Jeff Karabanow

Getting off the street - Exploring the processes of young people's street exits

This article explores the ways in which young people across Canada attempt to exit street life. Through semistructured interviews with 128 young people and 50 service providers in six Canadian cities, the goal of the research was to identify the strategies and challenges of street exiting to inform service providers and policy makers as to the complexities and struggles involved in young peoples experiences with street disengagement. Findings suggest that there are several interrelated dimensions to the exiting process including contemplation, motivation to change, securing help, transitioning from the street, changing daily routine, and redefining ones sense of self.

Creating a Culture of Hope: Lessons from Street Children Agencies in Canada and Guatemala

Employing in-depth interviews with street children and service providers, and case analyses, this article explores programs and/or organizations in Toronto, Montreal, and Guatemala City that have been successful in attracting street children. Four keyelements regarding service delivery are proposed: provide direct and immediate basic services; build a sense of community that is safe and supportive; create linkages to mainstream culture; and, advocate for needed resources and/or better treatment.

Making Organizations Work: Exploring Characteristics of Anti-Oppressive Organizational Structures in Street Youth Shelters

• Summary: Human service organizations are often viewed by clients as bureaucratic, formal, oppressive and insensitive environments. Through structured interviews with 42 service providers and 65 street youth in Toronto, Montreal and Guatemala, and participant and non-participant observations in all three locations, this analysis explores tenets of antioppressive organizational structures within the youth shelter construct. • Findings: Anti-oppressive organizations allow for the emergence of meaningful and vibrant community settings by embracing grass-root social development, active participation, a structural analysis of the problem, consciousness raising and social action. These findings can be interpreted as lessons from the field – noting what seems to work best for hard-core and marginalized street youth populations. The current academic discourse concerning notions of anti-oppression has tended to focus upon pedagogy and/or practice; this analysis moves the discussion to a new realm involving organizational behavior. Anti-oppressive organizational structures attempt to build safe and respectful environments for marginalized populations. • Applications: Such findings can hopefully impact the manner by which social work administrators and practitioners understand service delivery within their particular organizational setting and more specifically, how they conduct meaningful social work within their day-to-day practices.

Access to harm reduction services in Atlantic Canada: Implications for non-urban residents who inject drugs

Awareness of drug use in rural communities and small towns has been growing, but we know relatively little about the challenges injection drug users (IDUs) living in such places face in accessing harm reduction services. Semi-structured interviews were conducted with 115 IDUs in urban and non-urban areas of Atlantic Canada. In many instances, geographic distance to a needle exchange program (NEP) meant that individuals living outside of urban areas and who were not provided services through an NEPs outreach program were at a disadvantage in terms of an array of supports offered through many NEPs. These include access to free clean injecting equipment, and such ancillary services as clothing, food, referrals, information and social support. The integration of the services and approaches provided by NEPs into mainstream health services in non-urban places is one possible model for improving such access.

Intimate relationships and women involved in the sex trade: perceptions and experiences of inclusion and exclusion

This article reports on a qualitative study exploring the intimate (non-work) relationships of women involved in the sex trade. Women working in the sex industry and intimate partners of women in the industry were interviewed in order to understand how intimate relationships are perceived as influencing the womens general health and well-being. The research suggests that intimate relationships can, and do, provide a space for feelings of inclusion and safety that are perceived as positive forces in womens general health and well-being. At the same time, however, feelings and experiences of exclusion (fuelled by the dominant stigmatizing discourse related to prostitution) can enter into intimate relationships, and are perceived as having a negative impact on the womens well-being, particularly their emotional health. Although there are attempts to keep the womens work separate from the intimate relationship, cross-over between the two spheres does occur. The research suggests that health care and service providers need to look beyond the womens working lives, and understand the relationships between work and home, as well as the ways in which intimate relationships can influence womens lives and health through both positive and negative forces.

