The Positive Outlook Program model encompasses an approach that addresses the physical, spiritual/traditional, mental, and emotional needs of persons living with HIV/AIDS. Working within the framework of our model, our primary mandate is to provide treatment services to HIV+ clients. The model bridges gaps between hospital, community and the myriad of specialized services in Vancouver’s Downtown Eastside.
Respect for First Nations cultures forms the basic tenet of the program. Flexible approaches recognize the complexity of needs and the individual situation of each client. Components include daily drop-in, food bank, meals, crisis intervention, legal advocacy, counseling, prevention education, maximally assisted medication therapy and on-site access to physicians, nurses, social workers, addictions counselors and outreach workers.
Staff members collaborate within and outside of the program and work with clients in various settings including hospitals. Strong partnerships are in place with all existing AIDS service organizations; this includes a social work liaison position with St. Paul's Hospital 10C ward to provide ongoing consultation and involvement in discharge planning.
Our multidisciplinary team consists of 1 R.N. Coordinator, 1 Administrative Assistant, 1 Registered Medication Nurse, 1 LPN/Mental Health Nurse, 1 part time Social Worker/Case Manager, 1 day a week Elder, 2 Drug and Alcohol Counselors, 3 peer Community Health Counselors (CHCs), and 4 Outreach Workers. We provide seven-day week coverage without relief staffing. Through partnerships with other agencies and a strong volunteer base (consisting of our clients) we are able to offer the necessary services to our community.
Positive Outlook Program (POP) Philosophy
Each of us has our own dignity, deserves the respect & autonomy to direct our care
Links HIV+ persons into a network of health related social, cultural, emotional, and proactive support
Offers respect and understanding of First Nations Cultural history and tradition· Provides a harm reduction approach
Services are provided in a flexible, non-judgmental, nurturing, accepting manner
Offer a safe, accessible, welcoming drop-in environment with an open door philosophy
Positive Outlook Program Model
Encompasses an approach that addresses the physical, spiritual/traditional, mentaland emotional needs of HIV/AIDS persons.
Positive Outlook Program
The Medicine Wheel Approach
Towards Aboriginal Health and Healing (TAHAH)
"Towards Aboriginal Health and Healing” was developed and funded through Health Canada as an innovative community treatment initiative that aimed to reduce disparities in HIV care and treatment, which built on experiential knowledge, community resources and strengths, and peer health advocacy. The project aimed to 1) reach HIV positive Aboriginal peoples living in the Inner City who were not accessing care and treatment, through peer-based outreach programs and peer networking; and 2) to link HIV positive Aboriginal peoples with a holistic, comprehensive HIV prevention, care and treatment program which included not only medicine provision and treatment of the physical, but social, emotional, and spiritual support and advocacy (through a part-time nurse, part-time social worker and community health peers).
TAHAH program concomitantly addresses historical and cultural barriers and delivers primary health care/ HAART to marginalized, urban Aboriginal peoples – something that no other program in British Columbia currently offers – with positive clinical and psychosocial outcomes. The project successfully has assisted the majority of our participants to increase their CD4 count, decrease their plasma viral load, stabilize their income (primarily through PWD provincial assistance), and find secure/affordable housing.
However funding for all community-based programs was discontinued by Health Canada in March 2010. This past year the British Columbia provincial government announced that it was providing $48 million dollars to address HIV/AIDS care for individuals identified as hardest-to-treat STOP/AIDS Seek & Treat Initiative. The TAHAH program was funded under the Seek & Treat Initiative in January of 2010, the funding supports 1 FTE Nurse, 1 FTE Social Worker, .2 FTE Elder Supports, and .2 FTE Peer Supports.
Alcohol and Drug Services
During 2010, the Positive Outlook Program Alcohol and Drug Counselling and Support Services experienced a significant demand for concurrent substance dependency and mental health interventions primarily related to client complex trauma history. Services to clients who identify as aboriginal dominated new intake statistics with 70% within this category versus 45% in 2009. Male aboriginals accounted for the majority of new client intakes (60%) and female aboriginals maintained 30% of total client services although intakes decreased from the previous year period. New HIV diagnosed client intakes also decreased and Methadone patient intakes remained stable with a total averaging 130 patients per month in 2010.
In addition to individual counselling or treatment sessions, group programs expanded to address the specific needs of multi-diagnosed clients. The Methadone support group, the SMART early recovery support group and the Breakfast Club group (HIV members) continued to provide low threshold support services with a substantial increase in participants for the Breakfast Club. A women and health psycho-educational group was maintained on a weekly basis and provided a gender specific option for women members of the Positive Outlook Program as well as clients of the counselling program. Healing circles and smudging ceremonies were offered to clients on both an individual and a group basis and the Medicine Wheel concept of healing and wellness was adopted where appropriate with the assistance of the program Elder and by aboriginal practicum students. A Place of Healing was created as a community art project under the direction of students from UBC Medical and Fine Arts programs and a community art exhibition was held at the counselling office site.
Counselling staff served in an integral role in association with medical clinic nurses to implement a tobacco cessation program for patients of the medical clinic. A pre-program survey was conducted by a practicum student to assess the need for and the commitment of potential tobacco cessation program participants in this regard. Counsellors conducted patient nicotine dependency and mental status assessments and co-facilitated an information and support group for the tobacco cessation program which involved thirty patients at the inception of this program with increased patient participation to date due to further funding access. The Boucher Institute for Naturopathic Medicine provided six female practicum students to develop a health promotion presentation relevant to HIV and tobacco or nicotine dependency and this presentation was held for members of the Positive Outlook Program. Posters were developed as educational resources for the tobacco cessation program.
Counselling staff supervised practicum students from UBC Master of Social Work program, Nicola Valley Institute of Technology Social Work and Substance Abuse Counselling programs and the Vancouver Community College Substance Abuse Counselling program. This experience was mutually beneficial for counselors, students, and clients and provided the opportunity to offer conventional and traditional services to clients as well as to program staff. Overall, 2010 was a period of innovation and evaluation with a client survey conducted indicating a high degree of satisfaction with services available and affirmed therapeutic interactions and relationships with counseling and professional staff of the Positive Outlook Program.