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BEHIND THE STUDY

Behind The Study

The Middlesex-London Health Unit (MLHU) and the Centre for Research on Health Equity and Social Inclusion (CRHESI) from Western University Health Sciences engaged in a research partnership to understand how a temporary overdose prevention site in southwestern Ontario has influenced the lives of people who use drugs (PWUD).

Funding for this study was provided by MLHU. Additional in-kind contributions from both MLHU and CHRESI.

Research Question

Our research question:
How has the temporary overdose prevention site
changed the lives of those who have accessed the site?

We were interested in finding out about the following
types of changes in site users lives, including:

  • Behaviours,
  • Relationships,
  • Interactions with others,
  • Feelings, and
  • Perceptions of self and other.

Methodology

  • Our research design included a Photo Narrative Method which involved recruiting people who use drugs (PWUD) at the overdose prevention site to participate in semi-structured interviews and were provided with a camera to take photos that represented the influence of the site on their lives.
  • Semi-structured interviews took place between May-September 2019.
  • The transcribed interviews were analyzed using a critical narrative analysis
    approach.
  • The analysis was conducted by the research team members in a multi-phased
    process involving individual and group analysis with the overall goal being
    to generate a core narrative supported by key themes.

Recruitment

Site staff assisted with:

  • Pre-screening
  • Introducing potential participants to researchers, and
  • Achieving maximum-variation sample.

Research staff were responsible for:

  • Explaining the study purpose and process,
  • Obtaining consent, and
  • Conducting the interviews.

Data Collection Process

First Interview

Semi-structured interviews were conducted to gather
information of their experiences on how the site had
influenced their day-to-day lives.

Participants were then provided with a disposable
camera to take photos that represent the influence
of the site.


Camera Return and Photo Development

Participants were asked to return the cameras to the site,
where the researchers then retrieved the
cameras and arranged photo development.


Second Interview

In the follow-up interviews, the photographs were
used to facilitate story-telling.

Participants were asked to share the meaning of the
photos they chose.

Changes to Data Collection Protocol

Due to a low rate of camera return (8/27 participants),
a new protocol was implemented utilizing a Peer
Support Worker employed by the Regional HIV/AIDS
Connection (RHAC) to accompany participants in a
digital photo taking process.

Second Interviews were conducted with participants
immediately following photo taking process with the
research team.

Participatory Approaches

We used participatory approaches throughout the study including:

  • Study Design – We engaged site users and site staff in discussions on the study design.
  • Formation of an Advisory Team – We formed an Advisory Team which included four community stakeholders (i.e. site staff, staff providing services in the Aftercare Room) and three site users.
  • Member-checking – Member checking was an important part of the café event that gathered feedback on the preliminary findings with participants, site staff and community stakeholders.

Café Event to Share Preliminary Findings (Fall 2019)

Contact Us

The Project Team:

Our Project Team included the following individuals
which also aligns with the authors of our reports:

Michelle Sangster Bouck, MA Program Evaluator
Middlesex-London Health Unit,
michelle.sangsterbouck@mlhu.on.ca

Abe Oudshoorn, RN, PhD
Western University,
aoudshoo@gmail.com

Melissa McCann,
MSW Middlesex-London Health Unit, melissa.
mccann@mlhu.on.ca

Shamiram Zendo, PhD Western University,
szendo@uwo.ca

Helene Berman, RN, PhD
Distinguished University Professor Emerita, Western University
Academic Director, Centre for Research on Health Equity and Social Inclusion

Jordan Banninga, MSc
Middlesex-London Health Unit,
jordan.banninga@mlhu.on.ca

Marlene Janzen Le Ber, PhD
Brescia Excellence in Research Professor,
Chair School of Leadership & Social Change, Brescia University College

Zayya Zendo, BSc Western University,
zzendo@uwo.ca

Acknowledgement:

We would like to acknowledge the following for their contributions:

All our participants for sharing your stories All the staff at CarePoint

With special thanks to:
Sonja Burke, Director
Kailey Anderson,
Peer Support Worker

Advisory Committee
Blair Destini
Jennie
Mike
Sam
Sommer
Trevor

For More Information:

What to learn more or have questions about the study?
Email the Project Team: photo.study@mlhu.on.ca

Local Context

Background & Local Context

Drug Overdose Crisis in Middlesex-London:

Our community of Middlesex-London, like many Canadian communities,
has been significantly impacted by opioid-related deaths.

