selected into the program as a youth participant, VYVC member or as a UBC health science student. Participants were assured anonymity, informed that they were free to withdraw from the interview at any time and were asked to sign a consent form. Abby Maestas

+ Analysis Focus groups were audio recorded and transcribed after which a discourse analysis was performed. Reviewing the transcripts allowed for identification of common themes within single focus groups and across focus groups with each of the three populations; that is health science students, VYVC members and youth participants. Abby Maestas

+ Results Carlotta Archuleta 30

+ Results of Participants Three Groups 1. The Youth 2. The VYVC Youth Instructors 3. The Health Science Student Instructors 31 Carlotta Archuleta

Recruitment of Evaluative Focus Groups Coded Categories and Themes February Group March Group April Group May Group 1. 7 Participants each month 2. Total of % Male and 59% Female 4. Average Age Carlotta Archuleta

+ Program and Individual Level All Groups Divided into Coded Categories and Themes Survey is composed of two sections 1. Health Experiences 2. Feedback Categories Identified 1. General Feedback 2. Workshop Specific Feedback 33 Carlotta Archuleta

+ 1. Impact 2. Internal/External Factors Health Experience Living On The Streets Impact: Five Themes Emerged 1. Networking and Social Skills 2. Health Literacy Skills 3. Feelings of Helplessness 4. Rejection of Mainstream Culture 34 Carlotta Archuleta

+ Internal/External Factors: Three Themes Emerged 1. Access to Shelters and Drop in Centers 2. Access to Health Care 3. Access to Nutrition 35 Carlotta Archuleta

+ Feedback on the Youth Wellness Project: General Feedback: Six Themes Emerged 1. Reasons for participating 2. Impact of VYVC presence 3. Impact of student presence 4. Impact for participants 5. Facilitation style 6. Curriculum Carlotta Archuleta

+ Workshop Specific Feedback Topics are as follows: 1. Mental Health 2. Substance Use 3. Reproduction Health 4. Nutrition 5. First Aid (Fitness workshop was not available at time of evaluation) 37 Carlotta Archuleta

+ Results Cont. Anthony Barajas 38

+ Chapter Five: Results Youth Group Demographics Four Youth Recruited Two Female Two Male Avg. 24 years of age Student Group Demographics Three Students Recruited One Male Two Female Avg. 25 years of age Recruitment of VYVC Youth Recruitment of Health Science Students 39 Anthony Barajas

+ Focus Groups Reason being involved VYVC Presence Facilitation Style Curriculum Impact for Participates Program Structure Challenges Reason being involved VYVC Presence Program Facilitation Implications for Future Practice Challenges VYVC Youth Identified 7 Themes CHIUS Students Identified Five Themes 40 Anthony Barajas

+ Motivators of Focus Groups Supporting VYVC Supporting Street-Involved youth Youth reported that they needed to be more productive and main reason is to support youth. This is street-youths opportunity to make a difference in their Life. Insufficient Exposure to marginalized populations Opportunity to provided services and learn about marginalized populations Prospect of improving health of street- youth Reasons YVVC Youth being Involved Reasons CHUIS Students being Involved 41 Anthony Barajas

+ Presence Factors for Focus Groups Positive effect on youth lives Gained Valuable knowledge through facilitation Addressed Self-Stigmatization among YVCV youth VYVC play a vital role in facilitating workshops VYVC ability to communicate with street-involved youth VYVC act as ‘bridge’ or liaison for CHUIS students with street- involved youth VYVC help build relationships VYVC Impact on Development of YWP Perceived Impact of VYVC on YWP by CHUIS Students 42 Anthony Barajas

+ Youth react negatively to top down approach Due to having little control over life choices Positive reactions when co- learning is employed Youth tend to learn from each other Increased learning when interactive discussion takes place Lecture style found in inappropriate for street- involved youth Students out of comfort zone Students changed style to suit street-involved youth Discussion based style more effective Information sharing very effective as a learning tool Facilitation Styles for VYVC Program Facilitation for CHUIS Students 43 Program Facilitation Styles for Focus Groups Anthony Barajas

+ Impact for Participants Important step to begin improving health Learning to effectively utilize knowledge to benefit health Important step to build trust between adults and street-youth Promotes respect between street-youth and health science students 44 VYVC Youth Instructors Anthony Barajas

