November 2025 Instructor Roundtable: Frontline Work and Harm Reduction in BC

In HSABC’s inaugural Instructor Roundtable, host Sarah Kift brings together an extraordinary panel of frontline leaders, clinicians, peers, and harm reduction advocates to talk candidly about the realities of homelessness, health, and overdose response work in 2025.

Calling in from across multiple Indigenous territories in BC and Alberta, the panel shares grounded introductions shaped by decades of experience in nursing, palliative outreach, substance use health, peer leadership, emergency medicine, and policy advocacy.

Together, they explore:

• The current harm reduction climate — what’s shifted, why so many workers feel exhausted, and how political backlash, under-resourcing, and misinformation are shaping front-line realities.
• Workforce challenges — high turnover, lack of training and mentorship, moral distress, and the impacts of long-term crisis response.
• Peer-led leadership and community wisdom — especially the unique strength and expertise of people with lived experience.
• Sustaining ourselves in the work — how seasoned practitioners recognize bias, regulate burnout, and stay grounded in compassion even in moments of frustration or grief.
• Why they’re still here — small victories, community, reframing, and a shared commitment to dignity and safety for people who use drugs.

This conversation is honest, nuanced, and deeply human—offering both validation and guidance for anyone working in homelessness services, harm reduction, or community health. Whether you’re new to the field or feeling the weight of long-term frontline work, this roundtable offers mentorship, solidarity, and hard-earned wisdom from those who continue to show up with courage, humour, and heart.

Guests:

Corey Ranger (he/him)

Clinical Director at AVI Health & Community Services, a board member of the Canadian Drug Policy Coalition (CDPC), and a research and communications intern with the International Drug Policy Consortium (IDPC). Based in unceded Quw’utsun Territory, Corey is a registered nurse with extensive experience in street outreach, community, and public health nursing. 

https://www.hrna-aiirm.ca/our-team/

Shari-McKenzie Ramsey (she/her) Forensic Nurse Examiner at Island Health - Vancouver Island Health Authority, ER nurse, frontline staff trainer and early adoption Naloxone trainer

http://www.spiritustraining.com/our-story.html

Rachael Edwards (she/her) 

RN, MPH- Indigenous Peoples Health, Harm Reduction Nurse, Advocate, Educator, Community Health Nurse

https://www.mtroyal.ca/Summit/helping_the_homeless.htm

Rachel Plamondin-Assu (she/her)

 Empowering PWLLE Leadership and Employment Opportunities | Culturally Innovating Community-Driven Harm Reduction | Low-Barrier Employment & Peer Leadership | We Wai Kai Nation

https://www.parkerandassu.com/

Dr Heather Fulton

Registered Psychologist specializing in mental health, substance use, and severe concurrent disorders. She provides clinical care and oversees psychotherapy training at Royal Columbian Hospital, while supervising and mentoring trainees across multiple MHSU programs. With certifications in CBT, Seeking Safety, Motivational Interviewing, and Brief Action Planning, she also consults and trains providers in trauma-informed, evidence-based concurrent disorder care. Dr. Fulton frequently publishes and presents on innovative approaches in MHSU treatment. 

https://www.drheatherfulton.com/

Topics include handling vicarious trauma as frontline workers, supporting safe co

Transcript

Sarah Kift, HSABC Host: 0:01

Hello, you're listening to HSABC's very first instructor roundtable. I'm Sarah Gift and I'll be hosting today. Around the table with me are a group of instructors who've been teaching our members on topics of homelessness and health, improving safety. And I'm so excited to be talking together today around some of the challenges that face us in this work, some of the ways that we can take care of ourselves, and some of the ways that we can advocate for those that we work with with compassion, strength, bravery, and a sense of humor. I hope that you enjoy this conversation and that it encourages you and supports you in the hard work that you are doing. Well, hello everybody. We're here today to talk about home assistance and health. This is our HSABC instructor roundtable. And I just feel very lucky to be in a room with all of you virtually. My name is Sarah Kift, and I'm calling in from the unceded ancestral and traditional territories of the Kakite, Cape Sea, Quatlin, and Musqueam peoples. And I've been with HSABC for about 10 years now. And before that, I worked in frontline nonprofit services, including in Vancouver's downtown east side at Carnegie Community Center. And I'll be hosting and facilitating today. And really what that means is I just get to hang out with these cool and smart people who are gonna talk all about our topic today, which is um based on all of the questions and the conversations we've been having over this last term of curriculum. So we've been all of these folks, most of them have been teaching and uh talking about homelessness and health from palliative care to substance use to peer engagement to harm reduction. Um and so it's just nice to all be together and kind of talk through some of these things. So I'm gonna hand it over to uh Shari. Do you want to tell us about yourself? Absolutely.

Shari Mackenzie Ramsay: 2:06

Hello, nice to see everybody. Um my name is Shari Mackenzie Ramsey. I'm calling in from the unceded territory of the COMOX First Nation. It's absolutely stunning up here in case anyone wants to come and see it. My current role outside of doing some programming for with HSABC is as an emergency room RN registered nurse. I also work as a forensic nurse examiner, and we are a specialized group of nurses that come to CSS and support people that have been impacted by sexual violence or interpersonal violence from the ages of zero essentially all the way up to 113. And then my third role in my day-to-day life is as a clinical practice educator for our military uh search and rescue, the big yellow helicopters you see flying around, as well as first-year paramedic students. So to bring them into that zone. On the outside of this, I am the co-owner of Spiritus Wilderness Medical Training, and we are an organization that has been doing injury prevention uh teaching and consulting with in conjunction in conjunction with the Red Cross since uh 2001. In 2016, we were fortunate enough to start working with the Portland Hotel Society, doing their healthcare provider CPR, and then tagging on to that uh the naloxone training before it was actually a public access because of the need that they had in the downtown east side. So lots of different um areas that we've been able to um experience as far as this the whole overdose uh crisis has uh has impacted everyone, and um super thrilled to be here with you all.

Heather Fulton: 3:50

Thank you, Shari. Uh Heather? Hello, uh my name is Heather Fulton. I am calling in today from the traditional unceded and ancestral lands of the Coast Salish peoples, specifically Kakite and Coquetlam First Nations, and it's also part of the larger territory of the Helcomal speaking peoples, colonially. It's known as New Westminster. I am a clinical psychologist, really working at the intersection of mental health and substance use health. I am a clinical assistant professor at UBC in the Department of Psychiatry, an adjunct professor in the Department of Psychology. I work at a local hospital training psychiatry residents in motivational interviewing and cognitive behavioral therapy. I also have a private practice where I do organizational consulting. Um, worked previously in various shelters, outreach uh in the East Coast and in Ontario, and just so happy to be here with you folks.

Sarah Kift, HSABC Host: 4:52

I'm so glad you're here, Heather. Uh Rachel P.

Rachel Plamondin-Assu: 4:59

Hi everyone. Um uh uh um which means uh thank you. Uh my name is uh potlatch name that's passed down through my grandfather, uh, which means um woman who throws wealth around. And when I first found that out, I was like, I got no money. But but uh uh when I really look at the meaning of my name, it's um the knowledge of my wealth, my lived experience. Um and uh um uh I'm from the Weevakai Nation. Um and I've grown up reserve and been in the lower mainland for uh in the Quantlin and KT territories for 30 years. Um I've grown up away from my language, so I know very little. And so being able to introduce myself was something that was like I was always so nervous about doing it the wrong way. Um and so that's just a little piece of um my my background. And um I've been working in harm reduction um on the downtown east side uh for the last 15 years um in support of housing. Um and in the last six years, I've been working specifically um in um creating um overdose response uh um throughout the organization, but specifically with um um opening controversial OPSs in controversial neighborhoods, um, along with launching the new OPS inside St. Paul's. So I feel like when I read the one question, I was like, ooh, that one's mine. I feel like but um I'm really grateful listening to where everyone's coming from. I also do consulting. Um when I have I want to say like I have spare time when I but I'm actually off of work right now. I took some time off because I needed to being in front line has uh taken a toll. And so the last question, um, I'm currently um I'm practicing it right now. And uh so uh grateful to be here, share my knowledge. Um and uh yeah, I'm very excited to go through this and hear from North Corey. I'm a fan. I'm a fan. I've been in a few of your trainings, so yeah.