Understanding 'Elder Abuse and Neglect': A Critique of Assumptions Underpinning Responses to the Mistreatment and Neglect of Older People

This article provides an overview of the ways in which the mistreatment and neglect of older people have come to be understood as a social problem, one which is underpinned by a variety of substantive and theoretical assumptions. It connects the process of conceptualizing elder abuse and neglect to political-economic and social evolution. The authors draw on a review of the literature, government sources, interest group websites, and their own research to provide a critical commentary illustrating how these understandings have become manifest in legislation, policies, and programs pertaining to “elder abuse and neglect” in Canada. Suggestions are provided for changes in direction for policies, programs, and research.

The power of relationships: implications for safer and unsafe practices among injection drug users.

Aims: To explore the influence of social relationships, at the interpersonal and community level, on safer and unsafe drug use practices among injection drug users (IDUs) in Nova Scotia, Canada. Method: Thirty-eight current injection drug users were recruited through two needle exchange programs. Fifteen women and 23 men participated in semi-structured interviews about their daily lives, relationships and safer/unsafe drug use and sexual practices. Findings: Most participants were well aware of the risks associated with injecting drugs and reported purposely engaging in numerous strategies to minimize those risks for themselves and others. However, several IDUs revealed that the dynamics of their relationships with other IDUs and with non-IDUs could and did lead to unsafe practices including needle sharing. Stigmatizing encounters with non-users and social exclusion from mainstream resources and structures appear to underlie and reproduce these unsafe practices. Conclusions: Within the current Canadian political context, there is a move to shift drug policies away from harm reduction toward a more enforcement-based approach. This shift will likely only exacerbate the current discourse of blame and stigma directed at injection drug users. In addition, it may serve to increase the interdependency among IDUs, and social and economic exclusion from non-IDUs.

A Clash of Cultures: Rural Values and Service Delivery to Mistreated and Neglected Older People in Eastern Canada

There is considerable evidence to suggest that older people living in situations of mistreatment and neglect are reluctant to accept help. This is attributed to the high value that older generations place on their privacy and family integrity, and on their ability to cope and remain in charge of their lives. These values are particularly strong in rural communities. The paper explores the challenges these cultural norms pose for formal and informal helpers. The discussion is illustrated by the findings of a study of service delivery in rural Eastern Canada. The study revealed that the efforts of formal and informal helpers to accommodate older peoples cultural norms, and respond to what they want, are frequently successful. However, this help is continually under threat from the centralisation and rationalisation of service delivery, as well as an increasing focus on the potential for litigation resulting from harm to clients or helpers. The implications of these findings for practice are discussed.

Brief report: Youth pathways out of homelessness - Preliminary findings

While there exists an extensive body of knowledge regarding the risks associated with youth homelessness, very little work has addressed the process of exiting street contexts. This paper reports baseline findings from an ongoing longitudinal study assessing factors associated with a successful transition out of homelessness. Fifty-one formerly homeless youth who obtained stable housing in the past 2 months to 2 years participated in this study which took place in two Canadian urban centres. Findings include poorer functioning across all domains for youth residing in housing contexts without supports, a lack of relationship between psychological and behavioural aspects of community integration, and the central role of self-concept in mental health and quality of life. These findings suggest the need for ongoing support for youth exiting street spaces and social contexts, with attention to the importance of self-concept and psychological aspects of community integration.

Key challenges in providing services to people who use drugs: The perspectives of people working in emergency departments and shelters in Atlantic Canada

Aims: Many people who use drugs (PWUD) have multiple health and social needs, and research suggests that this population is increasingly accessing emergency departments (EDs) and shelters for health care and housing. This qualitative study explored the practices of those working in EDs and shelters when providing services to PWUD, with a particular focus on key challenges in service provision. Methods: EDs and shelters were conceptualized as ‘micro environments’ with various components (i.e. social, physical and resource). One-on-one interviews were conducted with 57 individuals working in EDs and shelters in Atlantic Canada. Findings: The social, physical and resource environments within some EDs and shelters are key forces in shaping the challenges facing those providing services. For example, the social environments within these settings are focused on acute health care in the case of EDs, and housing in the case of shelters. These mandates do not encompass the complex needs of many PWUD. Resource issues within the wider community (e.g. limited drug treatment spaces) further contribute to the challenges. Conclusions: Structural issues, internal and external to EDs and shelters need to be addressed to reduce the challenges facing many who work in these settings when providing services to PWUD.