+ Program Structure feedback by Youth Instructors Diversity of Youth Involvement Synergistic Relationship Developed between YVYC and CHIUS Ensure Long Term Sustainability of YWP VYVC need to develop trust in others long term 45 VYVC Youth Instructors Cont. Anthony Barajas

+ Implications for Continued Participation by CHUIS Students Provides valuable knowledge to provide medical care to street- involved youth Opportunity to acquaint students with street-involved youth Acquaints students with needs of street-involved youth Prevents assumptions and stereotyping of street-involved youth and their needs Better informed decisions in terms of health care of this population Students realized difficulties working with a marginalized population 46 Anthony Barajas

+ Challenges going forward for Focus Groups Open Lines of Communication between VYVC and Health Students More Opportunities to know each other VYVC youth feel unappreciated by Health Science Students Acknowledgement of VYVC youth life skills and experiences Lack of stability of VYVC youth frustrating Lack of commitment outside meetings by VYVC youth Students unable to convey more information during workshops Challenges for VYVC Instructors Challenges for CHUIS Students 47 Anthony Barajas

+ CHUIS Students Final Report Trust issues- youth simply do not trust Health Care system Judgment- youth feel that they are judged by the way they live and not understood well Students learned important not to be judgmental in terms of life style of street youth Heavy drug and alcohol users Lack basic hygiene Negative attitudes Students surprised- Youth respectful and polite Level of education Engaged in discussions Types of question asked Street Youth Perceptions of Health Care System Perceptions of Street Youth 48 Anthony Barajas

+ CHUIS Students Final Report cont. Diverse population Different stages of recovery Some youth open and outgoing, some shy Lack of stability in terms of living condition Lack of concept of time Thinking outside the ‘box’ in delivery of health care to street-youth Working with street-youth is a niche Feared burn out working with marginalized populations Despite reservations expressed willingness to continue working with street- youth Working with Street YouthImplication for the Future 49 Anthony Barajas

+ Program Conclusion/Limitations Oliva Lopez 50

+ Chapter Six: Discussion 51 Oliva Lopez

+ Multilayered problem requiring multiple support services Services: shelter, clothing, food, medical Availability of harm reduction oriented programs and health promotion programs Motivators: help youth, improve health and quality of life to make a difference 52 Reasons for Participating Oliva Lopez

+ Teach youth to identify signs and symptoms of illness and drug addiction Promote sharing of knowledge, discuss health issues, find solutions Dialogues, interactive methodology Peer trust effects 53 Program Facilitation Oliva Lopez

+ Collaborators on the YWP: contributions from youth, more support for youth and community based org., increased credibility and legitimacy YWP on Collaborators: lower youth fear, gain skills in public speaking, source of income, build reputation and connections, service learning 54 Impacts Oliva Lopez

+ Intra-personal, interpersonal, organizational and structural Different life structures Monetary compensation Disagreement on target 55 Challenges Oliva Lopez

+ Participatory Evaluation with Street Youth Apply knowledge to benefit both sides Learning opportunity Collaborative health promotion model to break barriers to health among youth Academics and PE partners Community Youth in PE 56 Oliva Lopez

+ Research Time in P.E. Collaborates with community members Takes into consideration individual capacity; interest and life stability Determines how to use interest, abilities Develops focus group to address priorities of academics and community members Academics: role of initiator, consultant Community and academic level of participation 57 Oliva Lopez

+ Participatory Evaluation Indicators of success Community members and academics interests PCHR learners concerns Ensure success= relationship at the onset of PE 58 Oliva Lopez

+ Differences Distances evaluator and participants Ensures accountability of program Methods adapted to local culture Intends to empower local people to: initiate control, take action 59 Conventional Research Participatory Evaluation Oliva Lopez

+ Street-involved youth input PCHR gains Sense of ownership Journals Main approach Fundamental characteristic 60 Other Observations Oliva Lopez

+ LIMITATIONS AND CONCLUSIONS Chapter Seven Oliva Lopez

+ Informal structure of peer education presents a challenge in identifying program strength and outputs making sustainability difficult Results are not good enough to measure impact of participation on health/quality of life No longitudinal data to aid in determining if participation will influence future practice Self bias: program facilitated by youth leaders participating in focus groups to evaluate program 62 Limitations Oliva Lopez

+ Conclusions Collaboration: university and community based = effectiveness Engaging A building tool Interactive approach Participatory evaluation steps w/ street youth Future research is needed 63 Oliva Lopez

+ Youth Wellness Project (YWP) Vancouver, Canada