Sarah Kift, HSABC Host: 7:30

Thank you, Rachel. I'm so glad you're here. Uh well, uh Corey, why don't we pass it over to you then? And then we'll come to Rachel E.

Corey Ranger: 7:39

That is very kind praise. Thank you so much. Um, my name's Corey. I use he, him pronoun. I'm a registered nurse. Um I'm joining today from the unseeded, the never ceded Cowitin tribe territory in what is colonially referred to as Duncan DC. Uh and I've been a farm reduction nurse for the last 13 years now. Uh worked in street outreach, public health, establishing take-home the lock film programs, supervised consumption services, and most recently have been focused on uh prescribed alternatives, otherwise known as safe supply programming in British Columbia. I'm the president of the Harm Reduction Nurses Association. I sit on the board of the Canadian Drug Policy Coalition, and I'm the North American representative for the Members Advisory Council with the International Drug Policy Consortium. Very excited to be here and so excited to learn from this amazing group of panelists.

Sarah Kift, HSABC Host: 8:38

Thank you, Corey.

Rachael Edwards: 8:40

Rachel Hello, I'm joining from uh Treaty 7 Territory in Calgary, Alberta, which is the ancestral home of the Blackfoot people, um, the Dene people uh in Sonya Nakota, um, as well as the Metis regions five and six. Um I'm originally from BC, so uh even though I've been in Alberta for 20 years, um, I will still say I am from Co-Salish Territory on the BC coast. Um but um yeah, I have been working for the last 19 years, frontline harm reduction, um shelter settings, community health, public health on and off reserve, um, as well as sexual health, um specifically hepatitis C and HIV care and STBBI testing. Um, and I have had the privilege of working closely with Corey through a few projects. I'm the prairie representative for the uh harm reduction nurses association, and I started a palliative outreach program uh here in Calgary that serves people who are unhoused, um unsheltered, or maybe living in harm reduction housing who have limited access to palliative, mainstream palliative services. So that's yeah, that's me.

Sarah Kift, HSABC Host: 10:04

Thank you, Rachel. Okay, well, let's get into it. Um hopefully our conversation today can open up some more conversation for those listening, um, helping us all to think a little bit more critically, to act compassionately, and to create those safer spaces for the people that we support. I want to start off. I have a list of questions that I've pre-sent to everybody, but I wanted to just start off with just a quick snapshot of how you're feeling right now in this harm reduction climate. It doesn't have to be a long thing, but given that all of you have been in this work for a long time, um, something that I've been hearing from our training participants and in the front line is that things are different now. And I wonder if you just want to give a quick snapshot of how you're feeling and and what you're seeing. Um hopefully that's specific enough, and anybody can jump in and start. Let's talk about the landscape of where we are right now.

Rachael Edwards: 11:05

Can I start since Alberta is a dumpster fire? Yeah. Um yeah, so Alberta um is a very unique setting for harm reduction practices and philosophies in general. Um so I think that um, you know, really and probably across the prairies in in traditionally conservative ridings, we have to be a little bit creative in how we navigate some things. Um, and I think I think the sentiment across the board is pretty exhausted. You know, we feel like we've made some headway and then everything gets taken back. So um, and I think that's par for the course globally at the moment. Um, but I think something that was really telling was at a recent conference where you know we had everybody stand up and people who were new to harm reduction kind of sat down first. And it was really telling to see how many people have stayed working in harm reduction in some way, shape, or form for longer than 10 years and how you know we're losing that mentorship of people that have come before us because people are taking time away. They are going to vaccinate babies because that's not political at the moment and it doesn't seem like a fight. Um, and so I think that this is a really timely, um, timely conversation that we're having today because I think we do need to reach out and find creative ways to support one another in this work, um, keeping not only clients safe, but you know, ourselves and our own mental wellness safe. So I think, yeah, we're exhausted.

Sarah Kift, HSABC Host: 12:54

Yeah.

Shari Mackenzie Ramsay: 12:55

I I guess I just want to piggyback a little bit on what Rachel E was mentioning. And so one of the places that I work at is an emergency department. And, you know, we see these big pushes for exciting ideas and the kind of this waxing-waning aspect of it. And I think people, overall meaning kind of staff and people that are engaging on a regular basis, because it's been so long, you know, there's they're starting to see these cracks in like, you know, I hate to say it, but why why are we bothering? It's not gonna work, nothing is gonna fix this, kind of this this this uh fed up uh feeling towards it. However, on the flip side, I also see these little pockets of organizations that are are trying things that are new, are bringing, you know, looking at how this whole thing is impacting people and looking at it from different angles on how do we continue to have that momentum so that people are looking at it, engaged in it, attempting to support in whatever manner, you know, building that community support and building that frontline support when people are just like, oh, exhausted. It's like you just you can't win. We just can't win, right? And and especially for you know, my profession as an emergence nurse, like we like to win, you know, we like to we like to know what's going on, we like to be on top of things. And you know, as a whole, I think we're just like, man, how come we can't get a handle on this? Yeah, I feel that.

Sarah Kift, HSABC Host: 14:30

Rachel, I know you want to jump in here.

Rachel Plamondin-Assu: 14:34

Yes, to all of that. Um the the turnover rate um in nonprofit is insane. Um, people are leaving on like um I I can't remember like our director was sharing that like we have like one of the highest rates of mental health leaves for work safe right now. Um it's uh it's been really hard, I think. And but what I can say, I feel like after being like through COVID, through all the the crisis, because we were in this huge rush to like hire, hire, hire, because um, you know, uh there wasn't enough workers um in that time, I feel like um we've we've under we've totally um we've harmed I feel like we've caused harm to the people because we haven't trained people properly to be in this work. Um and and and because we're all in unions, uh those unions protect all the wrong people. And I I'm a pro-union, I'm a manager, but I'm also very pro-union. Uh I just feel like uh the that mentorship, I I I feel like I was very, very, very lucky to have some super incredible mentors walk alongside me, but we did, we lost that somewhere. And and and um I was I've been lucky enough to to work specifically with people of lived experience, mentoring people with lived experience. So I've been able to carry that mentorship. So but our department functions very differently than the rest of the organization. Um and we are underfunded, we don't have anywhere close to enough money to to to take care of the people the way they deserve to be taken care of, like um in honorari roles and et cetera. But uh I I can say though that we we have put time into mentoring people in a good way. And so the folks that are coming from and in these honorari roles, we've had like such a unique little system. Like everything is run completely peer-led. Uh, and um from the like the service user to the honorary, I like to I don't come in and tell anyone what to do. I take direction from from the folks, right? Which is very hard for people who have worked the opposite way to to grasp, um, or even have uh health partners come in and take lead from, do you know what I mean? Because it's been such an opposite system. The hospital was a very huge learning curve. We had some incredible nurses on board, but the point is that like you're right, we're losing people. I I'm off right now currently, been off for six months, you know. Um, and my brain is like, how do I I want to be involved in being able to teach people how to come alongside in a good way, you know what I mean? And yeah. Sorry, I'm going off a little bit onto it, but like the point is I feel like in it is that we have stopped training people the way they need to be trained before they're coming to work into this kind of crisis and population, honestly.

Sarah Kift, HSABC Host: 17:32

Yeah, and we see that a lot. I mean, part of what HSABC does is try to give people that training. You know, when I started at Carnegie, I was 19 and I knew how to run a cash register and cook food and you know, a little bit of customer service, but I had no idea how to deal with uh complex mental health challenges, with substance use, with folks who were dysregulated and were just really had high needs. And so I appreciate you saying that, Rachel. And I I want to say I really appreciate the work that you do. Um, I know you're taking a break right now, but the mentorship and the leadership that you give to your folks has made a difference in our sector for sure.

Rachel Plamondin-Assu: 18:11

Well, and that the uh, you know, that that mentorship grew, a leadership that I I'm not there. It's still, do you know what I mean? It wasn't me. It was I was uh create someone created space for me and uh and trusted that you know um that this was gonna work in the way it did, and we were able to do and expand and create leadership and have people in places, people with lived experience in educational hierarchy places that you would need to have a degree normally to work in. And um, you know, but I find that that's also exhausting, right? Doing that work for the folks, and but but widely uh just taking peers out of it, people that are coming into the work um need to be better informed, um better training, more regular training. It's it's not something that you just learn overnight if you haven't had uh and I feel like that's where we have a lot of new people that want to be in it because it's union wages, benefits, X, Y, Z, all the wrong reasons to be in the work.

