HOW DO THEY DO IT? LIVING POSITIVELY IN THE FACE OF STIGMA AND DISCRIMINATION. By Renee Haynes B.Sc., Northern Caribbean University, 2012 PRACTICUM REPORT SUBMITTED IN PARTIAL FULFULLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF SOCIAL WORK UNIVERSITY OF NORTHERN BRITISH COLUMBIA April 2021 Ó Renee Haynes, 2021 ii Table of Contents TABLE OF CONTENTS .......................................................................................................................... II ABSTRACT ................................................................................................................................................. IV ACKNOWLEDGEMENTS...................................................................................................................... V KEY TERMS .............................................................................................................................................. VI CHAPTER 1: INTRODUCTION........................................................................................................... 1 Introduction to Topic .............................................................................................................. 1 POSITIVE LIVING NORTH: NO KHE̅YOH T'SIH'EN T'SEHENA SOCIETY .................. 2 HISTORY ...................................................................................................................................... 2 SERVICES PROVIDED .................................................................................................................... 3 Support Services Department ................................................................................................. 3 Education Department ............................................................................................................ 4 Fire Pit Cultural Drop-In Center ........................................................................................... 4 Harm Reduction ...................................................................................................................... 5 CHAPTER 2: PERONAL POSITIONING ......................................................................................... 5 SOCIAL LOCATION ....................................................................................................................... 5 PERSONAL AND PROFESSIONAL EXPERIENCE ............................................................................... 6 THEORETICAL ORIENTATIONS...................................................................................................... 8 Strengths Perspective .............................................................................................................. 8 General Systems Theory ....................................................................................................... 10 Harm Reduction Model ......................................................................................................... 12 CHAPTER 4: LITERATURE REVIEW ............................................................................................13 STATISTICS ................................................................................................................................ 14 TREATMENT ............................................................................................................................... 15 STIGMA AND DISCRIMINATION................................................................................................... 16 COLONIALISM AND HIV ............................................................................................................. 19 RESILIENCY AND COPING........................................................................................................... 20 iii SOCIAL SUPPORT NETWORKS .................................................................................................... 22 CHAPTER 6: PRACTICUM EXPERIENCE ...................................................................................24 EXPERIENCE............................................................................................................................... 24 Central Interior Native Health Authority (CINHA) .............................................................. 26 Preventing Overdose Undoing Stigma (POUNDS) .............................................................. 28 Crisis Prevention, Intervention & Information Center for Northern BC ............................. 29 LEARNING GOALS ...................................................................................................................... 31 Strengthening my professional development. ....................................................................... 31 Increase knowledge of HIV/AIDS. ........................................................................................ 34 Develop understanding of services provided by PLN to help PLHAs to lead positive and productive lives. .................................................................................................................... 35 Refine clinical practice skills ................................................................................................ 39 Learn the Indigenous approaches that may be employed. .................................................... 41 Expand on knowledge of PLN’s practice environment and agency structure. ..................... 44 CHAPTER 7: PRACTICUM IN A PANDEMIC..............................................................................45 RESTRICTIONS............................................................................................................................ 46 MASKS AND MESSAGES ............................................................................................................. 