Keeping the peace


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Keeping the peace

  1. 1. Marliss Taylor RN BScN(Ashley Schwanke LPN)Streetworks, EdmontonMay, 2013Streetworks, Edmonton 1
  2. 2.  Expertise from people both from the streetand from educational backgrounds canprovide a holistic community response. Sometimes there is a gulf between thevarious staff members due to different worldviews, cultures and histories.May, 2013Streetworks, Edmonton 2
  3. 3.  For the purpose of this presentation only, thestaff will be either “outreach” or “professionals”.- Outreach are the staff with a street background- Professionals includes nurses (6), socialworker (1), and addictions counsellors (2)-This team is 50% professionals and 50%outreachBut all staff are on a continuum from extremeprofessional to very recent exit from the street.May, 2013Streetworks, Edmonton 3
  4. 4.  Extreme professional Comfortable in both worlds Extreme streetMay, 2013Streetworks, Edmonton 4
  5. 5.  Focus groups were held with both the outreachand professional groups from Streetworks, and 2from Boyle Street Community Services. As well,private conversations occurred. Topics were brought up. Notes were taken aboutthe ensuing conversation. Staff needed to feel safe in disclosing, but mostfelt it was a relief to share their experiences. All staff have given their kind permission to usetheir words.May, 2013Streetworks, Edmonton 5
  6. 6. May, 2013Streetworks, Edmonton 6
  7. 7.  Have had to tell their story over and over◦ “I was in a college class and the teacher asked aquestion. I put my hand up and basically told mywhole life story. The other students looked at melike a was from another planet. I was used to tellingeverything.” Used to fighting for everything“You‟re ready to fight because that‟s how it is on thestreet - with welfare, with nurses - it‟s always afight. When a supervisor approaches you, you areready to fight. You already have shit in your head asto what is going to happen, and you have yourpeeps to back you up.”May, 2013Streetworks, Edmonton 7
  8. 8.  Lots of employment abuse◦ “Anyone in the position of authority has power over you.Not knowing the boss personally is scary and causes meto not talk. And to cower.”◦ “I didn‟t realize there was such a thing as sick time. Inmy old jobs, I would just not get paid if I was sick. I feelguilty if I‟m off.”◦ “I‟ve been fired for no reason, and not paid for the work Idid.” Used to living in the context of welfare◦ “ I got a pay check in the middle of the month. I wasthinking what is this free money?”◦ “ Getting paid every 2 weeks fucked me up. I didn‟t haveto shoplift anymore.”May, 2013Streetworks, Edmonton 8
  9. 9.  The past is always a breath away- “There‟s a tape in my head that won‟t stop. Ittells me „you‟re going to fuck up‟.”- “Its teaching a bird to swim when it wants to fly.The street never leaves you. You are always going tobe that bird who wants to fly, and it‟s not easy.”- “ I can go from lady to ghetto in 2.5 seconds.”- “PTSD is my reality.”May, 2013Streetworks, Edmonton 9
  10. 10.  Feels like you‟re always sitting on the fence- “Its hard to enforce the rules, because you get it.”- “I can identify with the clients, but that means I can beeither more compassionate with them, or harder on them.”- “You don‟t want to be holier than thou - you need to staytrue.” Stress can come from co-workers- “Sometimes people try to knock down other outreachworkers on the team. Its lateral violence and a lack ofconfidence. Its like, if she looks bad and I look good, thenI won‟t get fired. You love the job so much, you don‟t wantto lose it.”May, 2013Streetworks, Edmonton 10
  11. 11.  Its easy to beat yourself up- “I‟m my own biggest critic. If I screw a smallthing up, I immediately am afraid I‟ll get fired. Itshappened before.” Street rules remain- “On the street you don‟t rat. So if someone atwork is doing something wrong, its hard to report it.”- “We get upset with what the professionals dotoo, but we just don‟t say anything.”May, 2013Streetworks, Edmonton 11
  12. 12.  Getting a good job has been very difficult- “You have to change everything – you lived a certainway (street), and then all of the sudden its different.”- “Have to choose your environments, and it is a lonelyday when you decide to choose one over the other. Youlose a hard part of your life. You have to let go of yourfamily and friends.” From family, friends, and community- “It‟s like crabs in a bucket. People don‟t want you to getahead.”- “The other people look for flaws.”- “People can tell lies about you.”May, 2013Streetworks, Edmonton 12