Sarah Kift, HSABC Host: 19:18

Uh Corey or Heather, did you want to jump in here?

Corey Ranger: 19:25

Heather is gesturing to me like it's my turn, and I have so much to say on this subject, so I apologize in advance. Um, but first, you know, just a shot across the bow for Rachel Edwards, who who managed to say that vaccines isn't that political in comparison to harm reduction right now when Canada just lost its measles elimination status two days ago. Um yeah, but you know, there's there's so much that we should be concerned about in the direction that we're going from a policy standpoint, from a work workforce standpoint. Um we are in an incredible austerity period, and that is reflected in federal and provincial budgets. We are seeing programs that are already under-resourced lose funding for valuable positions. Um, and then just thinking about the scope of this crisis, we're into our 10th year of a declared public health emergency here in British Columbia. Over 53,000 Canadians have died uh during that time. And some of us have been working our way through this since the beginning. I I was a harm reduction nurse before we were talking about fentanyl and have seen the drug supply change multiple times, and what I've seen is just a layering of grief and prolonged stress and moral distress that people have accrued over time, and it is no wonder why people are leaving the workforce. It is incredibly difficult to sustain yourself, and then when you consider the under-resourcing and the funding scarcity, many people and many programs are reliant on exceptionalism, people showing up, doing extra, working off the sides of their desk, coming in early, staying late, skipping breaks, and you can do that in a moment of emergency. You can rise to meet the challenge. But when you're doing that for your 10th year, even the most resilient of people, even the people who have the best support networks, they're gonna find themselves really challenged to maintain that. And then making things even more complicated has been what I would call um the the demonization of harm reduction and substance use and people who use drugs. And in my master's, I've spent the last two years focusing on the policy implications of misinformation, disinformation, and moral panic. And we have seen a very concerted effort from people of high influence, people in power to frame harm reduction as something that is bad or wrong or harmful. We've seen intentional um attempts to show distrust in evidence, in research. Uh, and so you can just Google and see some of the articles that are coming out in mainstream media about harm reduction. And so when you combine the fact that you're under-resourced, you're grieving, you've accrued vicarious trauma and moral distress, uh, and then on top of that, you see this vilification and and how thankless this work can be. Um, it's really hard to keep doing the work. It's really hard to keep doing the work, and we need to do it now more than ever because people are still dying, and we still haven't found our way out of this emergency. So, yeah, I would say immense amounts of concern. Uh, and uh we really need to push back against regressive policymaking here in Canada.

Sarah Kift, HSABC Host: 23:06

Yeah, thank you, Corey, and I know that's part of the work that you're doing on an ongoing basis. Um I was thinking about something you said, Rachel, and I know this is from you, Corey, but you know, we talk about under-resource, and when you actually look at harm reduction budgets, I think it's something like 8% actually goes to harm reduction, and the rest is going to policing. Uh, I'm sure that's not quite the right step, but Corey, you can correct me on that. But I want to just give Heather a chance to jump in here first.

Heather Fulton: 23:36

Yeah, I I echo what everyone else is saying, and I think I feel intensely ambivalent because I've been around now long enough to see these cycles of the pendulum swings and then swings back, and it swings and it swings back. And on one hand, I am excited and optimistic because substance use health and mental health have never been more prominent and in public discourse than ever before. And if at least we can have a shared goal of we need to do better with mental health and substance use health, that is great. Even just the fact that people know what harm reduction is, although sometimes they do not because they have the wrong definitions, but just that it's in their vernacular compared to 20 years ago. And again, this focus, it's very exciting. And exactly what Corey is saying is sometimes there's budgets for all right, we're going to expand harm reduction and yet never give you the resources to actually make it work. And then people say, hey, it doesn't work. Well, you never gave us the resources to actually make the plan. And then it leads to that nihilism. See, nothing works. That doesn't work. You never gave us that program. We never got to implement it. So that's when it gets intensely frustrating. And also, again, if you've worked in substance use health, overdose has always been there. It was never not there. And yet the severity and the risk has gone up. And so the burden on people working and families of the terror, the sheer terror of just one mistake, one slip has a new lethality that it didn't have or didn't always have previously. It's it's very scary. And again, then you see the acquired brain injuries, the traumatic brain injuries. Oh, this is it, it can't, it can be very overwhelming. It's very distressing. And there's this whole terror management part of, yeah, how do I sustain myself and go through this? And yes, it's constant emergencies where I'm asked to extend myself, do extra. So yes, it's kind of zoom in versus zoom out. If I go, hey, compared to 20 years ago, wow, I'm excited and optimistic. And I'm also frustrated. And how are we still having the same conversations and even more exhausted? So I feel real ambivalence and a lot of mixture. We're unsurprisingly, this is a very complex issue with a lot of different systems and things going on. So I I feel it all. I feel it all, and I think other folks do as well.

unknown: 26:15

Yeah.

Sarah Kift, HSABC Host: 26:15

I I just want to say thank you for all of you for sharing that, you know, your snapshot of where we're at right now because there's a lot of seasoning in this room. And, you know, we talked a little bit about mentorship, and I'm hoping that part of our conversation today for folks that are listening is that they will get some of that gift of your seasoning today. So we're gonna move into some questions here. Um around based on our conversation. No, I think I'm gonna stick with this. So we've recognized that this is hard work and that we're overwhelmed, that we're burnt out, that we're grieving, that it's exhausting, that there's a lot of toxic political things, that there's a lot of under-resourcing. And yet, all of you are still here. And I want to ask you actually, I'm gonna go to the final question because that makes sense. So how do you take care of yourself and recognize your own biases and stay in the right headspace so you don't inadvertently cause harm? But also, how are you still here in this work? Because you, you know, Rachel, you're doing an amazing job by taking time off and recognizing that. Um, but all of you are still in this work. So talk to me about that because and think about it from the perspective of somebody who's coming into it and feeling overwhelmed, or maybe somebody who's been doing it for a while and is just like, I don't know if I can do this anymore. So, yeah, anybody can can start.

Shari Mackenzie Ramsay: 27:49

Uh I'll go ahead. Um, so I'm I'm just thinking about this from a perspective of a nurse. So you you kind of framed it a little bit, Sarah, with you know, people that are coming into it. So our new, say, our new emerged nurses, um, our search the search and rescue, the paramedics. And so when when I'm there as one of the old parts, I have an opportunity. And I like to take that opportunity to to listen to how they're they're looking at situations, their conversation and their languaging around situations, and then really work at reframing it. And not only does that help, I think, help them change their perspective on how they're viewing an individual, a person, uh, but it also helps me recenter my nervous system at times. And so I know that I sometimes will get a visceral response when I'm about to approach a person or a person is approaching me. And I say visceral, meaning like I feel a little tinge of maybe some anxiety, maybe there's like some, you know, some tension that I'm feeling, and and doing like a quick check-in to be like what it where is that coming from? Um sometimes it's past experiences, you know, it's it's traumas that have happened in the past that kind of you know fled back a little bit. Um, and and it's being able to reframe that and re-approach that person in my mind as somebody that uh is somebody's child, their parent, their their loved one, versus looking at them from the point of view of their you know, their illnesses, their uh things that they're addicted to, their, et cetera, et cetera. And so that for me is really helpful to bring that person-centered care and also to apply that that teaching of a trauma-informed approach of, you know, I'm I'm thinking of a particular example of one of my Sartec students, and we had a patient that had come in, and she was in a pretty terrible situation. Her kids were in the room, et cetera, et cetera, and going in there and and helping this individual out. Long story short. And my Sartec, when I came out of the room, uh He and he still talks to me about this particular situation to this day. And he was like, How can you how can you do that? Like, how could you treat that person with such kindness when like look what they have done, right? This like look at the disaster that they have created. And you know, because that is a common perspective, especially when you're you're hearing, you're seeing, you're you're not involved per se, you're not constantly being asked to reframe the way that you think and you approach. And and really trying to promote, not only within people that I work with, but within myself, they the trauma-informed approach of unconditional positive regard can sometimes help that person come back to to see us again if they need us. And if we don't do that, they're not going to come back. Um but holding that trauma and being a host to that trauma on a regular basis. I think that's where you see, especially in an emergency department, people that have a really, really dark sense of humor, which sometimes the public is like, you know, you guys are are uh funny at a dinner party, but you know, terrible. How can you say these things? Um, but that's the way that we deal with it. And then that peer peer bonding, if you will, uh, when we're talking about our collective traumas, because it's somebody that can understand where we've come from and the the types of things that we've looked at. So I think that peer-to-peer is really, really important, I know for me, to offload and even to check in with somebody, uh, one of my peers, as far as how was that, you know, those kinds of check-ins. Leaving it at the door is incredibly uh important. So when I come home from, say, a particularly tricky forensic nurse case, um, you know, that has all of the basket of all of the things going on for this individual. Often these are sometimes these are very vulnerable people in a host of different ways. Um, you know, being where my hands are, that kind of regrouping, reframing, coming back into myself, doing those tasky things to kind of put that uh put that aside, all of the information that I just took in, the experience that I just took in, um, so that it I'm not mulching it over, I'm not like reliving it again over and over in my head. Um, so coming back into my body and getting letting it go before I walk through the door to see my family is uh is absolutely key. Because if if I can't reframe the way that I see people, that I teach people to come and be with another person who has multiple challenges, like we all do, then I take all of that home with me and I collect that all for myself. Yeah, thank you, Sherry.