47 OPPORTUNITIES FOR GROWTH ................................................................................................... 49 CONCLUSION.............................................................................................................................. 50 REFERENCES ...........................................................................................................................................51 APPENDIX ..................................................................................................................................................58 PRACTICUM O UTLINE ................................................................................................................ 58 MSW PRACTICUM: LEARNING CONTRACT ................................................................................ 59 CERTIFICATES ............................................................................................................................ 63 iv Abstract In reviewing the literature it is apparent that HIV diagnosis and treatment has improved greatly over the years. Treatment is now simpler with fewer side effects and the concept of U=U, having an undetectable viral load means the virus is untransmittable, has given many women more confidence to lead healthy and positive lives. Many women are supported by the work of organizations such as Positive Living North which allows them a place to access nonjudgmental peer interactions and acceptance. The purpose of this report is to summarize my practicum experience at the Positive Living North: No khe̅yoh t'sih'en t'sehena Society (PLN) in Prince George, British Columbia. This report outlines my expectations and goals within my practicum and how my learning objectives were met through observation, discussion, and practice. This experience allowed me to examine and reflect upon inherent biases as well as reimagining my future practice as a social worker. v Acknowledgements Thank you, seems like such an inadequate term to sufficiently convey the debt of gratitude I owe to all who have been instrumental in helping me to complete this journey of higher education, but I will settle with them for the purposes of this task. I want to say thank you to Dr. Si Transken for being a source of knowledge, kindness and encouragement. I am most grateful to Dr. Christina Dobson who came into my life at precisely the right point in my journey providing great insight, guidance and inspiration. Thank you to the members of my committee, Dr. Tammy Pearson and Nicole West, who graciously accepted the task to assist in the successful completion of my graduate requirements. Also, thanks to all the staff at Positive Living North who were all extremely welcoming and willing to teach me exactly what it is like to work with Persons Living with HIV/AIDS. I am really appreciative of Catherine King who helped me to navigate all the areas of graduate life from my first day on campus; I will never forget her calm ways and genuine efforts to assist me. To my friends who supported and encouraged me to keep going when I felt like I was coming apart at the seams, thank you. I am eternally grateful to God for his faithfulness, grace and tremendous provisions for me throughout this entire journey. To the loves of my life, Rebecca Miles whom I call “Mummy” and Tricia Miles, my only sister, I am thankful for the many prayers you prayed, all the love and encouragement you gave me. To my husband, Gradson Haynes, who believed in me and provided a steadfast support on this wild, but wonderful journey; thank you. Lastly, I dedicate this final work/report to my nephews, Shemar Cunningham and Ashani Miles, who are currently undertaking their undergraduate programme to encourage them that they, too, can reach for higher heights. The best is yet to come! vi Key Terms AIDS – Acquired Immunodeficiency Syndrome. The most severe phase of HIV infection (Centre for Disease Control and Prevention, n.d.). CD4 - A laboratory test that measures the number of CD4 T lymphocytes (CD4 cells) in a sample of blood. In people with HIV, the CD4 count is the most important laboratory indicator of immune function and the strongest predictor of HIV progression. The CD4 count is also used to monitor a person’s response to antiretroviral therapy (ART) (HIV/AIDS glossary, n.d.). Cope - “to deal successfully with a difficult situation” (Cambridge Dictionary, n.d.) Discrimination – Behaviours that result from stigma or the act of treating people living with HIV/AIDS differently from those who do not (Centre for Disease Control and Prevention, n.d.). HIV - Human Immunodeficiency Virus. It spreads through certain body fluids and attacks the body’s immune system (Centre for Disease Control and Prevention, n.d.). HIV+ - HIV positive PLHA – People Living with HIV/AIDS (Centre for Disease Control and Prevention, n.d.) Positive – 1 shortened form of having HIV/AIDS. 2 “ full of hope and confidence, or giving cause for hope and confidence” (Cambridge Dictionary, n.d.) Stigma – Negative attitudes and beliefs about people living with HIV. The preconception that comes with attaching labels to an individual as part of a group that is believed to be socially unacceptable (Centre for Disease Control and Prevention, n.d.) Survival Sex Work – A term used to describe an exchange of sexual services for shelter, food and/or drugs (Population-specific HIV/AIDS status report, 2012). vii WLWH – Women Living with HIV/AIDS (Carter et al., 2015) 1 CHAPTER 1: INTRODUCTION The ensuing report will outline the experience I had during the course of my practicum placement at Positive Living North: No khe̅yoh t'sih'en t'sehena Society (PLN) and visits to its referring agencies Central Interior Native Health Authority (CINHA), Preventing Overdose Undoing Stigma (POUNDS), Crisis Intervention Centre and New