Homelessness & Substance use Flashcards

1
Q

What is the seaton house?

A

Houses up to 600 homeless men but as many as 900
Three programs, including a Managed Alcohol Program (MAP)
Medical services provided within the shelter beginning in 2003

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2
Q

What is a street nurse?

A

Advocate for the rights of people experiencing homelessness and people who use drugs and alcohol
Meet people where they are at (i.e, in shelters, on the streets, in their homes, community, clinic)
Have a better understanding of the needs of people experiencing homelessness

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3
Q

What is neuropsychology?

A

Examines relationship between brain and behaviour
Assessment techniques uncover cognitive abilities
Profile of strengths and weaknesses
Guides interventions

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4
Q

What is neuropsychological service?

A
Chart review
Screening and comprehensive testing
Clinical interview
Examination of several cognitive domains
Provide support for: refugees, ODSP, DSO, diagnostic clarification, rehabilitation, treatment recommendations
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5
Q

What are some examples of cognitive domains examined in neuropsychological service?

A

Memory, Executive functioning, Speech and language, Intellectual and academic functioning, Adaptive functioning, Attention, Visual and spatial abilities, Motor speed and coordination, Emotional functioning and personality

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6
Q

What conditions might require assessment?

A
Neurological Disorders and Diseases
Psychiatric Disorders
Developmental Disorders
ADHD/ADD
Acquired/Traumatic Brain Injury and Concussions
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7
Q

Approximately how many Canadians experience homelessness in a given year?

A

Over 235,000 Canadians experience homelessness within a year

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8
Q

Approximately how many Canadians experience homelessness in a given night?

A

35,000

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9
Q

How many homeless people are between the ages of 25 and 49 ?

A

52%

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10
Q

How many individuals in ottawa are chronically homeless?

A

1,000 and 72.7% are men

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11
Q

Who is at risk?

A

People experiencing discrimination, oppression, racism, stigma, inequitable distribution of resources…

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12
Q

Who is at highest risk?

A

People at higher risk:
Racialized minorities
Indigenous people
People experiencing homelessness or poverty
LGBTQ2S community
People with mental health and/or cognitive challenges
People with a family history of substance use

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13
Q

What is the relationship between mental health and addictions in Canada?

A

1 in 5 Canadians experience mental illness or addiction
People with mental illness are twice as likely to have substance use problem compared to general pop.
At least 20% of people with a mental illness have a co-occurring substance use problem
Canadians in the lowest income group are 3 to 4 times more likely than those in the highest income group to report poor to fair mental health

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14
Q

What do a lot of homelesss people have in common?

A

TBI’s (53%) (70% occurring before homelessness), mental illness, developmental disability, chronic health conditions, ER visits, food scarcity, and homeless when incarcerated

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15
Q

What is the majority of race/ethnic identity of toronto’s homeless?

A

White (37%), black (33%) and aboriginal (10%)

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16
Q

What are shared characteristics of those first experiencing homelessness?

A

Low SES background, mostly male, parent had substance use/disability, child abuse, high unemployment, did not complete HS, 3 distressing life events in prior year, chronic illness in previous year, lifetime diagnosis of mental illness and/or substance abuse dependence

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17
Q

What are some social determinants of health?

A

Housing, Income and employment, Food Security, Access to Health Care, Education and Literacy, Social Supports/Inclusion, Childhood Development, Gender, Culture, Social supports and inclusion (need to be connected with people and community)

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18
Q

Homeless in toronto from (2017 to 2018)

A

total deaths: 145 people

average age of death 50 y/o, 110 male identifying, causes of death: drug toxicity, cardiovascular, other and unkown

19
Q

What is the housing crisis?

A

Not enough affordable housing, Not enough shelter beds, Increasing number of people using the shelter system, Gentrification, People sleeping outside

20
Q

What is the relationship between homelessness and substance use

A

Substance use is common among the homeless (83%) and moderate to sever TBI associated with increased drug risk and mental health issues

21
Q

What are homeless people with a substance use disorder more likely to report?

A

health as being fair/poor, high stress, self medicate, experience physical assaults, loneliness, considered and attempted suicide compared to other homeless individuals

22
Q

Homelessness and alcohol use

A

Heavy alcoholism reported in 53% to 73% . Of the chronically homeless in Ottawa 48% to 63% have a history of alcoholism
Drinking non-palatable alcohol is common
Recurrent ER visits related to alcohol related issues
Intoxication lead to police encounters and arrest
Rehabilitation unlikely and rates are low

23
Q

What are the health consequences of alcoholism?

A

Risk of a variety of physical health issues
Enlargement of the sulci and ventricles
Reduction in grey and white matter (prefrontal/frontal cortex)
Volume deficits in the anterior hippocampus, corpus callosum, mammillary bodies, caudate nucleus and putamen, pons, thalamus and cerebellum
Associated with cognitive declines and in some cases Korsakoff syndrome
Excessive use associated with early death

24
Q

What do they examine in a neuropsychological assessment of alcohol related brain damage?