Rachael Edwards: 32:46

Um can I chime in on something related to that? Thank you, Sherry, for for saying that. Um I actually have like a visual at my front door. Um, it's actually my back door because that's where I come in, but I have a hook at the back door. Um, and we are a family of two first responders. And so we have this hook outside the back door that I touch it on my way in just to say, this is where I'm leaving. This is where I'm leaving this day, this is where I'm leaving these things. It doesn't always work. Of course, we carry um we carry the things with us, but sometimes that visual sort of practice of just like intention of leaving that at the door helps me. Um, and uh something else I wanted to say related to that is um, you know, we talk we talk all the time about non-judgmental care, which of course we should strive for, um, but there's an unintentional um consequence sometimes of hammering in that non-judgmental um philosophy, is that as humans, these judgments float past our faces because of our experience, because of our, you know, our own history. Um and so what I always say when I'm talking to students or to fellow nurses or peers is that you know, the problem is not the judgment, the problem is acting upon that judgment. So, you know, approaching the situation and and the encounter with curiosity and humility and recognizing that the client is is the expert in this situation, and it's certainly not us as a person who has, you know, been been given the opportunity to meet with them. Um so I think what that does is it helps take away the guilt of having those judgments, you know, because after doing this for so many years, of course we're gonna see some things that are you know recognizable. I've seen this before and this is what happened. Um, but never act on those, you know, approach it as if this were a brand new situation every time, even though you have had that judgment.

Sarah Kift, HSABC Host: 35:00

Yeah. Good. Um, I know there's a there's a lens here that I'm sure Rachel, you want to jump in on around if you are a peer, um, sometimes it's hard to leave your work at work, hey?

Rachel Plamondin-Assu: 35:15

Yeah. So I found uh so I feel like I'm I I have a deep lived experience. Um that's where my perspectives are from. So uh I'm you know also on a wellness journey. Um I have almost all of my family members who are affected or um, you know, um have had uh been affected by some sort of substance use or from some form of generational trauma. So it's been the biggest job in my whole entire life being a cycle breaker one. And then also trying to like stay well in this work and learn um you know how to apply like I coming into it, you know, with just lived experience. I don't want to say just like I mean, I did there's some things that I felt like being in my role that uh um I uh I don't know how to explain it. Like so I when I get when I come home, I'm at my my family's dying or in hospital or um, you know, um trying to get into treatment or my friend, you know what I mean? So it's it's something that's layered, right, and complex, and there's a lot of intersections to it. And I've learned um um, you know, uh how not to take care of myself, you know. I I, you know, um Corey was saying that 10 years into the crisis, well, before we even had naloxone, that's sort of when I imagine you two were responding with no naloxone. So like it was just like all of a sudden it was just we're you know responding to like 10 to 12 um ODs per shift. That's an eight-hour shift. We are finding people um, you know, um half away in their suites because we didn't know what we were dealing with, right? So, you know, uh I also ended up um in a place of relapse because I wasn't taking care of myself in all of that. Um, I'm you know, very, you know, the creator had bigger plans for me. And I was able to, you know, uh, you know, dig in and do what I needed to do. And and this time it was culturally and um um trying to get myself reconnected. And I believe that that also um it doesn't need to just be for indigenous people going out, being on the land, on the water, touching the theater, you know, like being being able to ground myself. I've also been able to step back in a good way a few different times now from this work, but I find that my time online is shorter and shorter every time I go back. Uh my my my ability to um uh have capacity. Um I have a 15-year-old daughter who is, you know, I thought was just a giant trigger my whole time that I was working, but actually, uh like I wasn't even giving her her own experience, right? Um, because I was the worst case scenarios were at my work. And so uh I was like, okay, hang on. So at now six months in, I I've you know, been in a place where I've I've also just lost my dad. But because I I have been off and I've been taking care of myself, I've been able to move through that in a way, more healthy way. I I don't think about that work that it would I would have handled that well. Uh and and so uh I think to take care of myself, like my body holds it. So my body is holding on to all of the that stress. I hold it in my ear, like my jaw clenched for like, I was like, wow, I just unclenched my jaw for the first time this year when I took time off, right? And but like breathing, like I hold my breath, like all of those things I'm very try to be very aware of. And and it seems so, so, so um frivolous or something that you, yeah, yeah, breathe this, that, but like honestly, being able to regulate myself and pay attention to what my body needs, uh, and um to be able to show up, not dysregulated, uh, um, you know, angry. But that's what happens when you're in grief all the time. My body has been in a state of grief. And so for the last six months, I've just been like a little puzzle, putting myself back together. And uh, and you know, I don't know, I don't think that there is a soul. I don't know how to stop people from being in this this this um position in the work we're doing, right? So uh I just wanted to share that culture with um being able to do the schematic with like the actual massage and like uh um being on the land. Um and I'm in therapy, honestly. Yeah, best thing I ever did for myself. Uh one person who knows zero about my life, except you know, there's no biased opinion. It's like I'm telling them what's going on and what my perspective is, and they're like, okay, you're right out of it. Or or or you know, I totally get what you're coming from, but but like I I need that. I need that one person who, you know, because uh I also rely on my peers um a lot, like um, especially for debrief, not just right after. Like I am in constant conversation and connection with my peers, have just really, really, really dark humor. So yes to that. Uh and people probably think that we're acting right out of it again when we're talking about it. But that is how we move through with humor and and being able to like um support each other and lift each other up. But like uh I wouldn't be able to do that. I have like had like probably like three people in my 15 years that I've just been constant because the work uh people don't stay in it that long, right? And so these three people have just sort of been my constant and are um and and then have supported me and like uh uh being off and and really looking at what I need to do. And I'm my heart wants to be in this work. I don't know you know if it's if it's frontline anymore. Do you know what I mean? Like I I wasn't able to, I wouldn't be able to have that perspective right now if I wasn't off, if that makes sense, right? Like I it was the best thing I've done for myself. I've attended a bunch of cultural grief and loss retreats um throughout the last couple of years that have been um hosted by my nation. And that's where I've been rooting in. And I know that that isn't for everyone, uh not everyone has access to that, but um I really leaned into that to take care of myself this time around.

Sarah Kift, HSABC Host: 41:28

Thank you, Rachel. Corey or Heather, do you want to quickly jump in? Uh why are you still here? Sure.