Hope. Inspiration to do my practicum with this organization sprung from having worked with People Living with HIV/AIDS (PLHA) in Jamaica for nine months in the year 2019. As a result of this experience, I witnessed the unique ways in which women living with the virus were impacted, hence this report will highlight this population throughout. This chapter will provide an overview of the structure, mandate, and core mission of Positive Living North: No khe̅yoh t'sih'en t'sehena Society. Introduction to Topic In the early 1980’s HIV was thought to only affect men who had sex with men (MSM) as such it was initially called Gay-Related Immune Deficiency (GRID). However, it was soon renamed to Acquired Immune Deficiency Syndrome (AIDS) once it was discovered that the disease could be transmitted through sexual intercourse (A History of AIDS, 2019). In 1983 the first woman was diagnosed with AIDS sparking the discovery that it can be spread through heterosexual sex (A History of AIDS, 2019). Today, women make up more than half the number of people living with HIV worldwide with young women between the ages of 10 – 24 being twice more likely to acquire the virus than their male counterparts (Women & Girls, HIV & AIDS, 2019). In Canada, it is estimated that 16,880 women are living with HIV/AIDS representing 22.4% of the national total (Women and HIV, n.d.). Looking at the statistics through local lens reveals that approximately 1199 women are living with HIV in British Columbia (British Columbia Centre for Excellence in HIV/AIDS, 2 2010) with Vancouver Coastal and Northern Health Authorities accounting for the highest rates of new diagnoses (BC Centre for Disease Control, 2018). Women Living with HIV/AIDS (WLHA) who are members of marginalized groups are particularly at risk of being stigmatized. This is further compounded by gender inequality, discrimination and low socio-economic status (Rothschild, Reiley, & Nordstrom, 2006) and intimate partner violence (IPV). HIV is not only driven by gender inequality, but it also entrenches gender inequality, leaving women more vulnerable to its impact such as limited access to information, education and healthcare. Women, however, are known to be resilient, some seemingly being born resilient. Having the ability to take whatever one is dealt while still focusing on staying positive requires a certain level of awareness, understanding, and action. Without this mindfulness, many will become so entrenched in negative thinking that nothing can convince them there is hope or possibilities. Yet, WLWH have it within their scope to change the character of their lives by taking control of their thoughts and choosing to make the relevant changes. A HIV+ diagnosis can destroy the confidence of women leaving them struggling to manage their health. However, when women are supported and empowered a sense of inner security can be fostered leading to improved health seeking behaviours, successful maintenance of greater health and positive living. POSITIVE LIVING NORTH: NO KHE̅YOH T'SIH'EN T'SEHENA SOCIETY History Positive Living North: No khe̅yoh t'sih'en t'sehena Society (PLN) is a not-for-profit community-based HIV/AIDS/HCV (Hepatitis C Virus) service organization which was 3 established in 1992 (Positive Living North, n.d.). Ninety per cent of the population served are of Aboriginal descent, but service is also provided to individuals of other minority groups as well as Caucasians. As PLN solidified their identity as an Aboriginal organization they were able to add to their service output, increasing the number of individuals served by the opening of the Fire Pit cultural Drop-In Centre in 2003. The Fire Pit is a street-level HIV/AIDS/HCV prevention and support program grounded in the philosophy that culture and healing are critical components in reducing the risk for HIV/HCV (Positive Living North, n.d.). Funding arrangements between Public Health Agency of Canada (PHAC) and Northern Health Authority (NHA), PLN was able to remotely manage the previous Positive Living Northwest (PLNW) operations in Smithers in October 2008. Then, in 2013, hire an Outreach HIV/AIDS Educator for the Northeast region of BC (Positive Living North, n.d.); expanding the geographical reach of educational services offered. Overall, PLN provides services to over twothirds of the NHA region under the mantra by working together, we are closer to achieving our common goal: Stopping HIV/AIDS/HCV in the North. Services Provided Positive Living North provide services to anyone who is living with, affected by, or at risk for HIV/AIDS/HCV, regardless of race, creed, gender, or sexual orientation. PLN offers the following services to all members: Support Services Department This department provides advocacy, case management, and resource distribution i.e. weekly food hampers, breakfast program, and assistance with transportation. 4 Another activity undertaken by this department is a weekly check-in with members through their Positive Prevention Program. Here, members are provided with a warm meal while being able to talk about any challenges they may be facing at the time. The Support Services worker is then able to assist members, if requested, with resources to achieve their goals. Members at PLN are afforded the opportunity to use the telephone to keep in touch with their family, contact external agencies such as the Ministry of Child and Family Development (MCFD). Also, access to computers and internet to complete forms, resumes, and to check emails. Education Department Staff in the education department conducts educational presentations within the community to schools, adult and youth detox centers. This is done in an attempt to inform individuals about the prevalence, treatment and care of HIV/AIDS/HCV so as to help with prevention and management. The