  13. 13.  Triggers are prevalent and an almostdaily occurrence- “Triggers are more then just seeing drugs. It canbe the way other professionals talk, violence, the waya man talks to a women, past lived experiences, notbeing able to fight, gangs.”- “I had a bad experience with a child welfareworker. It triggered me, I wanted to knock the fuckout of him. I got in my car after and all I could do iscry. I felt hopeless, helpless and didn‟t know what todo.”May, 2013Streetworks, Edmonton 13
  14. 14.  Prevention and support are key- “I was holding everything in and I lost it the firstyear. I went on a bender. It was the support of mysupervisor that pulled me through and brought meback.”- “ I have to take care of my emotional well being.I have to be together all the time- emotionally,physically, mentally and spiritually.”May, 2013Streetworks, Edmonton 14
  15. 15.  There are no boundaries on the street- “I had zero boundaries. I had to watch, listen,and learn how to establish boundaries from thepeople I work with.”- “I had to make it clear with the community I hadtwo roles. 1- Worker 2- Relative.”- “Sometimes I know too much, but I also can‟tun-know.”May, 2013Streetworks, Edmonton 15
  16. 16. - “I had to learn to say no. I was burning out.When you are on the street, you‟re there to survive -your animal instinct takes over. Now I can see when aclient no longer has that, and have fully given up, soyou need to help them.”- “You have survivors guilt, so youovercompensate. You feel that if you don‟t do this forthis person they may not survive. I have been therebefore.”May, 2013Streetworks, Edmonton 16
  17. 17.  Communication skills aren‟t the same- “Confrontation means “confrontation”.”- “I can know what someone else (from the street)is thinking just by a look. Its our secret code. Weknow.”- “On the street you can‟t look weak.”- “We have a sixth sense and can feel the streetenergy.”May, 2013Streetworks, Edmonton 17
  18. 18.  A lack of confidence can make work harder- “We overanalyze and over-think everything.”- “Making decisions is hard. You second guessyourself. Sometimes the street and the work don‟tjive. Who do you represent?”- “Sometimes I‟m not sure what to do. I just crossmy fingers and hope I‟m doing it right.”May, 2013Streetworks, Edmonton 18
  19. 19.  Mainstream service providers have neverworked with workers with a street history- “Other professionals use our past history againstus.”-“ You feel that people assume that you are onlyfrom the street and that‟s all you know.”- “I can say something and they don‟t believe me.One of our professionals can say the exact samething, and everyone believes them.”May, 2013Streetworks, Edmonton 19
  20. 20.  “I thought that professionals must live in awonderful world. But really, it was not what Iexpected and I realized that they are just asmessed up as I am. It was very disheartening thatthey aren‟t what I expected.” “I had to reinvent what my dreams were, and what Iexpected about being a normal person. Normalisn‟t what I expected normal to be.” “I put people above myself (better). One-on-onetime with the professionals has helped me get overit, and see the professionals as people, and thatthey come from fucked up places as well.”May, 2013Streetworks, Edmonton 20
  21. 21.  “When the nurses talk about their weekend andhow they went to the mountains, that‟s really cooland I think that‟s awesome. When I say I hung outwith my kids and did laundry, they are notimpressed. Normal life stuff, (taking your kids toschool, cooking supper for your kids) is reallyimportant and valued. I never thought I would behere. This is ground breaking for me, I am the firstone in my family to be normal. Professionals don‟tunderstand that stuff.” “One slight from a professional can destroyeverything that you have worked for.”May, 2013Streetworks, Edmonton 21
  22. 22. - “That the professionals are truly empathetic.”- “When I am trying so hard, it feels better when itis noticed and appreciated.”- “They don‟t act like they are better then thecommunity.”- “Having supervision that is supportive but notafraid to be straight, and setting clear boundaries forme.”- “Having patience with my learning curve.”May, 2013Streetworks, Edmonton 22
  23. 23. May, 2013Streetworks, Edmonton 23
  24. 24.  “We have had bad stuff and things happen in ourlives. We just don‟t talk about it the same way. Weare more private.” “We have different coping or avoidance skills. Wehave a different front.” “I have a conservative background - my Daddoesn‟t even know I drink - but my studentexperience at Streetworks stripped away all mypreconceived notions about working here.”May, 2013Streetworks, Edmonton 24
  25. 25.  The professional education staff receivedwas not adequate for this setting- “Schooling only slightly prepares you for thisworld, but no where near what it really is.”- “They don‟t talk about how important a sense ofhumor is.”- “School drills in us that we can‟t tell a person ourname, we can‟t tell them where we live, or even whatcity we are from because “they will stalk you or comeand kill you.”May, 2013Streetworks, Edmonton 25