Heather Fulton: 41:37

And I think I'll I'll build off what uh Rachel P was just adding there is sometimes changing up how you work, right? Thinking like, why did I first do it? And there's there's usually even when it's like you can sometimes feel numb and so burnt out where I feel nothing and feel that real nihilistic part, but then like, why did I go into it? And could I do it differently? Like, could I be the mentor and support that I needed during during those dark times, right? And maybe work differently. Yeah, maybe I'm vaccinating babies now, but you know what? I'm also working on a peer support mentor network or something else. I can do things different. Do I want to maybe change make change within the system? I'll do an advocacy group. Or again, how how much do I have available? Right. Again, if I'm running on fumes, I might not have that much fuel in the tank. So maybe a step away. And then how do I connect with that? And the other thing I want to think of is because I think it's related to what Rachel P was saying, but also Rachel E, um, of like, I'm gonna mess up, right? And I think that self-reflection of I'm burnt out. And I I've had these moments of I can hear of trying to be compassionate, but I can hear my voice where it's oh no, Heather, like, are you becoming one of those people you said you'd never be? Like, and I remember a distinct moment of trying to be compassionate, and I can hear it in my voice where I'm like, oh no, kind of thing. And recognizing I am a human too. I gotta reflect. I'm learning, I'm gonna make mistakes, I'm gonna mess up despite my intentions, my best intentions, and yet that self-reflection and capacity of okay, I'm I messed up here. I messed up. This is not who I want to be and how I want to act. I try and create space so people will give me that feedback. And if I notice it or someone else notice it, like let no mistake go unwasted, right? Of how am I going to learn from this? Because the only thing humans are perfect at is being imperfect. And so why that happened, despite my empathy, compassion, and values, what happened there, right? Because James will shut down my learning and it's gonna really drive that burnout even farther. So recognizing, okay, James has shown up, Jane has entered the chat. Why is it showing up? And then again, don't let it go to waste instead of going into James Biral of how am I gonna deal with this? How am I gonna learn from this? Like, why am I so frustrated by this? Why am I blaming and mad at this person in front of me instead of the system factors that shaped this and shaped my response kind of thing? And then what is in my control to change of sort of shifting that and that going to understanding and curiosity rather than this sort of shame, guilt spiral that can really further drown me and further spiral the burnout is something that's been really helpful for me as well.

Sarah Kift, HSABC Host: 44:51

Thank you, Heather. Yeah, when shame enters the chat, we want to pay attention. Hey. Corey, did you want to get in on this?

Corey Ranger: 44:59

Yeah, I mean, such a rich conversation happening and you know, thinking to myself, why am I still in this or what do I do to sustain myself? I would say I'm definitely still a work in progress. And it's required a lot of uh reflection, um, a lot of sitting with discomfort, a lot of uh trying to kind of roll back the tape on what happened with a critical yet compassionate lens for myself, and learning how to do better the next time. And you know, some of the things that I've learned throughout uh my my tenure in harm reduction has been that a lot of the principles and practices that I teach people about harm reduction can and should actually be applied to myself as well. And so finding opportunities to establish solidarity support networks, people you can debrief with who get it so that you're not bringing it home. Um, you know, trying to resist that reactivity that is so common in these ongoing emergency scenarios. And you know, I can travel back in time and and talk to myself when I first started in harm reduction. I I recall multiple times where I showed up when maybe I wasn't at my best self, or I thought that I needed to be there because if I wasn't there, some terrible harm would happen to the people who have relied on me. It's taken me a long time to realize that that mindset was more about me than about them. And and also that you know, you can slow the bus down, even though it's an emergency, even though everything is awful and terrible, we can slow down as a team, we can slow down, we can pause, we can reflect, we can debrief with each other, we have to make space uh for those opportunities. And so now I'm in a leadership role and I'm seeing you know, these younger versions of myself doing the same thing, showing up when they're sick, showing, you know, working overtime, skipping their breaks. Uh, and it's it's my job now as a leader to try to break that cycle and to tell people actually, no, we're gonna we're gonna pause, we're gonna close early today, and we're gonna debrief and we're gonna make sure that we have an opportunity for everyone to be uh heard and and to share their experiences. And and I think the last thing too is just you know amidst all of the you know uh grief and loss and and witnessing the poverty and structural violence that can be so hard is also just an overwhelming sense of moral distress because it's never enough what we have that we can give someone, um, whether it's from a programmatic standpoint or as an individual standpoint, the needs are endless. And so um finding ways to name that moral distress and to and to act on it and find ways to support your teams to act on that moral distress uh is a really great way to kind of scrub the moral residue that starts to accrue over time. Uh, and so you know, sometimes our teams will volunteer to do something, will participate in a in a protest or some kind of direct action together because it's very overwhelming and makes you feel helpless when everything is changing and it's so big because it's the systems that change. So, how what what small things can we do together as a team today to push back against that? It goes a long way in terms of resilience and and sustainability.

Sarah Kift, HSABC Host: 48:43

Yeah. Oh, I feel like we could just talk all day, but we're gonna move on to a big question here. Uh right now, this is in the news a lot. Uh, people are talking about it. There's a lot of uh what they call NIMBYism going on, like you can't open a safe injection site in our neighborhood. And actually, I have to be clear here, we're we're talking about safe consumption sites now because the model of harm reduction that was implemented was injection-based, and now we know that up to 70% of drugs are being smoked. And so there's a whole new, well, maybe not 70%. I according to my staff guide, I'm getting wrong. Anyway, I'll just say uh what does it actually take to support, operate, sustained, advocate for safe consumption or overdose prevention sites? So we can talk about community engagement, we can talk about harm reduction principles and staffing, we can talk about that whole community impact of are you getting into arguments with the business owner? Are you trying to work together with them? How are you combating the news? How are you getting your funding? Um for folks that are you know thinking about uh trying to get that into their community or trying to be more supportive, what what would you have to say? And and I love that all of you have had a lot of experience in this from different kinds of ways of thinking about it. So let's uh let's give people some advice on this. Uh Corey, do you want to kick us off?

Corey Ranger: 50:15

I'll take a crack at this one if that's okay. Um, and then happy to pass along and uh wouldn't be myself if I didn't correct your stat. It's 73%, but that's that's the the mode of consumption among people who are dying by overdose. 73% of people who died by overdose were smoking their drugs when they um when they passed away, is is the statistic. Um, supervised consumption services, overdose prevention sites, um, they're evidence-based practices. They are life-saving services, they improve individual connections to health and social services, they reduce community harms, they reduce instances of disease transmission like HIV and hepatitis C. They're death prevention sites and their connecting people uh sites. And so they are incredibly important components of our continuum of care. They're incredibly important um uh interventions in our response to the toxic drug poisoning emergency. And there's a whole bunch of like technical, you know, if you want to like how do you technically start an overdose prevention site or a supervised consumption service? Um, it depends on the province that you're in in DC. We have a ministerial order that technically allows for the establishment of overdose prevention sites wherever there may be a need. Um, federally, there's something called the urgent public health needs site. Uh, and so because of that kind of subsection exemption to the controlled drugs and substances act, people can email their provincial minister of health and request support in establishing uh a UPHN or an urgent public health need site. Um, and then if you have a non-supportive provincial government, which lots of uh people do, uh you can actually still apply for an old-style traditional supervised consumption service with a Section 56 exemption by emailing the federal government yourself. Um, that's like you know, the technical how-to. It doesn't speak to the fact that there is a lot of resistance to these services now. And so we are not just contending with bureaucracies and red tape when it's when it comes to, we're also contending with that moral panic and that misinformation about uh about these types of services. And so in addition to getting you know the approval from the federal or provincial governments, depending on where you are, we really do need to do a lot more public education about what these services are and what they're not. Um policy changes when the public indicates a need for policy change. And so policymakers and people in power uh won't suddenly endorse the service when they feel like the current uh public attitude towards it is is quite negative. Uh, so we actually have less of these services in Canada than we did last year and the year before that. We've seen closures in Ontario, we've seen closures in Alberta, we've seen defunding, we've seen restricted access to harm reduction supply distribution in provinces. And so we need to get back onto the advocacy campaign of explaining to the public why these services are needed and also what the limitations of these services are. They are not a panacea, they are not going to address poverty, they are not going to suddenly address our housing crises across all of the different provinces and territories in Canada. What they do is they stop people from dying, right? And they and they provide some ancillary benefits, but they are a starting point. It's an emergency response to a now prolonged crisis, and we need the structural change to accompany it. Uh, you know, like the laws and policies that are putting people at risk to begin with need to be addressed. Otherwise, we are always going to be all the way downstream. And supervised consumption services are a very downstream response to the toxic drug poisoning emergency. We are acknowledging the drug supply is poisoned, it's toxic, it's gonna kill you. Uh so if you're gonna use, please come into this space where you're legally allowed to use, and if you die, we'll resuscitate you. Uh, and so we need it, but we need everything else fully invested in if we're actually going to support people to move through the continuum and we're gonna see an end to this to this uh devastating crisis.

