New team scours the Downtown Eastside for homeless youth

new team scours the downtown eastside for homeless youth

Youth care worker Kerry Ryan and social worker Carlos Mendez Espinoza are members of Vancouver Coastal Health’s Downtown Eastside youth outreach team, which works with vulnerable youth on the streets.

Armed with harm-reduction supplies and a backpack full of treats, Carlos Mendez Espinoza and Kerry Ryan walk the gritty streets of the Downtown Eastside looking for Vancouver’s most vulnerable teenagers, who might be hiding in alleys, living in ramshackle tents, or couch-surfing in tiny hotel rooms.

As the first two employees of Vancouver Coastal Health’s new Downtown Eastside youth outreach team, they search for homeless young people. These young people usually have substance use and mental health problems, and often struggle with childhood trauma, sexual exploitation, and a lack of any healthy relationships in their lives.

“We walk from here towards downtown, mostly in this neighbourhood,” said Ryan, standing in an alley off Princess Avenue near Powell Street, behind the Downtown Community Health Centre where the new team is temporarily based.

“There is a huge need for it. There are so many young people down here and I think the population keeps growing as well. (We’re) filling in a gap in services.”

Ryan is a youth care worker, and Espinoza a social worker, but their jobs are also part detective work. On a chilly day earlier this month, wearing their unofficial team uniforms of jeans, colourful hats, and welcoming smiles, they walked more than 20 km, weaving back and forth along Downtown Eastside streets.

Their goal is to find and then build rapport with vulnerable youth who have lost faith in government systems, and have no reason to trust these outreach workers either. Ultimately, Espinoza and Ryan want to reconnect these youth with medical and social services, to make their lives healthier and safer, but it usually takes several visits to break the ice.

So, they carry stuff that the youth need: Naloxone kits, needles, push sticks, bubble pipes and other clean drug-using tools. Also sleeping bags, foam mats and warm socks. And many, many treats, the most popular of which are Passion Flakies and Ensure protein drinks. Ice cream is also a big favourite, even if it’s cold outside.

“A lot of the times they’re kind of invisibly homeless. So they’re living in other people’s SROs, they’re living in tents, so you can’t really see them on the streets. So a lot of our job is going out there trying to find them and build connections,” said Espinoza.

“Their health is very complex. Their mental health can be very complex. The addictions are very complex. And they just have no one to turn to…. Over time, (we’re) building that relationship, and then bridging them to another service provider, whatever their goal is — be it employment, mental health, addictions, or something like that.”

The Downtown Eastside youth outreach team, launched in November, is important, Espinoza said, because most services in the impoverished neighbourhood are geared to adults. Youth who need these resources must have the courage and know-how to pursue them on their own, which isn’t the case for most teens in traditional homes with parents who watch out for their well-being and book their medical appointments.

new team scours the downtown eastside for homeless youth

Kerry Ryan and Carlos Mendez Espinoza in the Downtown Eastside.

The new team aims to change that dynamic, meeting the youth where they’re at and asking what they need. It is one of the improvements made in recent years to help high-risk young people, in response to growing concerns about youth mental health and addictions, especially given the deadly toxic drug epidemic .

Vancouver Coastal Health created the  child and youth mental health and substance use program in 2017, one year into B.C.’s state of emergency over the overdose crisis. Right now, it provides “high-intensity support” to 129 youth who typically come into the Commercial Drive-area clinic several times a week.

The following year, that program formed a team to target vulnerable youth aged 13 and older, called intensive case management, or ICM , in response to a scathing report by B.C.’s children’s representative , who found 19-year-old Paige fatally overdosed after social workers, medical professionals, teachers and police collectively failed to keep her safe.

The report concluded Paige fell through the cracks because organizations in her life, whether it was detox facilities or homeless shelters, weren’t speaking with each other. Now, service providers can refer these vulnerable teens to ICM, a one-stop-shop multidisciplinary team that can help them address nearly all of their needs, including health care, substance use, and community supports such as housing.

Then, in November, the second team was launched, the Downtown Eastside youth outreach team for 15- to 24-year-olds, many of whom might have been referred to ICM but needed to be found and convinced that the service is truly there to help them.

