About this organization

Mission

Street Health works to improve the health and well being of homeless and underhoused individuals in southeast Toronto by addressing the social determinants of health through programs, services, education and advocacy.

History of Organization

In 1986 a group of homeless people in Toronto met to discuss the health care issues they were facing. They felt discriminated against within the health care system, and given their circumstances were often unable to follow prescribed treatments. The group identified nurses as the people they would feel most comfortable going to for health care.

Upon learning of the initial discussions, a group of volunteer nurses opened the first Street Health nursing station in September 1986 at the Toronto Friendship Centre drop-in, in the All Saints Church at Sherbourne and Dundas. Other nursing clinics followed, located where homeless people congregated, in order to provide hands-on health care and assistance in accessing and navigating the existing health care system.

Accolades and Accomplishments

For over 25 years, Street Health has been providing physical and mental health programs to homeless and under housed individuals in the southeast core of Toronto. Our work focuses on the neighbourhood around Dundas and Sherbourne streets, which has the largest concentration of homeless shelters and drop-in centres in Canada.

We provide our services on the street, in alleys, along the lake shore, in parks and ravines, in homeless shelters, and drop-in centres. The people we work with have lives characterized by extreme poverty, chronic unemployment and/or seniors on a fixed income, insecurity in housing, poor nutrition, high stress, and loneliness. They also have more frequent and serious illnesses, and on average die younger than the general population.

Street Health works closely with others within and outside the social service sector who want to learn about health and homelessness from our experienced staff. Presentations and training sessions are regularly given to the general public, and workers in the health, social service, and government sectors.

Our belief is that the services we provide, should ideally not be required, finds expression in our advocacy work, both as advocates for individual clients and for enduring social and political solutions.

Programs

>The Safer Stroll Project
>Drug Information Project (DIP)

Nursing Program:

Staff nurses work with volunteer RNs and NPs to operate scheduled clinics in drop-in centres and shelters.  Nursing outreach is designed to locate people living on the street who generally avoid mainstream services.  The nurses advocate for clients on an individual basis.  Mentoring students and other health care related disciplines, and conducting public education, are important components of our program. 

Community Mental Health Program:

Provides support for people who are homeless or under-housed and experiencing mental health issues.  The Workers assist people in trying to access basic needs.  Other support includes crisis intervention, outreach, informal counselling, and legal support as well as facilitating access to other community resources.  The program also focuses on advocating for individual clients and addressing systemic issues of poverty, homelessness, and human rights.  

The Safer Stroll Project:

Safer Stroll peer outreach and educational program is aimed at breaking down barriers sex-working women face when accessing health and social services.  The program provides educational workshops on topics such as self defence and healthy lifestyle choices.  The project furthers the development of stronger peer led networks for sex workers. 

Harm Reduction Program:

The street outreach team provides clients with referrals and peer support related to the harms associated with substance use.  The program includes needle distribution, safer crack kit distribution, street outreach service, and support for sex workers.  We have regular participation of 15 peer workers in our street outreach and kit distribution and education programs. 

I.D. Replacement - Access to Health Cards for the Homeless:

Street Health’s Access to Health Cards program was established to assist homeless people with the onerous task of applying for health cards and the other personal identification they need to access health and socials services. 

ID Safe:

Homeless people can easily lose their identification due to unstable living conditions.  The program offers security for homeless people by storing their important documents, helping them to maintain access to services which require proof of identification.  People can also have mail delivered and stored at ID Safe.

Research:

Street Health has focused our research efforts on evaluating the effectiveness of existing programs and services. 

The Safer Stroll Project

The extreme stigma and marginalization that sex workers often experience reduces social status creating isolation, denial of rights and services, ostracism and violence.  According to the Toronto Police Sex Crimes Unit there are 4-5 assaults on sex workers in Toronto every night (Toronto Police, Sex Crimes Unit, 2004).  The Safer Stroll project is based on a community capacity building approach that addresses violence perpetrated against women who work in the context of “street level” sex work.  The project provides mentorship training and educational components that increase sex workers' and non-profit organizations' capacity to effectively address violence that targets sex workers. 

Sex workers participate in training that leads to mentorship activities such as street outreach and facilitating peer education sessions. The training graduates initiate between 600 – 700 contacts with sex workers during each year of this project. Between 70-80 staff members of social service agencies receive training enhancing the capacity of social service agencies to effectively respond to violence directed at sex workers.

These activities are currently cycling over a 4 year period allowing for the sustainable development of our community’s capacity to effectively address violence against sex workers.

Funding and Program Partners

Street Health along with the Regent Park Community Health Centre and the Bad Date Coalition initiated a partnership in 2008.  Funded through the Status of Women Canada and the City of Toronto the partnership established the Safer Stroll project.  

Organization descriptions:

• The Bad Date Coalition produces the Bad Date Booklet and distributes the booklet to social service agencies and sex workers.  The coalition provides our partnership with the expertise that can come only through lived experiences.

• Regent Park Community Health Centre (RPCHC) has been providing primary health care to low income, marginalized people for over thirty years in Toronto.  Multi-disciplinary services are provided with a particular expertise in delivering care to individuals who struggle with complex health and social issues.  RPCHC offers an optimal environment for sex workers to receive compassionate care. 

• Street Health has a long and rich history of providing community work and nursing care to some of Toronto’s most marginalized citizens.  Street Health has embraced mentoring projects for well over a decade. Our program evaluations tell us this model is extremely effective in reaching marginalized communities, further to this the credibility and expertise our mentors provide is an invaluable asset for our community.