Sarah Kift, HSABC Host: 54:53

You're listening to the HSABC Podcast. We are the Homelessness Services Association of BC, which is an umbrella organization of shelters, drop-in centers, homeless outreach teams, and other service providers addressing the needs of persons experiencing homelessness in the province. Our over 260 member organizations can access regular workshops and webinars, participate in regional efforts and coordinations and research initiatives, and benefit from advocacy of the AFCR sector. Our members can access live webinars, recorded webinars, our self-directed online learning platform as well at HSABC, and we also travel around for profits doing in-person trainings and regional events. To learn more or to sign up, please go to our website at hsa-bc.ca. Thank you for listening. Rachel, I know you mentioned that you helped set up the uh OPS at St. Paul's, and I don't know if uh any other folks from that sort of healthcare perspective. What was successful for you in getting that going? And how do you how are you sustaining that in terms of your work?

Rachel Plamondin-Assu: 56:04

Um well, the biggest part of sustaining it was having uh um uh healthcare workers and nurses and doctors that actually believed in the service we were going to provide. We had them championing uh, you know, for the service um and had you know their uh guidance and and they took ours. You know what I mean? It didn't feel like they were telling us what to do. They were very, very receptive of a peer-led model, like um, and uh uh believe you me, there was Nate Bayers, uh, but like they they you know conjoined arms and and kind of you know um you know walked us through. And and and honestly, um I wish I had the stats right here, but I just the uh the reduced uh risk and uh uh the reduces in overdoses uh because it's only for hospital patients. You actually can't come as a um somebody from outside and come inside. You have to be a client of the hospital in one of the programs, whether it's on one of the units or yeah, accessing their OAT program to RAC. Uh but there's like uh everyone was sort of on board, if that makes sense. Like uh the units people are coming from. Um and and because it was completely peer-led, uh, I feel like from talking to the service users, it started off small in an eight-hour pilot, moved to uh, and now it's just moved to, I think, uh 16 hours or something like that. Maybe so that it's open from or maybe even more than that. Uh but but they they because the the need of the hospital or the patients was so great after closing time, they started adjusting. So what they did is they actually were really look like listening to what the people needed and and taking stats around it. And then having uh the actual allies and people championing alongside the work we were doing was so, so important, right? Um, and and when I I I want to explain what like peer-led means and why we want to do it from that uh standpoint, you know, I feel like um from the person that's receiving the care, uh I feel like have had they've uh either experienced being in such broken systems, uh not getting served the way that they need to get served, especially when it comes into healthcare. Um and uh, you know, uh being able to create space with other people um who have been through a similar journey is having a familiar face. Um when they come on site, that you know, I would be more inclined to start a conversation with somebody they know. Uh, and also in some cases inspires some hope, you know, that that that maybe, you know, uh having enough time with somebody to have a conversation and them asking where, you know, I think that was the biggest thing that I used is that people just couldn't believe that I had, you know, made an exit. And and um it gave people hope because I was, you know, and it wasn't going out trying to like sell my recovery, but it it was genuinely hopeful for people to see. And so when that started happening and there was more and more lived experience embedded, you could see how people were um able to trust, uh, how we were able to connect services, um, how we were able to uh de-escalate in a situation. Um it just it just really started to make sense, I feel like. Uh and I I I um I think that that just a little bit to the last question is what's kept me in the work is seeing uh um space being created for um people that uh it I mean our peers and the people that are um uh in this work are even outside of the work are the are responding regardless if they're getting paid or not, right? So being able to create um like fair employment opportunity um to the people that are actually, you know, they're there before the first responder. They're they're we're responding before the fire trucks, before the ad. ambulance and so being able to hold space for that and I think that and and create space for that for the experts to be in these roles right and and to take guidance from them and and they're with their experiences in it. And it has been one of the most humbling and um rewarding experiences but it's also really exhausting and uh in for that matter of what we were chatting about before. But the peer employment opportunity um that comes in being able to engage people in their care, I think is the most rewarding thing that I've seen.

Sarah Kift, HSABC Host: 1:00:35

Yeah yeah absolutely I'm gonna move on um I did want to just uh check in with our Alberta contingent here um uh around OPSs. Um I know you had mentioned you've been doing some sort of not guerrilla work but uh advocacy type work in unofficial spaces.

Rachael Edwards: 1:00:54

Did you want to say anything quickly about that when it relates to OPSs am I the only Alberta contingent yeah um so there are some pop-up OPSs that are happening here in um probably in Edmonton as well but uh locally for me in Calgary um and you know I think we really have to recognize the privilege that it takes for people to be able to participate in that um because that's not that's not always the case for folks um with lived and living experiences to be able to partake in that without um facing consequences in our in our political contexts. So we actually have um some physicians that are sort of spearheading these projects and letting those of us who may be union workers or non-union workers and and you know with regulated governing bodies um to so those physicians kind of are taking the heat for that where we just kind of volunteer our time um which is which is really lovely. So again recognizing that that's that's really not for everybody because you know in a union setting in this political context where you know our health system really is in um a bit of a flux right now right I I don't know if you know but our one Alberta Health Services has dismantled and is is um spread out into four different um health services and there's just a lot of uncertainty. So people are really scared um about what you know kind of what is happening. So those OPSs are um understaffed uh well attended um and we only here in Calgary have uh opportunity for injectable consumption sites we don't have spaces for smoking um which is problematic um but um yeah we kind of are making do with our one our one um provincially funded uh injection site um yeah so I I don't know I just wanted to recognize that that privilege it really you have to be willing but some of the you know the more upstream things I think that we can and maybe those of us who have been around longer have the opportunity to do is to speak with our representatives and to try to make change um at that level you know where we're thinking about who we're voting in you know in our next elections is really important. But that again takes a lot of time right we found that smaller group settings um it's a lot easier to have conversations you validate people's fears about harm reduction about consumption services um is a lot easier in a group of you know three to ten people versus larger scale settings and so the time and commitment that is required of people to do that um is is again um prohibitive as far as cost and time and and human resources. So um yeah I think we're we're not holding the optimism baton here in Alberta currently we're gonna pass that off to somebody.

Sarah Kift, HSABC Host: 1:04:25

I will say um before you move on I think about my own experience coming out of uh a very conservative upbringing and not knowing what harm reduction meant or um thinking that uh or being told that people who smoke cigarettes were going to hell, right? Like let's be frank here around some of the things that people are coming in with prejudice around. And I think that one thing that has been really effective for me is just hearing from folks and the work that they're doing and redefining the terms. And that can be as you know like that's like following Corey on Facebook or or um any one of you you know and so I hope that part of the hopefulness is that through you talking about your work honestly and authentically it actually does change people's opinions. You know there are always going to be people that are going to get mad on on our community groups on on various social media platforms but there are people that are listening around redefining those terms and sharing those stories. So I hope that you keep doing it. It is hard though. Okay so because um I want to prioritize these two questions I'm gonna kind of combine them together because this is the thing that comes up in almost every training. So people talk about harm reduction and meeting people where they're at and they go oh that's all nice and good when everybody's feeling calm and everybody's doing okay. And what happens especially for new frontline workers is that lack of confidence and that fear. And so two questions that always come in are um if a client is really experiencing something like psychosis or they're escalated or you know a lot of people are just kind of like well this person's just screaming at me. This is not a meet people where they're at moment. And I'm not necessarily talking about you know if you feel unsafe obviously you need to make yourself and the people around you and that person safe as well. But I'm talking about that kind of interstitial space where you know I'm not going to work every day at Carnegie and expecting everybody to ask me nicely for everything or to be able to articulate what they need in a way that might not come across as aggressive or out of it or whatever. And because all of you have been working frontline for so long and you understand these things I really want you to give me a practical answer to this. Give me some tips. So when you're working with someone in crisis if they are experiencing psychosis so part one of this question is or they're elevated how do you stay grounded and respond safely and compassionately let's get let's get this seasoning going. We we want to know your expert tips because you have all talked to a lot of people who are elevated who are overwhelmed who are experiencing challenges what do you do to respond safely compassionately and stay grounded I'll I'll I'll jump in with this and again it's gonna be so context specific here.