education department facilitates a program called Front Line Warriors that invites members who are willing to publically share their status and receive training to conduct presentations out in the community. The goal of this work is to remove this stigma so that HIV/AIDS/HCV related issues can be discussed openly and honestly without fear. Dialogue leads to awareness; awareness is prevention; and an ounce of prevention is worth a pound of cure (Positive Living North, n.d.). Fire Pit Cultural Drop-In Center The fire Pit is a cultural drop-in center which offers an off-site culturally-based prevention resource aimed at the most vulnerable members of the community. Here members and nonmembers are able to come together in a safe space to do crafts, join a talking circle, receive information on HIV/AIDS/HCV and enjoy nutritious meals. This allows people to take part in 5 cultural activities that lead to healing and reduce risky behaviors among vulnerable individuals experiencing homelessness, poverty, racism and discrimination. Harm Reduction This program helps in the prevention and control of infectious diseases by distributing safe supply kits to members and non-members who engage in substance use. Prior to COVID-19 restrictions, peers would gather to create the kits, smoking and injection, which provided them with an opportunity to socialize with each other and, when necessary, access information from staff regarding new research and information about HIV/AIDS/HCV. CHAPTER 2: PERONAL POSITIONING The purpose of this section is to engage in reflexive practice and to examine the ways in which my personal and professional experience may influence my practice. Throughout this chapter, I will outline my personal position and theoretical orientations in relation to my practicum setting. Social Location I am a 35-year-old, heterosexual, able-bodied female from the black community. I was born and raised on the beautiful Island of Jamaica in the parish of Clarendon. In September 2019, I took the bold step of moving from my Island home to Prince George, British Columbia, Canada to pursue my dream of completing master’s level education internationally. Here, I swapped the sunshine for the snow. The experience in this new location has been most eventful, never did I imagine that I would have encountered a union strike at the university and be living through a 6 pandemic; adjusting to new ways of learning. Nevertheless, all that I have been through has allowed me to grow personally, professionally, and academically. Personal and Professional Experience In 2012 I graduated with a Bachelor of Science in Social Work from the Northern Caribbean University in Mandeville, Jamaica. Throughout my academic journey in the Social Work programme, I gained valuable insights into the challenges many populations face over their life course as well as the various fields of practice that exists. Hence, I was inspired to pursue practice in the field of Medical Social Work as I have always had an interest in working within healthcare owing to the unique opportunity of meeting individuals at a time of acute vulnerability and having the privilege of helping them to return to some or full functioning. After graduating with a degree in Social Work, I was employed to the Southern Regional Health Authority under the Ministry of Health and wellness where I gained professional experience in Primary (Clinic) and Secondary (Hospital) Healthcare. I began working at the hospital in the year 2013 where I was the only Social Worker serving a 90-bed facility. This provided me a unique opportunity of working with all populations across all firms, i.e. medical and surgical wards and the emergency department, at the hospital. Most of my work involved engaging with adult patients who were abandoned at the facility due to chronic illnesses and lack of social supports i.e. housing; also, young girls who became pregnant at an early age. These individuals would sometimes present with comorbidities such as HIV/AIDS which sparked within me an interest to work more intimately with this particular population. As such, in January 2019, I made the switch from secondary care to primary care as they had a HIV/AIDS programme set up to meet the needs of the men and women who are afflicted. 7 Prior to concretizing my decision to work with People Living with HIV/AIDS (PLHA) I shared the idea with my family who all immediately objected. They registered a deep-seated fear that I could be infected with the virus by being around positive people daily, especially if one were to get upset and deliberately pass on the disease to me. My sister was the most concerned worrying that even by a mere touch I would be in harm’s way. Their reactions made me even more determined to work with PLHAs as this response from my family is not unique to them; many people today make judgements from a place of fear and misinformation. As a result, many PLHAs are discriminated against and stigmatized daily. It is typical for people to assume that all infected with HIV/AIDS brought it onto themselves through engaging in risky behaviours and promiscuity. Women are often judged more harshly with the latter. Therefore, I wanted to be a part of the solution to stigma and discrimination and I wanted to start with those closest to me, my family. With this in mind, I plunged into the world of working with PLHAs in all earnestness taking a special interest in women as they experience double stigma of being female and positive. Women also struggle with disclosure of their status once they become pregnant and are forced to make a decision about taking the risk to breastfeed or bottle feed their newborn. Both options come with its own risk. Choosing to breastfeed may lead to vertical transmission of the virus to baby and in choosing to bottle feed the woman