This month, Malcolm Tourangeau and Chris Livingstone joined us at the CAI office to answer questions about their work as members of CAI’s Overdose Prevention and Education Network (OPEN) Evaluation Steering Committee (ESC).
Formed in 2019, the ESC grew from a significant finding in OPEN’s 2018 Phase 2 evaluation which identified that coalitions in the network recognize the importance of centering the role of peers in overdose prevention and response work. Findings also suggest that harm reduction efforts became more widespread in locations where coalitions are active, and where coalitions exist, community awareness of the overdose crisis increased.
Using a Participatory Evaluation Approach, Malcolm, Chris and the ESC are exploring this finding and will test the assumption that when peers direct and lead overdose prevention and response work, the uptake of harm reduction strategies and interventions increases within the community.
Peers have played a key role within the evaluation process for this project. In addition to providing feedback and input into the evaluation design, process, methods and analysis, peers have conducted numerous recorded interviews of OPEN peers and co-created and co-lead a data party session our recent October 2019 knowledge exchange event, hosted by the Sto:lo Services Agency.
Malcolm and Chris come to the CAI table with extensive and unequivocally valuable knowledge of the overdose prevention landscape of BC.
Chris Livingstone currently works at the Metro Vancouver Aboriginal Executive Council (MVAEC) as a peer navigator and sits on the Board of Directors of the Aboriginal Front Door Society. He is also a founding and current board member of WAHRS. He has experience working with several different coalitions in BC, including the Urban Indigenous Opioid Task Force.
Malcolm Tourangeau currently sits on the Board of Directors for the Vancouver Area Network of Drug Users (VANDU) and the Western Aboriginal Harm Reduction Society (WAHRS). He has experience working with the Downtown Eastside Street Market, Tenant Overdose Response Organizers (TORRO), Binners Project, Spikes on Bikes, Mission Possible, the Washington Needle Depot and the Maple Hotel.
We asked Malcolm and Chris to answer questions related to their work with OPEN and the ESC.
Read bellow for their answers.
1. Tell us something neat about you?
Malcolm: I delivered my last child at home, underneath water with a midwife. I was the first to pull her out of the water and the first person she looked at. I named her Madana – which means “inquisitive one”.
Chris: One neat thing? My job. I enjoy my job because I get to go out into the community and meet people who are doing all kinds of work. So far, it’s included working with people in Tent City, people in overdose prevention, WAHRS, and so on. There are so many different groups – too many to list.
2. What has been the most beneficial aspect of being a part of the OPEN ESC/Working with CAI?
Malcolm: Being part of the community is the biggest benefit for me. This has meant being able to get to know different organizations and networking. Once you get to know someone and build rapport with them, you begin to build community trust. Instead of infighting, we can bring all groups together to work as one against the opioid crisis. I love being out there with the people.
Additionally, when you get to know peers you get to interact with different ideas and work out new responses. You get ideas for what might work a little faster or better, and we can tweak it together and generate new ideas.
Chris: I like that it has given me an idea of what’s going on across the province. The ESC peer interviews show us where peers are at province-wide. When I think about people with lived experience (PWLE), I’m thinking about all the varied aspects that are in the community responses, whether it be homelessness and social housing, overdose prevention sites, cultural health, and so on. I see it as good opportunity to see who the actual peers are, where they are at and how they are supported within the different strategies.
And to Malcom’s point, it is also an opportunity to be learning about “shortcuts”. There’s of course a clinical response/professional response from doctors, nurses, researchers, etc. – but this response is more peer driven. It’s like a “shortcut”. It’s cost saving as well as lifesaving.
A while ago there was no OPEN network, and everyone was off doing their own thing and didn’t know what was going on provincially. It’s a huge step in getting everyone that needs to be at the table at the table providing input, such as first responders, community organizations, peer groups, First Nations people and organizations and so on.
Malcolm: Something I think that has also come out that has been beneficial is that the OPEN ESC lets people out there know who the very true “first responders” are: the peers. These people should be credited for overdose response being where it is. This crisis would be a lot worse if we weren’t here.
Chris: I also like to compare what is “valued” with wages. There’s a lot of peer volunteerism, but I think a lot of volunteerism should be turned into work and supported so it can be expanded. It’s more than “volunteering”, it’s a life path and career.
3. What has been the most interesting takeaway you’ve gotten from this work so far?
Chris: I like the way CAI does their granting process. It’s not overtly complicated. It’s not like responding to some grants where you need a 47-page document. I like that it seems more flexible than regular programming.
Malcom: The people. That’s basically what it comes down to: the comradery. The family we’re building. We can trust each other, get to know one another’s ideas and take that home and grow from there. An example is the Data Party at the October OPEN Knowledge Exchange event. The collection is coming together and we’re going to find a broader idea of what is happening and working out there. No one is higher than any other. We are all working towards the same goal, which is to get a hold on this crisis and see how we can keep it at even keel.
And we get to learn interviewing skills and be interviewed!
Chris: OPEN offers a unique coalition opportunity. All groups are considered. It allows for a broad perspective and opportunities to work together, and it’s an opportunity that might not otherwise exist.
4. Can you speak to what some of the challenges have been, either broadly or specific to OPEN ESC?
Chris: A big challenge for First Nations people is making sure culture is included in language and programming and that it is evaluated properly. There are not a lot of tools that will connect how valuable culture is in programming other than our lived experience. Culture implies connection and togetherness. Connection and togetherness are the opposite of “addiction”, which is isolation and disconnection.