  26. 26. - “There was no, to next to no, education onHarm Reduction. I had to learn it on the job.”- “They didn‟t teach us that sometimes its ok tojust shoot the shit.”- “They teach these strict boundaries, but how areyou supposed to develop a relationship with someonewhen you can‟t even talk to them about yourself. It‟sa little unfair to ask someone to bare their soul whenyou can‟t even tell them your last name.”May, 2013Streetworks, Edmonton 26
  27. 27.  There are many pressures from outside ofthe workplace- “You hear from other people that you are not areal nurse because you work in the inner city.”-“I get major pressure from friends and family.They are always afraid I‟m going to get hurt. Theysimply don‟t understand what or why we do the workthat we do. We are constantly defending our job.”May, 2013Streetworks, Edmonton 27
  28. 28.  Pressure to perform appropriately isconstant- “In a medical emergency we are it, and alwayshave to be confident, knowledgeable, and fearless.You can‟t show any doubt. You can‟t tell anyone elseyou‟re scared shitless. That‟s why we tell each other -we get it.”- “In this program we have blurred lines. Butsometimes we have our professional bodies thatrequire we follow some very strict rules.”May, 2013Streetworks, Edmonton 28
  29. 29.  Triggers are not about addictions or streetlife, but about how their adoptedcommunity is treated- “When other professionals treat our communitywith disrespect or are derogatory, it‟s very upsettingand I take it hard.”- “The only time I have screamed at another humanbeing was when EMS was treating a communitymember with such disrespect, that I lost it.”May, 2013Streetworks, Edmonton 29
  30. 30.  The professional staff can feel judgmentin the workplace- “We love being a part of this community andobviously we want to be here. Hearing “you dumbwhite girl” from community members that you trulycare about is very hurtful.”- “Sometimes I feel that outreach staff think weare being culturally insensitive, but really sometimes Iam just busy and can‟t partake in a cultural activity.”May, 2013Streetworks, Edmonton 30
  31. 31.  The professional staff have redefined forthemselves the concept of boundaries- “School doesn‟t prepare you for the boundariesthat you need to set here in the community center.”- “School, and the systems, really drill into you thatboundaries should never be crossed. It‟s ridiculoushow can you connect if you don‟t give somethingback of yourself?”May, 2013Streetworks, Edmonton 31
  32. 32. - “When I worked at another job, the place I workedat had two separate smoking areas outside – staff andclient. They were fenced off and right beside eachother and if you wanted to have a smoke with a client,you had to talk through the fence.”May, 2013Streetworks, Edmonton 32
  33. 33.  The professional staff feel challenged intrying to communicate with the outreachstaff- “I don‟t know how to express to someone inoutreach that I don‟t see them any differently thanme.”- “I never want to sound like I am talking to a clientwhen I am talking to someone in outreach.”- “Sometimes they hear a request as an order.”- “I have avoided asking for help because I don‟twant it to sound like I am bossing outreach around.”May, 2013Streetworks, Edmonton 33
  34. 34. - “Sometimes when we make a suggestion it isheard as being critical or passive aggressive.” Learning to translate medical-eserespectfully is a necessary skill- “We nurses threw medical talk out the windowwhen we got here, and it is sometimes hard to turn itback on!”- “I think we are good at explaining things to non-medical staff members. We really try.”May, 2013Streetworks, Edmonton 34
  35. 35.  This workplace is more chaotic than almostany other professional setting- “This place creates „squirrel brain‟ and that‟s agood thing here, but anywhere else, no.”- “ I am always multitasking but everything isequally important.”- “I can‟t pee without being stopped 5 times onthe way to the washroom.”May, 2013Streetworks, Edmonton 35
  36. 36.  There is frustration with the rigidity of themainstream world- “We think there is no where else that is asresponsive as we are - every other place is stupid.”- “In the mainstream system, things like clothes,time limits, rules, are real barriers to people. I neversaw inner city community members when I worked inthose systems.”May, 2013Streetworks, Edmonton 36
  37. 37.  There can be frustration with what isperceived as less rules for outreach- “Some things should be the same like beingaccountable, being on time etc.”- “Why should I try and make it to work on timewhen other people don‟t have to?”May, 2013Streetworks, Edmonton 37