runs the risk of inadvertently disclosing her status which can lead to issues of homelessness, abuse, and stigma. This is especially so with the promotion of exclusively breastfeeding babies for the first six months of their lives. Consequent to this brief stint in the HIV/AIDS programme I became curious about learning more about this chronic disease and what diagnosis, treatment and support services may look like in a new country. Completing my practicum with PLN revealed that in as much as 8 things are different they also remain the same. The ways of diagnosis and treatment are the same here in Canada as I experienced them in Jamaica, however, there is a significant positive difference in social resources available to individuals here i.e. better access to food and supplements. Throughout my practicum I found that it was important to identify and reflect on my position in life as it raises deep-rooted concerns and biases that may unconsciously affect my practice. I discovered certain biases and assumptions that I was not fully aware of until my I did my reflection activities, as such, I did my best to not allow my biases and assumptions to create barriers between clients and myself. However, I realized through my practicum that without continuous reflection it is easy to get lost in ones way of thinking without conscientious regard for individuals we serve. Theoretical Orientations Strengths Perspective I find that as a social worker/counsellor I work from a strength based position as it allows me to empower clients to see beauty, worth and resiliency in themselves. It was interesting, but sad to note that whenever I asked members to share a strength they found it difficult to identify and articulate same. This, for me, encourages my decision to work within this framework so women and men can see their inherent worth and strength during the course of our interactions. The strength-based perspective adopts the view that individuals and their families have strengths, resources and the ability to recover from adversity. Instead of underscoring problems, vulnerabilities, and deficits the strength’s perspective provides an alternative language to describe a person’s worries and struggles (Hammond & Zimmerman, n.d.). It allows one to see opportunities, hope and solutions rather than only problems and hopelessness. 9 The strengths perspective requires an accounting of what people know and what they can do, however incipient it may seem (Saleebey, 1995). Knowledge of the resources that exists in and around the individual, family or community is also needed. Therefore, the strengths approach will require some patience on the part of the worker in carrying out their professional work from a position that the client is the expert on their situation. “Too often practitioners are unprepared to hear and believe what clients tell them, what their particular stories may be” (Lee, 1994) especially if they have engaged in abusive, destructive or otherwise immoral behaviours (Saleebey, 1995). Importance is placed on the quality of the relationship that develops between the worker providing care and the individual being supported, as well as the rudiments that the person seeking support brings to the process (Duncan and Miller, 2000). Collaboration promotes opportunity for individuals to be co-producers of services and support rather than solely be consumers of those services (Morgan and Ziglio, 2007). The strengths perspective does not attempt to ignore the fact that people have problems and difficulties, but it operates from the premise that everyone has positive resources at their disposal in one way or another. According to Rapp and Gosha (2006) and Alvord and Grados (2005) an emphasis on strengths is founded on the following beliefs: · All people have strengths and capacities • People can change. Given the right conditions and resources, a person’s capacity to learn and grow can be nurtured and realized • People change and grow through their strengths and capacities • People are experts of their own situation • The problem is the problem, not the person • Problems can blind people from noticing and appreciating their strengths and capacity to find their own meaningful solutions • All people want good things for themselves and have 10 good intentions • People are doing the best they can in light of their experiences to date • The ability to change is within us – it is our story (as sited in Hammond and Zimmerman, n.d.) Having utilized this particular theoretical framework while engaging WLWH during my practicum was beneficial to the process. This is so, as it allowed me to start off on the right footing recognising and respecting that these women are the experts on their issues, they come to the table bringing strengths and resources allowing work to be carried out from a solution focused point of view. A central tenet to the strength-based approach is that individuals can exercise control, choice and change which I believe is a springboard for resiliency. As a social worker it is my aim to draw on and pull out the skills and talents of the individuals I serve in order to empower them to become the best versions of themselves; achieving self-actualization. General Systems Theory “General systems theory focuses on the wholeness and causality in interactive rather than in linear terms” (as cited in Connolly & Harms, 2015). This theory allows for adaptations and interactions to be understood through key concepts of emergence, open and closed systems, boundaries, steady state and entropy (Connolly & Harms, 2015). Emergence refers to the notion Bertalanffy (1968) posited that “the whole is more than the sum of its parts” (as cited in Connolly & Harms, 2015). In the case of a family this would mean that the family is inter-related therefore one part of the family