“There was a lot of clientele coming from the Downtown Eastside being referred to the ICM team, and these particular clients are very hard to find just because of the transient nature of their living standards. They’re kind of all over the place. So there was really a need for a team to be embedded in the Downtown Eastside, being there consistently looking for them, connecting with them and kind of building that rapport,” Espinoza said.

The fledgling team has just two employees now, but when fully staffed will include an Indigenous peer advocate, nurses who can do wound care on the street, and a nurse practitioner for more in-depth medical issues. The team will also open an office with a pro-harm-reduction drop-in centre for youth in the Downtown Eastside, as the closest drop-in for this age group is in the downtown core and is abstinence-based, said Emily Giguere, VCH’s clinical planner for youth substance use.

“We really want our office to be a space where they can hang out. There’s going to be computer access, food, a full kitchen that we can do some cooking in groups. So we really want to be a very welcoming space,” she said.

new team scours the downtown eastside for homeless youth

Vancouver Coastal Health officials Emily Giguere, left, and Anne Merrett-Hiley hold emotional-support pets used by youth outreach teams.

Services for vulnerable youth are starting to grow across the province, although experts maintain far more are still needed to meet demand.

Four of B.C.’s six health authorities have created various types of youth outreach teams, according to the Ministry of Mental Health and Addictions.

These include:

• Vancouver Coastal Health: ICM teams in Richmond, North Shore, Sea to Sky, Powell River and Sunshine Coast, in addition to the new youth team in Vancouver.

• Interior Health: Several ICM teams .

• Providence Health: Youth urgent response teams at Foundry Centres , which offer multidisciplinary services for youth, on the North Shore and downtown Vancouver. In Vancouver, a nurse or doctor accompanied by a peer support worker will provide opioid agonist therapy during outreach.

• Island Health: Several ICM teams ; a mobile outreach team that includes mental health, substance use, nursing and psychiatry specialists; and youth short term assessment and response (Y-STAR) teams that provide outreach in community and in-reach into hospitals.

Dr. Jennifer Charlesworth, B.C.’s representative for children and youth, calls these teams vital. They bring important services to young people, rather than expect them to figure out on their own how to connect with resources. They foster a sense of belonging, whether it’s finding an alternative way to pursue education or reconnecting with culture. And they are designed specifically for youth, and employ staff who want to work with young people.

“It’s just not OK for our young people to have to access services, like harm reduction or safe supply, through an adult system,” said Charlesworth.

And, she added, the workers are trained not to give up the first few times a young person tells them to get lost. They keep coming back with snacks or coffee until a bond can be formed.

“These are young people, by and large, who have experienced a lot of trauma and instability, and transactional relationships in their lives,” Charlesworth said. The workers “just know how to build relationships over time and earn their trust.”

Darius, 24, is living proof of how these teams work.

He was homeless and, by his own description, his life “had no control,” when he met ICM clinician Joan Kennedy two years ago in Strathcona Park, where he was sleeping in a tent.

“She saved my life, in a great way. And I owe it all to this woman here,” Darius said, nodding at Kennedy. “I don’t know where I’d be without her.”

Darius’s drug use was heavy, so the place where he was repeatedly showing up to detox referred him to the youth ICM team. Kennedy worked with him, connecting him with drug treatment, a nurse practitioner and subsidized housing. She helped him get a debit card and set up direct deposit for income assistance, and now his relationship with his family has improved and he’s more confident about next steps in his life.

“Helped me get connected with a psychiatrist to figure out my own mental health problems and the right medication I needed to be on,” said Darius, who asked that his last name be kept private.

“Helped me get connected with the Gastown vocational school, so I can get more work experience and get more training for my future so I can have a job.”

Kennedy has worked with Darius for two years, although their interactions are decreasing as he becomes more independent. It isn’t unusual to stay with these youth for years, she said, as the team can follow their clients up to age 25. Darius is an ICM success story, but he acknowledges the new outreach team that actively searches for youth living rough would have been beneficial in his case.

new team scours the downtown eastside for homeless youth

Tents on East Hastings St in the Downtown Eastside in 2022.

ICM workers like Kennedy also do outreach along with their other tasks to help stabilize youth in the long term. Espinoza’s new team, by comparison, exclusively focuses on combing the streets for youth and connecting them with what they need in that moment.