  38. 38.  “ We are very close. We are the same at the core.We believe in Harm Reduction, equality and basichuman dignity.” “We pull together because we are an island. Thelonger I‟m here, the more I pull away from theothers, like professionals, friends and family.” “As a nurse, I am extremely afraid that I will hurt orkill someone by making a mistake. The pressuresare different.”May, 2013Streetworks, Edmonton 38
  39. 39.  One on one time Getting together outside of work Patience with our learning curve Open communication and willingness to teach us Pretty much the same things that outreachsaid….May, 2013Streetworks, Edmonton 39
  40. 40. Issues to ConsiderMay, 2013Streetworks, Edmonton 40
  41. 41.  Managers need to decide if they will do “hard”management or “soft” management. Each group thinks the other is “the favourite”.Sometimes, you need to defend “the others”. Youmay need to point out the benefits for each. One must be in tune with signs that thecommunication is breaking down and take action. Watching non-verbal interactions may be the firstclue that things are awry eg, who sits where at astaff meeting. Sometimes, you need to make people sit down andtalk.May, 2013Streetworks, Edmonton 41
  42. 42.  Need to understand that reactions are often basedon past work abuses or experiences, and may notbe understandable in the moment. Helps to clarify what people‟s triggers are – howwill I know if things are going off the rails for you? You need to make it safe for open dialogue aboutissues like triggers, confidence, communityrelations, work habits etc. Be aware of what is ethical – are you putting youremployee in harm‟s way?May, 2013Streetworks, Edmonton 42
  43. 43.  Be aware that a new staff person can cause greatstress. There may be times where you see “educationalsnobbery” or “street snobbery”. Each staff group almost always forms alliances withtheir peers when the going gets tough. On our team outreach staff are always worried thatthey‟ll be fired. The professionals worry that theywon‟t be heard. Be aware that for outreach, many things can beintimidating, such as a first time at a conference.May, 2013Streetworks, Edmonton 43
  44. 44.  Take care with joking. Outreach staff maymistake teasing Pay differences can be a very sensitive subjectand be a malor stress point.May, 2013Streetworks, Edmonton 44
  45. 45.  There are more similarities than differences, butsome of the detail is different. Communication isn‟t easy and needs time,facilitation, and constant attention. Education for new staff on how to work in acomplex structure is helpful. Having a team of both people with streetbackground and educational background is crucialto the work the program does, and truly createsholistic services.May, 2013Streetworks, Edmonton 45
  46. 46. 2012Aboriginal decent 60%Discrimination based ongender, ethnicity, sexualorientation97.5%Remand, prison, charges,convictions32.5%Police hassle 77.5%Abusive Relationship 75%Sexual/physical assault 70%Homelessness 37.5%Mental health systeminvolvement40%May, 2013Streetworks, Edmonton 46
  47. 47. 2012Mental health systeminvolvement40%Someone close to youthat had a chronic/persistent MH illness70%Addiction 65%Someone close/ familymember that has anaddiction95%Detox/treatment/12 step 32.5%Gang involvement 30%Family/someone closeinvolved in a gang45%May, 2013Streetworks, Edmonton 47
  48. 48. 2012Lived in poverty 70%Prostitution 32.5%Unplanned pregnancy 52.5%Abortion 27.5%Child welfare 7.5%Social assistance 45%Criticized for working inthis field80%Employer abuse (notgetting paid, threatened,publically humiliated,fired without notice,yelled at etc.)60%May, 2013Streetworks, Edmonton 48
  49. 49. 2012OD 15.6%Withdrawal 43.8%Cotton fever 15.6%STD 50%TB 6.3%Hep B 12.5%Hep C 15.6%HIV 0%Traumaticdeath ofsomeone close68.8%May, 2013Streetworks, Edmonton 49
  50. 50. 2012Cocaine 54.1%Mushrooms 62.2%Heroin 13.5%Dilaudid 10.8%Morphine 29.7%Ts & Rs 13.5%Speed 32.4%Crystal Meth 24.3%Acid 43.2%May, 2013Streetworks, Edmonton 50
  51. 51. 2012Codeine 45.9%Benzos 21.6%Barbiturates 21.6%Methadone 16.2%Alcohol 94.6%Nicotine 81.1%Pot/Hash 91.9%Ecstasy 43.2%Crack 29.7%May, 2013Streetworks, Edmonton 51
  52. 52.  Gas receipts Staff sleeping with clients A violent incident happensMay, 2013Streetworks, Edmonton 52
  53. 53.  Thank you to the Streetworks/Boyle Streetstaff who shared their thoughts, feelings, andexperiences!!Marliss TaylorProgram Manager, Streetworks Edmontonmtaylor@boylestreet.orgTwitter: @StreetworksABMay, 2013Streetworks, Edmonton 53
  54. 54. Questions?Thanks to the Streetworks team for sharingthemselves so willingly!!Thank you for your attention!Ashley Schwanke LPNaschwanke@boylestreet.orgMarliss Taylor RN BScNmtaylor@boylestreet.orgStreetworks, Edmonton, Alberta, CanadaMay, 2013Streetworks, Edmonton 54