Program Impact

25 sex workers trained over the past three years:

• 80% graduation rate

• 100% of graduates report an increase in their: knowledge and application of safety strategies, sense of belonging, interest in activities furthering personal growth

• One graduate is in a college program

• Two graduates have been hired by local community agencies

Three years of mentoring activities produced the following highlights: 

• 1,878 contacts made with sex workers

• 3,988 referrals to community resources

• 52 educational workshops delivered to community organizations: Participants' feedback identified increased: skill and knowledge development, awareness of stigma concerning sex work

Toronto's Vital Signs® indicator(s) addressed by Program

“According to the latest General Social Survey (GSS) on victimization, conducted every five years, 69% of violent victimizations… go unreported to police.” 

(Toronto’s Vital Signs® 2011)

The Safer Stroll project links sex workers to resources such as the Special Victims Section of the police.  The project creates positive networks and social supports for women engaged in survival sex work.

Participant Vignette

By the time she was 25 years old, poverty and drug use had long since been a part of April’s life.  She recalls being very young when her aunt introduced her to crack cocaine.  She has been in and out of correctional facilities many times and homeless most of her adult life.  Despite those significant challenges, April attempted several peer training programs through Street Health, but it never seemed to be the right time as her addictions always seemed to win over her will to stay engaged in the programs.  After an overdose that almost killed her while living in an abandoned truck, April thought, “I have had enough.”  She enrolled in the Safer Stroll Project, determined to make it work for her and immediately felt her life changing.  April was always early for sessions, contributed to discussions, and volunteered whenever possible.  She graduated from the project armed with knowledge and skills to share with other women who needed help.  “I feel like now I am able to give back what I took from the community, I have done a lot of damage, and now I can make amends” says April.  Now, for the first time in many years April is drug free and has no charges pending against her.  She has been able to pursue her creative interests through a community art program and she is even taking classes at George Brown College.

Drug Information Project (DIP)

Street Health in collaboration with Regent Park Community Health Centre (RPCHC) offers an integrated model of care for individuals who are struggling with complex issues such as homelessness, substance use, and mental health concerns.  It is our experience that these citizens experience the deeper influences of poverty and the social disadvantage on health that radically increases their risk of: contracting infections such as HIV, Hepatitis C and TB, experiencing trauma and related mental health concerns, or acquiring head injuries and other physical injuries.  Our collaborative programming increases access to health and social services and builds upon participants unique strengths enhancing the ability to take greater control over one’s life.  Weekly drop-in components offer a safe, unstructured format where participants are able to rest, socialize, enjoy healthy food, access phones, laundry, and shower facilities.  In addition, participants are able to access health and support services such as nursing care and housing assistance.  Nursing care provides a broad range of assistance from prevention services, to crisis intervention and primary care.  Drop-in staff and peer workers link participants to appropriate services, provide support, encouragement and education.  The project excels at providing accessible and effective care to populations who are often described as “hard to reach”. 

Funding and Program Partners

Street Health and the RPCHC initiated this partnership in 2005.  Both agencies contribute to the funding of this project.     

Organization descriptions:

• Street Health has been providing community based health and support services to individuals who are homeless or underhoused for over twenty-five years.  Street Health programs include: nursing, case management, and identification (storage and application support, harm reduction services such as needle exchange, and street outreach).  Street Health has a strong history of addressing the social determinants of health through programs, services, education and advocacy.

• RPCHC has been providing primary health care to low income, marginalized people for over thirty years in Toronto.  Multi-disciplinary services are provided with a particular expertise in delivering care to individuals who struggle with complex health and social issues. 

Program Impact

• The project has continued to improve access to primary and preventative health care: 70% of participants report utilizing health services.  This model of care is able to provide easy and essential access to clinical and support services.

• 80% of participants report an increased sense of belonging and feelings of hope from participating in the drop-in programming. The following significant impacts for participants have been reported through project evaluations:  increased sense of community belonging, increased self-esteem and self-worth, increased ability to manage substance use.

• 30% of drop-in participants found housing with the support of the housing worker

Toronto's Vital Signs® indicator(s) addressed by Program

“Toronto’s homeless are hospitalized more often than the general population, (the rate is estimated at 23 hospitalizations per 100 people per year, compared to 5 per 100 per year in the general population). They enter hospital with more acute health problems (particularly mental health issues) and stay longer, often because they cannot return to a shelter and have nowhere else to go.”

(Toronto’s Vital Signs® 2011)

Our integrated model of care provides preventative health and social services that help to reduce hospital admissions.  Participants are able to significantly advance in their ability to stabilize, find housing, increase support networks and engage in their personal health care.  

Participant Vignette

Nancy's Story

"The drop-in is a great place to connect with people.  It is safe for those who struggle with drug use and or homelessness.  There are lots of supports offered and if you are lonely you can socialize with others and that could help – believe me I know.  I learned lots at the drop-in:

• I learned to be healthier, making wiser choices for my health: now my life is a lot better and more stable
• I got connected to other programs that broadened my knowledge
• I get help maintaining my positive changes
• I am NOT using today – because of all the support I received
• I have closer relationships with other people

I don’t think I’ll go back to using drugs ‘cause it would end my life.  I know my life has changed tremendously.  I have gotten the support I needed which helped me get my life back to normal.  IT WAS WORTH ALL OF THE WORK!  I like myself at this point in time, a lot better than before when my life was so unmanageable.

I try to remember two main things the drop-in program has taught me: Good people do drugs too and I am able to believe in myself and other people again."