FASD and Homelessness in Calgary, Alberta in 2015

Transcription

1 FASD and Homelessness in Calgary, Alberta in 2015 DOROTHY BADRY PHD, RSW & CHRISTINE WALSH, PHD, RSW FACULTY OF SOCIAL WORK, UNIVERSITY OF CALGARY MEAGHAN BELL, MA, CALGARY HOUSING AUTHORITY & KAYLEE RAMAGE, MSC INSPIRING CONNECTIONS: A RESEARCH AND PRACTICE SHOWCASE POLICY WISE FOR CHILDREN & FAMILIES, NOVEMBER 29, 2016 EDMONTON, ALBERTA Funder: Policy Wise for Children & Families,

2 Invisible: Individuals with FASD who experience homelessness In Calgary, homelessness grew by 800% between 1992 and 2008 and declined by about 2% by Calgary Homeless Foundation s (CHF) most recent point-in-time count estimates (October 2014) over 3500 people experience homelessness on any given night in Calgary.

3 Homelessness in Calgary: 2014 Point in Time Count Calgary Homeless Foundation Almost 1900 in emergency shelters Over 1200 in short term supported housing arrangements Over 200 in systems 215 individuals rough sleeping (38% ages with year olds overrepresented) Over 850 women included in the count and 209 families [78 families in emergency shelters] (slight increase from 2012) Source: Point-in-Time Count Report, Winter, 2014, Calgary Homeless Foundation. Online:

4 Project Description - ADVOCACY RESEARCH BACKGROUND Exploratory research limited research in this area focus on identification of population and service needs A collaborative project with the CHF and the University of Calgary METHOD Environmental scan and literature review to examine existing studies and housing models for individuals with FASD experiencing homelessness Quantitative exploration of the Homeless Management Information System Qualitative Interviews with 16 individuals with a diagnosis (12) or suspected (4) FASD Interviews with 19 service providers in the sector

5 Why conduct this research in the homeless serving sector? There is limited research on this population Lack of knowledge on FASD in service provision A lack of understanding of the needs of individuals with FASD The need to engage in effective interventions and case management to promote success Need to create awareness of FASD in the sector due to distinct service needs When FASD is not well understood, services are less than optimal Individuals with FASD are among the most vulnerable on the streets FASD-informed practice means we have to believe that there is a disability. We re finding that a lot of people don t. (Key Informant-Service Provider).

6 What has informed this research? Phone call received from a shelter worker in Edmonton, Fall, 2016 I m working with a young guy, about 24. He s been in a shelter and he has FASD. He grew up in care and has a really tough time making connections. I know he s been victimized just about every way possible. Every time I feel like I ve made a connection and am getting closer to making progress, he disappears. This pattern keeps happening and I don t know what to do. What do you think is going on? Trauma history attachment issues fear (among many other issues) I am able to help him with what he needs in the moment but I can t get beyond that

7 Scope of the Concern in Child Welfare Care out of home placement About 67,000 children in care, an increase from 5.7 in 1992 to 9.2 of 1,000 in 2007 (Mulcahy & Trocmé, 2010) Alcohol-exposed pregnancies remain a substantial concern in Canada (Tough, 2009) Approximately 16.9% (169 out of 1,000) had a condition in the FASD spectrum (Lange, Shield, Rehm, & Popova, 2013) FASD results in a range of social, health and economic costs (Popova, Lange, Burd, & Rehm, 2014)

8 Child Welfare Research & FASD FASD Prevalence Alberta Manitoba Ontario 10.3% 12.3% 10.5% Prevalence rates as high as 16.9% in child care settings (inclusive of CW placement) (Lange et al. 2013) As these youth age out of care what are the implications? A Tri-Province Initiative to Expand Understanding of Costs, Services & Prevention of a Public Health Issue: Fetal Alcohol Spectrum Disorder & Children/Youth in Care [ ] (Goodman, Badry, Fuchs, Long, & Pelech, 2014).

9 Homeless Management Information System FASD status is recorded on intake (n= 113) 3% self-reported suspected FASD 1% reported diagnosed FASD 9% did not know their FASD status Of those with diagnosed or suspected FASD: 33% were Caucasian 59% Aboriginal 45% 40% 35% 30% 25% 20% 15% 10% Table 1: Age distribution of individuals identifying as diagnosed or suspected FASD at Intake 23% 26% 39% 5% 0% 12% 24 and under

10 Homelessness & FASD Brownstone (2005) identified housing as a critical area of focus for individuals with FASD since 80% have difficulty sustaining independent living and most will require interventions and support throughout their lifetimes (p. 2). Individuals with FASD are particularly vulnerable to becoming homeless when aging out of services, such as foster care or school programs, or when their parents die, especially without strong social support or established housing placements (Backer & Howard, 2007). Adults with FASD may be characterized as difficult to house as they do not follow rules; this may be because they do not understand the rules or understand that the rules are meant for them or because they cannot remember the rules or apply them (Jonsson, Dennett, & Littlejohn, 2009).