A
Examination of frontal lobe/executive functioning
Visuospatial abilities
Memory
Attention
Psychomotor skills
25
Q

What are the cognitive consequences of alcoholism?

A

Impairment in several cognitive domains: Short-term Memory, Attention, Visuospatial Abilities, Executive Functioning, Postural Stability

26
Q

can cognitive impairment from alcohol abuse be reversed?

A

Some cognitive impairment can be reversed after abstinence Improvements in visuospatial functioning, attention and executive abilities (working memory) correlated with increases in brain volume for individuals with alcoholism

27
Q

Can cognitive impairment from alcohol abuse in individuals with korsakoff be reversed?

A

Those with Korsakoffs show some improvement in aspects of executive functioning, memory (visual) and general knowledge, but overall these remain impaired

28
Q

What were the traditional treatment approaches to alcoholism?

A
Motivational Interviewing
Withdrawal Management Centres 
Primary Treatment 
Medications 
Therapy 
Substance Use/Brain Injury (SUBI)
Self-help Groups
Neuropsychological Rehabilitation
29
Q

What is the harm reduction approach?

A

Decrease harm associated with behaviours, A spectrum, Client centered, Non-judgmental, anti-oppressive
Compassionate, empathetic
Evidence based, DO NO HARM

30
Q

What is managed alcohol program?

A

MAPs give a safe place for people to consume palatable alcohol in a controlled environment with a pathway into detox/treatment, if wanted
MAPs a form of HR to decrease the use of non-palatable alcohol (hand sanitizer, rubbing alcohol, mouth wash) and reduce overall alcohol consumption safely
(first map at seaton house in 97 now ~15)
For example the pour

31
Q

Ottawa MAP

A

Ottawa MAP 15 beds
17 individuals with at least a two year history of homelessness and alcoholism for an average of 35.2 years
Avg of 16 month enrollment in the program
Residents provided with a maximum of 90 ml of sherry or 140 ml of wine hourly from 7 am to 10 pm daily
24 hour medical care provided

32
Q

Do MAP’s reduce harm?

A

Monthly ER visits decreased from 13.5 to 8
Monthly police encounters reduced from 18.1 to 8.8
Participants reported reduced alcohol consumption since entering the program
Reports of improved hygiene and engagement with health and medical care

33
Q

What are some other examples of harm reductio?

A

Opioid Agonist Therapy (Methadone/Suboxone)
Heroin Assisted Treatment
Safe Injection Sites/Overdose Prevention Site
Harm Reduction supplies
Prison Health Harm Reduction

34
Q

opiate overdoses in Canada and Ontario

A

there is an overdose crisis, increasing OD death in Canada and Increasing OD deaths in Ontario

35
Q

How can the harm associated with Opiate use be reduced?

A
Try not using alone
Go to SIS or OPS
Let someone know you are using
Test your drugs before using
Test for fentanyl using test strip
Do a smaller test shot
Try not to mix different drugs or alcohol with opiates
Carry naloxone
36
Q

Why so many opiate overdoses?

A
War on Drugs a failure
Toxic Drug Supply (fentanyl or fentanyl analogs)
Drug use is criminalized
(Need to decriminalize drug use)
Not enough SIS and OPS
People use alone, isolated
Not enough detox or treatment beds
Need more funding and resources in the community
37
Q

What is the portugal model?

A

Drastic drug policy reform in 2001 Decriminalized drug use
Do not arrest anyone who carries illegal drugs for personal use
HIV rates declined from 1,016 cases to only 56 in 2012
Overdose deaths decreased from 80 to only 16 in 2012, Drug use has decreased

38
Q

What was the first supervised injection site to open in NA?

A

Insite in Vancouver, now 28 in BC, Alberta, Ontario and Quebec

39
Q

What do SIS/OPS offer?

A

Offer a clean, safe place to use substances under supervision and provide medical assistance if need be: Inject, Snort, Swallow, Smoke and Naloxone available

40
Q

What is Naloxone?

A

Life saving antidote in cases of opiate overdoses. Comes in 0.4mg IM or 4mg nasal formulations. it is Quick and easy to administer and Can get for free at pharmacies
We need first responders (incl. police) and community members to carry and be trained to use naloxone

41
Q

What are the signs of an overdose?

A

Unresponsive, can’t wake up
Slow, weak or no breathing
Blue lips, fingernails
Snoring or gurgling sounds

42
Q

What to do in an overdose situation?

A

Try to wake the person up (shout, sternal rub) and Call 911. Administer Naloxone, Administer rescue breaths/oxygen. Stay with the person until help arrives
*Administer second dose of Naloxone after 3-5mins if the person does not wake up or respond

43
Q

What are the politics of the OD crisis

A

Policy changes with current Govt., SIS and OPS have to reapply to operate and no new funding for existing sites. Only 21 consumption and treatment services in Ontario allowed and they are now treatment focused rather than client focused

44
Q

What are other groups at ICFHT?

A

Alcohol harm reduction group, lets move group, mindfullness group, healthy wellness group, kit making group