  • 62 deaths due to opioid overdoses in 2018
  • 60 deaths due to opioid overdoses in 2019
  • 25 deaths in the first quarter of 2020

The rates of emergency department visits, and opioid-related hospitalizations
had also increased during the 2018-2019 timeframe representing a large burden
on the health care system.

For the latest data on Opioid related morbidity and mortality in Middlesex-London
region, visit Public Health Ontario’s Interactive Opioid Tool:
https://www.publichealthontario.ca/en/data-and-analysis/substance-use/
interactive-opioid-tool

– In response to this intensifying crisis, multiple community and government
agencies have joined in local efforts to save lives, and address harms associated
with opioid use.

– One such effort was the establishment of a temporary overdose prevention site (TOPS).

– In February 2018, Ontario’s first legally sanctioned temporary overdose prevention
site opened its doors in London.

– It was a collaboration between its founding partners, the Middlesex-London Health Unit
and Regional HIV/AIDS Connection.

– In April 2019, TOPS began to transition to the new provincially-funded Consumption and Treatment Services (CTS) program, named CarePoint Consumption and Treatment Services.

About CarePoint

The site provides a safe place for people to consume substances under the supervision and care of health professionals (Registered Nurse or Emergency Medical Services) and harm reduction workers.

The staff are situated in the drug consumption room to support clients and provide education about substance use practices, as well as potential health concerns from injection drug use [e.g. soft tissue injuries, cellulitis, abscesses,
Invasive Group A Streptococcal Infections (iGAS), Hepatitis C Virus (HCV), Human Immunodeficiency Virus (HIV)].

The site is supported by several community partner agencies
that provide wrap-around services on a rotational basis at the
site. Among these are the

  • Southwestern Ontario Aboriginal Health Access Centre (SOAHAC),
  • London Cares Homeless Response Services (LCHRS),
  • Addiction Services Thames Valley (ADSTV),
  • London Intercommunity Health Centre (LIHC),
  • Canadian Mental Health Association (CMHA), and the
  • Middlesex-London Health Unit (MLHU)

  • When first established, the site operated six hours per day. However, with enhanced provincial funding
  • to the interim site in the summer of 2019, the hours expanded.
  • Currently, the site is open seven days per week, including Statutory holidays, from 9:30 am to 9:00 pm.

Our Numbers

After 2 years of operation, the site had provided

30000
Visits
209
Overdose Reversals
700
Referrals to health and social services

Acknowledgement

The authors would like to acknowledge the staff and leadership from Carepoint Consumption and Treatment Service and Regional HIV/AIDS Connection for their constant support and dedication to this research project. The team at Carepoint provided access to their facility, introduced us to their clients and worked with us every step of the way to make this research possible. Sonja Burke, Director of Harm Reduction, worked with us to ensure we could successfully integrate our research principles into their environment.

When we encountered challenges completing second interviews because of photo development delays, Sonja suggested we work with Kailey Anderson, their Peer Support Worker to accompany participants as they took photographs on a digital camera. Without the support of Sonja, Kailey and all the Carepoint staff, this project would not have been possible.

In addition, we would like to thank the community stakeholders and people with lived experienced who guided us on our

Advisory Committee:

Blair,
Destini,
Jennie,
Mike,
Sam,
Sommer and
Trevor.

Finally, we want to thank our participants who took the time to share their stories and photos with us, so we could share with others.
Your honesty and trust in us is truly appreciated.

Thank you.

For more information about CarePoint:

To find out more about CarePoint Consumption and Treatment Services, visit: http://www.hivaidsconnection.ca/carepoint