Malcolm: A major challenge is the question of how you effectively bring culture into a program when you have such a diverse amount of First Nations members within First Nations led organizations and others across the OPEN project. We are all from different nations – all our cultures are different, but we must have culture-based programs.
Chris: In 2004, we started organizing to get an Indigenous led harm reduction site run by a First Nations organization that had these cultural safeguards built into the space. But here we are in 2019, almost 20 years later add we’re still fighting to create First Nations cultural space and programming. I would like if it could all come in one loud, coordinated voice. I want to further Crab Park and have Indigenous peers creating the cultural content, and I want it to be focused. We need so many different spaces – but which one do we pick first? They’re all important, although I believe cultural wellbeing and access to cultural programs underpins all First Nations wellness.
Malcolm: Stigmatism and racism against First Nation people is another huge challenge. It is bad – I’ve experienced it firsthand. You have floor walkers in stores following you all the time, or being followed when using the washroom in a restaurant that I am buying things in. When the media focuses on the Downtown East Side, it always gives a negative image. The media is not doing anyone any favors.
Chris: It has been slightly better for people with substance use problems because there’s been further acceptance of a health definition recently. Other than just “they’re addicts” or “drug users”, people are starting to recognize that it is actually a health problem. But there’s a different narrative that’s needed overall – they often focus on inappropriately negative versions of us, and this stigma is why WAHRS started. Out on the street, it’s First Nations people who are disproportionately feeling the impact of disease, homelessness, reduced life expectancy. That was a way that WAHRS was brought together to collectivize and create support groups.
When I think about reconciliation, it’s more than about just acknowledging what land you’re on. It also needs to be about reauthorizing traditional First Nations authorities (chiefs etc.) and thinking about different countries like New Zealand that adopted a “wellness model”. It would be great for Canada to consider that. It’s surprising that it’s not been in the election at all.
5. The challenges that you’ve identified are systems level issues in many aspects. Do you see the same type of challenges within the OPEN project?
Chris: Northern and remote reach is an issue. Is this organizing something we can do for the entire province? Is it feasible to get community organizers to go out to perform support group meetings, start collectivizing, creating First Nations memberships in places like Terrace and Prince Rupert? They do not have a Community Action Team but have a lot of drug use and a large First Nations population. It might be interesting to start a committee and create a community buy-in tool that can be useable almost anywhere. I’d be interested in furthering the work to help mobilize, and provide support with resources.
Malcolm: In this project, I feel that First Nations people are included greatly, and it gets it out there that First Nations people have a valuable voice. But one of the biggest challenges is always the funding aspect. You need to include certain words, and if you say something wrong then you’re out of the running for funding. Things should be further simplified to make grants more accessible for people who might not have access to big-wig words.
Chris: Yes, I call this kind of funding “Gladiator Style”. You fight it out and whoever has the best RFP gets it. In organizations like MVAEC, there’s a willingness to resource and project share, but when it comes down to getting funding, it doesn’t really create an environment for sharing on the ground for organizations. We are a small organization and we do not have a lot of money for programming, but we want to do big things.
Malcolm: Why stomp on each other when we should be working together?
Chris: Additionally, the one-time only nature is difficult. There is no continuity in my job if funding is piecemeal. After December 1st there may no longer be a navigator position unless someone comes in and says they can fund it. So, then the things I’ve been working on will be stalled. Once I’m gone, what’s going to happen to all this work? This is a major issue.
6. What part of the OPEN ESC project to do you feel most proud of?
Malcolm: I’m proud of being able to talk with people I do not know. I have automatic trust that I’ve never experienced before. Everything about the way it was set-up was great, and it helped me a lot in developing new skills. When we learned interview skills, it brought out a lot of different parts of me that I’ve never explored before.
Chris: I am proud that peers are engaged in the ESC planning itself. It goes in line with “Nothing About Us Without Us”. Every peer gets to bring their unique experiences into what they want to do and decide where they go as an organization. There’s not a lot of this work happening, but thankfully it seems like there is more and more. I’m proud that people who use drugs are being heard and what they are saying is being considered. Sometimes it’s easy for organizations to form their own plans and strategies and say “this is the way it is”. Through the ESC, peers also get to do things they haven’t done before such as interviewing and participating in different trainings.
Malcolm: I agree with Chris!
7. Why are peers essential to overdose prevention?
Malcolm: Peers have the lived experience, and we are the ones that know each other the best. When you have somebody who knows “who’s who” in the community, then there’s trust that would not otherwise be there. We’re able to respond way quicker because people know and trust us. We are first responders. They would not talk to an ambulance attendant the same way they talk to peers. We genuinely care about who is there.
Chris: For peers, it comes a lot quicker to them what’s happening on the street. For example, if there is bad dope, we see the reaction of what is happening right away and can spread that information quickly. Peers are also more neutral – people who are involved in the illicit market can still interact with a peer. For example, a drug dealer can still access an overdose prevention site. In a way, it’s a shortcut. It’s cheaper than a clinical response and has a broader and flexible focus.
We are essential because peer groups can also strategically ignore or bypass things. We don’t need extra processes – we don’t need to do research on homelessness to know that we need more housing for people, or we don’t need to research to know what to do next. We have passion, impact and trauma driven responses. We’re able to mobilize quickly compared to other responses.