Heather Fulton: 1:07:39

What do I know about this client? What's happening in the situation but so just in general first is kind of what we were talking about before right with don't rush you know even if if anyone's ever called 911 you know how frustrating is sometimes paramedics they show up they go slow they put on their gloves they survey the scene there is no rush where sometimes you're like oh it's a rush come on and yet calm methodical even if inside I am like this is a rush of just take a breath let's be intentional and deliberate here and the first question I usually ask myself is what is the most important thing here right is my goal I need to keep other people safe? Am I keeping this person safe, right? Do I need to keep myself safe? What what is the goal and just assessing what is the risks? What am I dealing with here and getting clarity on what is the priority here of where I'm going to direct my time and attention because if my goal is actually I am most concerned about other folks' safety right now, then that's going to change a little bit how my respond is actually no, I need to help work with this person and can I help alleviate their distress. Right. So that sort of just strategic surveying the scene what is my priority here and then assuming the priority is all right I want to help them with their distress and I also may feel distressed as well is something that helps me is recognizing this is really hard for them. And how does their behavior actually make complete sense? And that's hard where sometimes someone's experiencing psychosis they feel like someone's out to get them I am out to get them or I am part of the problem I want to just convince them that no, I am not and yet that is probably not going to be helpful right of just understanding how does their behavior make complete sense and then can I normalize and validate I'm not saying it's okay or it's no big deal but just I see them I see how hard this is I want to be clear kind predictable transparent I want to say what I am doing why am I doing it never ever try to hide or ever be sneaky people will pick on the on that way before you even think about it. Right. But for me is again how to get that common humanity how does their behavior make complete sense and that also often will give me ideas of what I need to do next and then approach it in that sort of trauma informed culturally safe way of okay this behavior makes complete sense. And if it makes complete sense then as a result what do I want to do next so there's a couple breadcrumbs there and yes it will depend but that's a start.

Sarah Kift, HSABC Host: 1:10:55

Yeah I really like that this makes sense for them in this moment is a good starting point.

Rachael Edwards: 1:11:01

And that pausing all right Rachel I see your mic is yeah Rachel E, sorry I was just gonna say um first thing just don't take it personally right just like whatever is is happening it's not about you um and I think that that is really important uh because you know the minute we get defensive um really things will escalate very very quickly so you know yeah make sure you've got that that duck's armor on let the water just roll right off um and then you know some practical things if somebody really is feeling um sort of overamped or in in a psychotic state the best thing you can do um is really just reduce the stimulus around right so remove people who are not necessary for the scene make sure we don't have looky loo onlookers you know throwing in their two cents about what should be happening to sort of limit limit the situation to who actually needs to be there. And this can include things like you know even just turning down the volume of the music or turning off the music. Often you know when people hear music and TVs and other people chatting that can that can create that feeling of overwhelm. So just try to reduce all that environmental noise maybe turn down the lights if they're you know really bright aggressive lights and if you have like a little dimmer you can kind of just shut off some of the lights again to reduce some of that stimulus. Those practical things can be helpful. I often to uh offer food right off the bat, you know, hey do you want a muffin do you want to sit down and you know maybe we can chat about this seems like something's going on for you um maybe their blood sugar is is really low and they're quite hangry on top of everything else that that is going on for them right so um sometimes just offering that that piece of compassion in the form of a muffin is is really helpful.

Sarah Kift, HSABC Host: 1:13:09

Thank you Rachel Rachel I noticed you had your mic off do you want to jump in here and then I know Shari.

Rachel Plamondin-Assu: 1:13:16

Yeah um I feel like uh most situations um especially like in a shelter or OPS or um it's never an ideal situation to try and de-escalate or it always feels like there's you know a lot going on. So for me it's just like immediately trying to see how I can lower it. So it's my body language, it's it's it's my tone. I don't even I might not be able to meet the exact need that is happening but I'm trying to meet a need right away whether it's food, can I get you a drink, do you want a cigarette like immediately trying to offer some you know and if folks aren't responsive that way and are in some sort of psychosis, which is often like what privacy would be to you or to me might not be what it is to them. And so being uh brought aside somewhere where it you know it's quieter and it might not feel safe to somebody who's accessing space or or or doesn't have that close of a relationship or is just in psychosism isn't able to establish that relationship. So I feel like meeting a need whether it's the actual need most of the time it's never the actual need um but um the tone and the body body language is important. And then um being able to like um um like a psychosis is very real to them. So whatever is happening for them whether you know I I found that like a lot of times people disregard people's psychosis and um but whatever's happening to them is real. So like we're not maybe validating that but we're gonna validate their experience right about what's happening at UC you know like um trying to like I think when people you know uh hear that hear that you see you know that it's going on for them rather than judging or having a comment there's a lot of people that have a comment yeah so those would be the few things for me.

Sarah Kift, HSABC Host: 1:15:11

Yeah sorry Corey I know you've seen some stuff we've all seen some stuff.

Shari Mackenzie Ramsay: 1:15:21

I guess from my perspective being in an emergency setting so two different areas of it right so at at the front where you're beating them without that person being brought in by EHS or or police or whoever um I I think there's there's some components of it. The first one is to is checking yourself and I think a couple of you mentioned that so whether it's checking what what your state of mind is are you already amped before you engage with this person? Are you feeling can you comment centered you know even though people are like you should be really not common centered right now to reflect this person's behavior but it's it's not helpful right and so am I common centered on the outside by taking a breath am I am I good to go despite whatever is going on on the inside am I safe is my number one thing. So am I in a safe uh positioning in the room am I um wearing things that are are safe when I go in and encounter this person i.e this is a terrible thing to wear when you're dealing with people that are elevated um you know do I have a stethoscope around my neck is there anything in the room if I'm going into a room with them that they can throw at me that you know just as far as the the overall safety aspect of it and then assessing it do they have some semblance of adherence? And so I heard people um saying hey would you like to have a seat would you like a cookie would you like so on and so forth is if they have adherence or if they're able to able and willing to follow direction your communication level with them is going to be a little bit better than if they if they're brain on fire essentially for lack of a better word or phrase where they they just can't they're not ready to engage under any circumstances. And then in that case I'm also looking at what does their safety profile look like? So are they safe for themselves or are they safe for other people to be around them? And fortunately unfortunately for us if that person is safe in their environment and you as a person that's engaging with them feel that you can reduce the stimulation you can remove things that are hazardous they are in a in a safe room where they are not going to cause harm to themselves or going to over stimulate their already overstimulated situation and you can back out of there and just let them let them work through whatever's going on until you can try to approach again or do we need to because they are unsafe for them or for other people do we need to move to other steps which it obviously we try to do it in as trauma informed as possible but ultimately at least for their safety and for our safety and that could include things like medications security assistance you know to do something that turns their brain off temporarily to give it a rest sometimes that resets sometimes it doesn't you know and when we were talking about the whole psychosis thing right and it's looking at are they are they outward with it are they engaging in external stimuli are they engaging in internal stimuli are they very quiet um you know like so where is that looking and what is your kind of your area of safety with that person um obviously being compassionate with where they're at and trying to gain an understanding that that that behavior is you know because of an illness or because of you know sometimes it's drug induced uh if it's a if it's a behavioral crisis you know yes I get it they're in a behavioral crisis because of this situation that they're in and hopefully we can work our way through that by providing you know that safe space holding space for them using your energy as being you know calming your energy down so that they will hopefully mirror reflect that to a certain aspect but sometimes people the house is on fire and you you need to send in people that can tamper it down put the fire out so police fire not not fire literally but police or EHS or um you know security extra people around to do medication and things like that. Until you've you know sometimes you don't know if it's a a drug-induced psychosis or this is part of their mental health picture that you know hasn't been going so well for them.