If they are looking for a specific youth, the duo will canvas service organizations and, sometimes months later, may get a call saying someone matching the description has shown up. Other times they’re told where a youth was last seen, such as in a red tent on a certain street.

“We do loops of the Downtown Eastside looking for clients, and we stumble upon them a lot of the time,” Espinoza said. “It’s almost like catching lightning in a bottle.”

Locating them is only half the battle.

Bit by bit, Espinoza has to earn their trust. It might start with a funny joke and a question about snacks, so he can deliver their favourites at their next meeting.

“Meet them once, maybe they don’t really want to work with anything or have any involvement at that moment. But then throughout time just dropping in on them, saying, ‘Hey, how’s it going?’ Not pressuring them in any type of way,” he said. “Then we can start working on things slowly, so it’s at their pace.”

Some youth are distrustful of medical and other government systems because they’ve had professionals dismiss their concerns, or have experienced racism, in particular Indigenous youth.

“A lot of the time, it’s very hard for a client to go by themselves to a hospital, where they’ve heard bad things. They’re young, they’re scared,” Espinoza said. “So it’s just a lot of mistrust that’s built up over time.”

If they are successful at repairing that trust, team members must follow through with whatever they’ve promised the youth.

“If you say, ‘I’m going to do something,’ you need to do it because those are kids that have been burned many times by the system,” said Giguere, the youth substance use clinical planner.

“By the system, by their families sometimes. From a young age, everything has been taken from some people already,” added Elaine Durand, a member of the youth ICM team.

Both the ICM and the youth outreach teams support harm reduction, and will ask clients how they want to address their substance use. That will look different for each youth: For some, it will mean using drugs in a safer way, for others it will be about using fewer drugs.

Giguere understands some people will be uncomfortable with the concept of letting a 17-year-old, for example, continue to use fentanyl. Emotionally, the urge would be to force them to stop immediately, but that would only alienate them at a time when they need support.

And, she noted, the drugs typically are being used to cope with trauma or mental health problems, so the team also tries to help with those underlying conditions.

“The majority of our clients are folks who have been marginalized or been oppressed, at times by the health-care system, because we’re not always an easy system to access. So the goal of those teams is to make it easier,” Giguere said.

new team scours the downtown eastside for homeless youth

Elaine Durand and Carlos Mendez Espinoza walk with support dog Gael.

It is hard to quantify the exact scope of youth at risk from homelessness and toxic drugs.

According to the Vancouver Homelessness Count, 21 per cent of all unhoused people in the city were under age 25 in 2014, the worst year on record. Those numbers consistently improved until 2019, when seven per cent of Vancouver’s homeless were youth, but climbed again in 2020 to nine per cent — or 188 of the 2,095 people counted.

With the arrival of the pandemic, the homeless count was put on hold, but it resumed again this month. The results, expected later this year, will indicate whether the number of homeless youth has got better or worse.

Youth under 19 represent less than two per cent of B.C.’s drug toxicity deaths, but the grim tally of those who fatally overdose grows each year, from 12 deaths in 2016 to 34 last year. For the 19 to 29 age category, toxic drug deaths rose from 204 people in 2016 to 327 last year, the coroners service says .

Holding emotional-support dog Gael on her lap and wearing a T-shirt emblazoned with “Nice people take drugs,” Durand says more services are required to keep youth safe during the epidemic, such as the drop-in centre the new outreach team plans to open.

“There’s definitely a need for a place for a person to put their head down, where they might need to use substances and they’re not going to be stigmatized for that,” said Durand, an occupational therapist who helps youth adjust to their new lives once they are off the streets.

At-risk youth need protection from not just toxic drugs, unstable housing, and untreated health issues, but also from predators who find them easy targets if they don’t have a support network.

“I think those who are preying on young folks count on the fact that no one is looking for them,” said Durand. She hopes the work she and her colleagues are doing will change that — even if it is a long process that requires patience and kindness.

“The therapeutic relationship that you build with someone, in my experience, could take a year or more because you have to earn the trust. You have to demonstrate that you’re consistently going to be able to offer them support.”

[email protected]


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