11 Demographic Profile (n=16) 9 men & 7 women 93% reported addiction issues Average age 41 years 50% reported having a physical disability Average Length of Homelessness 12.5 years (Range 1-24 years) 68% involvement in the criminal justice system Average length of homeless for those under 35 years (n=5) 5.9 years Average length of homelessness for those over 35 years (n=11) 13.9 years 63% reported mental health issues 50% had past child welfare involvement 81.2% receiving social assistance

12 Screening Tool Description- Life History Screen The LHS was utilized in this research Childhood History Maternal Alcohol Use Screens clients for adverse life-course outcomes typically found in FASD Education Criminal History Substance Use Designed to guide followup assessments and treatment planning Employment & Income Living Situations Mental Health Day-to-day Behaviours Reference: Grant, T.M., Brown, N.N., Graham, J.C., Whitney, N., Dubovsky, D. & Nelson, L. (2013). Screening in treatment programs for Fetal Alcohol Spectrum Disorders that could affect therapeutic process. International Journal of Alcohol and Drug Research, 2(3): doi: /ijadr.v2i3.116

13 Qualitative Interviews Voice of a Service Provider Why placements break down so much is that people, like parents if you look at parents or families or services and everybody says, Well if he [individual with FASD] really wanted this, if you really loved us, if you really liked our placement, if you really wanted our program, he would come. He would follow through. They are counting on their relationship [with the individual], to [gain] compliance. Then I have to come in and burst their bubble and say, You ve got to give him a good day or he s not coming back, right? So that s why words like motivation and manipulation and all of those very strongly ordered words that we use in human service delivery are just not fair for the person [individual living with FASD] you have to have very good higher order brain function to be motivated [and to] manipulate.

14 Qualitative Interviews Participant Voices Women with FASD reported experiences of sexual assault, victimization, and sex trade work while homeless. They sexually abused me I m lucky I just made it through everything. I wish things would have been different. Then I ended up in prostitution made money to survive basically. I was in a super abusive relationship and I got away and I drank. Participants who were Aboriginal also talked about the removal from their biological families as a removal from their culture. It creates a whole identity crisis, with no roots or family or people to identify with culturally. Moving from home to home and experiencing trauma in the child welfare system led several individuals to run away and stay in shelters instead. Running away and living on the streets I guess it was my choice but it wasn t my choice. Because I didn t know where else to go...

15 FASD and Homelessness What we know about persons with FASD? Individuals are vulnerable Individuals are victimized in homelessness Individuals have challenges managing money Individuals are taken advantage of Gender based violence a concern What we don t know How many individuals have FASD in the sector What specific services are offered to this population How often individuals qualify for disability supports Effective case management

16 Recommendations 1. Increase awareness of FASD in the sector 2. Training and Education in FASD-Informed Practice 3. Screening for FASD- Screening is necessary to determine the need for referral for assessment and possible diagnosis. (Life History Screen) 4. Practice approaches must include: Complex Case Management - Assertive Outreach Systems Navigation Advocacy Support 5. Supports for Prevention- If appropriate, women should be referred to Parent- Child Assistance Programs (PCAP) for mentorship and intensive support 6. Gender Based Supports for Women s Health- Women with FASD are at high risk for victimization 7. Enhance Cultural Supports- Access to cultural supports is critical for Indigenous persons if so desired 8. FASD-specific Housing

17 Questions Dorothy Badry: Christine Walsh:

18 Selected References Backer, T. E., & Howard, E. A. (2007). Cognitive impairments and the prevention of homelessness: Research and practice review. The Journal of Primary Prevention, 28(3-4), Brownstone, L. (2005). Feasibility study into housing for people with FASD. Canadian National Homelessness Initiative for the Regina FASD Community Network, Saskatchewan Fetal Alcohol Support Network and Regina Community Clinic. Calgary Homeless Foundation. (2014). October 2014 point in time count report. Cook, Jocelynn et al. Fetal alcohol spectrum disorder: a guideline for diagnosis across the lifespan. Canadian Medical Association Journal (2015): Gaetz, S. (2010). The struggle to end homelessness in Canada: How we created the crisis, and how we can end it. The Open Health Services and Policy Journal, 3, Goodman, D., Badry, D., Fuchs, D., Long, S. & Pelech, W. (2014) A Tri-Province Initiative to Expand Understanding of Costs, Services & Prevention of a Public Health Issue: Fetal Alcohol Spectrum Disorder & Children/Youth in Care [ ]. Report to the Public Health Agency of Canada. Grant, T.M., Brown, N.N., Graham, J.C., Whitney, N., Dubovsky, D. & Nelson, L. (2013). Screening in treatment programs for Fetal Alcohol Spectrum Disorders that could affect therapeutic process. International Journal of Alcohol and Drug Research, 2(3), doi: /ijadr.v2i Jonsson, E., Dennett, L., & Littlejohn, G. (2009). Fetal alcohol spectrum disorder (FASD) across the lifespan: proceedings from an IHE consensus development conference. Lange S, Shield K, Rehm J, Popova S. Prevalence of fetal alcohol spectrum disorders in child care settings: a meta-analysis. Pediatrics. Oct 2013;132(4):e Lange, S., Shield, K., Rehm, J., & Popova, S. (2013). Prevalence of fetal alcohol spectrum disorders in child care settings: A meta-analysis. Pediatrics, 132(4), Thanh, N. X., and E. Jonsson. "Life Expectancy of People with Fetal Alcohol Syndrome." Journal of population therapeutics and clinical pharmacology= Journal de la therapeutique des populations et de la pharamcologie clinique23.1 (2015): e53-9. Thanh, N. X., et al. "Incidence and prevalence of fetal alcohol spectrum disorder by sex and age group in Alberta, Canada." Journal of population therapeutics and clinical pharmacology= Journal de la therapeutique des populations et de la pharamcologie clinique 21.3 (2013): e Tough, S. (2009, October). Incidence and Prevalence of FASD in Alberta and Canada. In IHE Conference on FASD-Across the Lifespan, Calgary, AB. Retrieved online: ihe. ca/documents/002-tough. pdf.