Sarah Kift, HSABC Host: 1:19:32

And I think that you know it's hard to translate this kind of seasoning and context into uh quick tips because you know I've had a knife pulled on me like you know just we've all been through escalated situations. And part of it is that reflection piece, that debrief piece and then what am I going to do differently next time? And then also that reframing piece which a lot of you have been talking about. Corey, I wonder if you can bridge um we're gonna end here because I think this is something that people ask about all the time and it was touched on already we're never in an ideal situation right like we've talked about lack of resources we've talked about understaffing we've talked about burnout like there's no magical OPS or reduction place that where everything is beautiful and the lights are dim and everybody's common centered and like that does not exist right and a lot of resistance we get in our training not resistance but like okay that sounds great but how can I actually do that given what we're facing and so the question here is when you're working with someone in crisis sometimes most of the time the setting isn't ideal.

Corey Ranger: 1:20:44

Maybe there are other people around you can't move to a private space so how do you navigate these moments that we all deal with with the tools we have while still providing that care and support let's like really land this in a grounded way and other people can jump in too but I know Corey you haven't had a chance yet to talk so yeah I mean sometimes and there was some really great uh comments from the last uh question so I didn't feel like I needed to to interject or to take up space in that regard but you know sometimes the space isn't ideal maybe you're in a shelter lobby or on the sidewalk but like care is always possible and and if there's one kind of like quick tip that I can give someone is to intimately understand the window of tolerance. To understand both that you show up with the window of tolerance and that the person you're trying to care for has their own window of tolerance and so knowing where you're at when you're showing up for shift when you're responding to crisis and being able to implement some um some self-regulation technique so that you can um be in your optimal zone and you can be problem solver and you can creatively think your think your way through a situation is imperative and also understanding where that person is at as well because it's going to dictate your communication strategy with someone if they're in the hyperarousal state and they're really agitated. They're not thinking things through with a lot of problem solving potential and so you're going to change your communication style so that it can be simple, clear, give options to people but it starts with you. It starts with how you show up and sometimes our window is really narrow because we had a bad day because we're on our sixth fifth in a row because we haven't slept very well we got into an argument with our all of that is going to contribute to the outcome of uh of your kind of your response and I'll just you know I'll I'll I'll end with a little bit of a an anecdote in that um I often ask new hires and people new in in nursing to go through a bit of a scenario with me and I'll tell them about this client who's outside in the rain, who's in distress who's soaking wet in the rain who's talking about things that you can't see and you can't hear who's perhaps verbalizing some desire to harm themselves and is adamant that they don't want to go to the hospital. They don't want you to call 911 and I ask these these individuals these uh new new nurses like what are you going to do in that situation and so many people are quick to I need to call 911 I need this person's obviously a danger to themselves they need to be formed and very few people think about getting them out of the range about offering them uh uh some warm shelter about reducing some of the stimuli about getting them warm and getting them fed and addressing some of those basic needs about moderating themselves and practicing some deep breathing of their own of modeling that kind of self-regulation you do all of those things you're likely going to reduce some harm and you're likely going to bring someone back to a little bit of more of a rational space even if we're dealing with something that can be quite serious like psychosis when we address the basic needs when we empower people and let them know that they are still a decider in their own care and and and in their own needs um the results are really fantastic most of the time that you can actually bridge the connection that you can actually understand what that person needs. And so really that's and that's that's the that's that's meeting people where they're at right and that's the literally meeting them where they're at that's the figurative meeting them where they're at with not applying any kind of judgment uh and that's the meeting people where they're at from the person-centered care perspective of understanding what their needs and priorities are and of you making that your priority and those are strategies that we can implement whether it's outside in the freezing rain or it's inside your clinic setting um and I think that that's probably been one of the most effective tools for myself in my practice.

Sarah Kift, HSABC Host: 1:25:11

And that phrase meeting people where they're at a lot of people know what it is. A lot of people think they know what harm reduction is but I appreciate the way that you've really laid that out clearly just as we close it brings to mind something that happened to me recently in um Terrace when I was there for a training and it was after the training I was at a coffee shop with my colleague it was pouring rain and there was a guy outside in the bush and I was like oh that's kind of wild and then I looked over and in the coffee shop were two paramedics and the ambulance was there and they were having coffee and I went over to them and I said hey what what's the deal? Like is that guy outside okay? And they said oh yeah he doesn't want to go to the hospital. We we can't force him he's fine and I'm like well is he breathing is he alive like yeah yeah he just we've checked on him and they continued having their coffee and I just you know like I'm not shading paramedics because they have a protocol. But in that moment I was like well who can I call that will so it's not a medical emergency this is what I'm trying to say. This guy is not wanting to connect with medical services probably for trauma all kinds of legitimate reasons right he is preferring to lay in a bush in the pouring rain rather than engage with these health professionals. So that tells me a lot about the system and the culture in Paris in particular there's a lot of great people there as well and so I called one of the local outreach teams and a peer showed up and went and talked to him. And it wasn't are you okay are you still alive? You know how can we get you into it was like hey you're really cold and wet like do you need a coffee? Like do you want to stand under the shelter of the outside like he didn't feel comfortable coming in and he went from being totally like the paramedics were trying to engage with him. This person showed up and he was immediately up and out of the bush. And again I just tell that story because it's so crucial the work that you're doing the mentoring that you're doing the care that you're giving to your new staff the work that you're doing in regards to talking to people about how to care for one another. Because you know when we're talking about harm reduction at the root of that is meeting people's needs and offering care. It's not about solving the problems because none of us can do that ourselves and we need to be engaged in all that advocacy work and and the structural stuff as well. But at the root of it is caring for other human beings. And so I just have to I'm so grateful for everybody here on this call. I'm grateful for all the people that are listening. And I wonder if there's anything else uh that's coming up for you before we close that you just wanted to offer um to folks that are just really seeking to know how to do this work well.

Heather Fulton: 1:28:13

I just wanted to mention one point because it connects to I think what Corey was saying and the points you were just making there of and that's why self-care is so important. Because if I am exasperated, I'm burnt out I was dealing with a whole crisis at home and then I get a call to show up how am I going to show up as sort of a wholehearted self of compassion for this other person or am I going to show up here's another thing I got to do and I I want to care but I'm tired. You know that is why self-care is so important as a strategic and tactical choice to go no I need to take a day off I need to take some time I need to do nothing related to this because I need to fill up my gas tank. I need to make sure my battery is fully charged so that I can be fully charged and ready to think outside the box, question my assumptions what why are we doing it this way? Why can't we just get outside the coal before we talk why can't I why can't I just get a muffin for this person right and question those assumptions and to show up fully for another person. That's why exactly what Corey was saying and what you were saying right now, that's why I think self-care is so important because my behavior also makes complete sense and that's why I have to be really strategic and tactical and intentional with my self care so that I can do exactly what you were saying right there.

Sarah Kift, HSABC Host: 1:29:46

Thank you, Heather it's a reminder that self care isn't just bubble baths and shopping excursions. It's literally taking care of your own body so that you can care for others. Well I'm really hoping and we did get To all of our questions today, but we got to a lot of them. And I'm gonna go away from this conversation really uh feeling hopeful actually. Um, not only because all of you are continuing to show up after many years in the work, but being willing to offer um mentorship and and advocacy to others who are just starting in this work. So thank you. Hey everyone, it's Sarah Kift from HSABC, the Homelessness Services Association of BC. I'm the training and communications coordinator here, and part of my job is making sure that people working in housing and the homelessness sector have the tools, skills, and support they need to do this incredibly important work. At HSABC, we offer a wide range of learning opportunities: live webinars, in-person workshops, regional trainings, and our self-directed platform, Learn HSABC. If you haven't checked it out yet, Learn HSABC is full of short, practical online courses you can take anytime. You can learn at your own pace and earn certificates in trauma-informed practice, de-escalation, harm reduction, leadership, indigenous governance, board essentials, and so much more. So when I think about when I first started in this field, I had none of this kind of training accessible to me. And I also understand how hard it is to take time off work when you're frontline to actually even attend training. So I'd really encourage you to check out LearnHSABC because it is available on your mobile phone. You can do it in three to five minutes per video, and it's a really handy way to squeeze that training in when you're needed at work. Whether you're brand new to the sector or you've been doing this work for years, we're here to support your growth and your well being and the training that you need in the frontline work that you do. You can explore everything we offer and sign up for training at hsa bc.ca.