Harm Reduction Needs Assessment Project

The Harm Reduction Needs Assessment project supports Ernestine’s Women’s Shelter to better understand the gaps in shelter services and barriers experienced by diverse communities of survivors who use substances. Ernestine’s has conducted a study that centres the voices of people who have experienced violence and use substances. The study highlights knowledge, experiences, gaps, and barriers that survivors experience. It also includes a list of recommendations for service providers to offer safe services with reduced barriers. Ernestine’s has successfully implemented some of the recommendations to create inclusive services for clients who use substances.

The Harm Reduction Needs Assessment Project identified, outlined, and described the harm reduction needs of diverse women and Two-Spirit, genderqueer, trans, and non-binary people with experiences of violence and substance use. It also identified the barriers and hesitations impeding their access to Ernestine’s shelter services. The project was based on the principles of “Nothing About Us, Without Us,” which involves including the voices of people with lived experiences at the centre of any decision-making regarding policies and programs that affect them. Ernestine’s has prepared a report outlining their findings with a list of recommendations that service providers can adopt to create inclusive and safe barrier-free services. Ernestine’s has been working on implementing these recommendations and wants to share them with other service providers.

“Women face more judgment around their substance use, especially if they are parents. If you are a Black and/or an Indigenous person, you’re facing even more barriers and judgments…Someone who leaves their abusive situation and who might have gotten access to a safe supply from their abuser is now trying to figure out where to get [substances]; these have safety connotations…They are often left out of services and need safe access to spaces; we want to make sure that our spaces are accessible and equitable, meeting the diverse need.”

In 2015, the Ontario Ministry of Children, Community and Social Services (MCCSS) introduced a standard requiring gender-based violence shelters to provide access to services to women who use substances. Ernestine’s shelter identified that people who use substances are underserved at the shelter and that there is a lack of harm reduction services and supports available for people who use substances and have lived experience of gender-based violence. Ernestine’s also recognized the need to better support clients who use substances, adopting and integrating harm reduction approaches and services as crucial. Thus, as a part of the work of Ernestine’s strategic priorities to expand its reach and improve inclusivity, Ernestine’s embarked on this Harm Reduction Needs Assessment Project with funding from the Toronto Urban Health Fund (TUHF) in July 2021.

The project established a Community Advisory Board of 5 individuals with very diverse lived expertise and experience of substance use, gender, and gender-based violence to inform the project activities. They reviewed the survey questions and helped analyze the data and results. The shelter hired community researchers with expertise and knowledge to inform and implement project activities. The project included asking almost 75 diverse women and Two-Spirit, genderqueer, trans, and non-binary people with experience of violence and substance use about their harm reduction and shelter services needs. The project team approached drop-in centres, safe supply or consumption sites, and community health clinics to reach people who were not accessing Ernestine’s services. Ernestine’s clients, frontline staff, and management also participated in the audit of Ernestine’s policies, physical space, and programs. The 39-page Harm Reduction Needs Assessment Project report highlights some of the findings from this project, mentioning the specific needs of survivors and including recommendations on how shelters can create inclusive and barrier-free physical spaces, programs, and service provisions, while also improving the capacity of frontline staff, policy, and management.

Ernestine’s has already successfully implemented some of the recommendations from the report. The shelter’s annual review shows that there has been an increase in the number of clients accessing the harm reduction supplies at the shelter since implementing some of the recommendations. Despite following this reduced barrier approach for the last few years, it’s only recently that clients are comfortably using supplies, accessing safety kits including harm reduction safety plans, and openly communicating about their harm reduction needs with staff. Shelter staff have undertaken multiple training sessions with community partners on understanding the unique harm reduction needs of women within racialized communities and survivors who are parents, equipping them to feel more comfortable by offering barrier-free services. One of the biggest strengths of this project is how it connects multiple service providers and agencies, led bypeople with lived experiences from diverse backgrounds.

“[Community members] felt it was powerful because they have never even been asked these questions…their opinions [were] valued. We reported back to them, inviting them to review the recommendations. They know their voices were heard…Our hope is that by sharing [the report], others will be implementing some of these learnings in their own shelter context.”