cannot be understood in isolation from the rest of the family as well as the family cannot be fully understood by examining each part separately. Open and closed systems suggest that certain systems in the environment are either open or closed allowing for continuous inflow and outflow, constantly adapting. In other words, 11 individuals, families, communities are constantly receiving information (input/inflow), processing it and providing feedback (output/outflow). This is especially so now that we are living in the time of a pandemic that has shifted our priorities, helped to shape new world views and has added significantly to the challenges being faced by women living with HIV/AIDS. Businesses, healthcare and social organizations have had to change the way services are provided to everyone with society’s most vulnerable individuals being significantly impacted. Women who are street entrenched are finding it even more difficult to access basic supports and services i.e. a place to stay warm during the days. Boundaries, as the word implies, speaks to the rules and roles within a system that allows for it to function optimally and to maintain its equilibrium. According to Germain (1991) entropy “refers to the fact that closed systems inevitably run down, become disorganized and are then unable to transform energy, matter and information, or to produce work” (as cited in Connolly & Harms, 2015). This is in contrast to open systems, which continue to take in new inputs and adapt to a new steady state (Connolly & Harms, 2015). Hence functioning in a closed system is not sustainable for any family or individual’s continued health and well-being. Finally, steady state refers to the overall identity of a system which remains unchanged regardless of whether or not there is input or output. This is critical to maintaining homeostasis or balance in the system thus individuals will constantly have to adapt to changing circumstances. One criticism of this concept is that families may be forced to maintain the status quo even in the face of problems within the system such as enmeshment which can lead to issues being suppressed causing oppression (Connolly & Harms, 2015). Adding this approach to working with WLWH is important as they do not exist in a bubble on their own. Most women, at the micro level, will likely be a part of a family system, at the 12 mezzo level will be a part of a community i.e. Positive Living North and at the macro level is likely to engage larger systems such as healthcare and education. Therefore, it is important to understand each woman in the context of the systems they are a part of and what the reciprocal impacts are to maximize outcome of the worker client relationship. During my tenure at the health centre (clinic), the general systems theory guided how I was able to plan interventions to assist young WLWH. It is important to note that my clients’ experiences were far better understood within the context of a larger set of interacting factors: family situations and its various subsystems, relationships with peers, impact of school, church, community and so on. Consequently, I anticipate that this approach will continue to be a guide for me as I get involved with a new group of WLWH in a new setting and context. In essence, the general systems theory provides me with a base from which to work the problem being presented as I likely begin to ask a series of questions that will be linked to the context of the presenting problem. Individuals are inter-linked within families and families are inter-linked in communities that are in turn inter-linked with classes, ethnic groups and cultures. Harm Reduction Model During my time at PLN I came to learn about the Harm Reduction Model, the foundation for which services provided are primarily based. Prior to my experience here, I had not given any thought to this model of service delivery and if I am honest I did not know much about it. Throughout my career as a social worker I primarily rely on the systems and strengths perspectives to inform my practice however, I have come to realise that my social work framework is not rigid, but constantly changing and evolving as my experiences are widened; learning and growing as an individual, worker, woman. 13 Harm reduction as an approach focuses on the reality that an individual’s readiness to change varies, understands that they may not be ready, willing or even able to totally modify or change behaviours of risk (Laforge, 2007). This model is grounded on the key principles of pragmatism – acknowledging that, while carrying risk, drug use also provides the user and society with benefits that must be taken into account, humane values – acknowledges the users right to self-determination and supports informed decision making, focus on harms – prioritizes decreasing the negative consequences of drug use to the user and others, rather than the drug use itself, priority of immediate goals – starting with where the person is in their drug use with immediate focus on the most pressing needs, and drug user involvement – users are seen as the expert in their situation and are encouraged to be involved in the conversation about the best interventions to reduce harm from using (Beirness et al., 2008). Positive Living North through their harm reduction program provides users with clean needles, syringes and crack pipes for members so as to reduce their risk of passing on HIV to others limiting their chances of being infected with HCV as well as being re-infected with HIV resulting in a new, stronger strain. While PLN does not provide a safe place for members to use their drugs due to a lack of qualified staff to do so, they educate and direct members to places within the community that they are able to do so i.e. at the needle exchange. Members are often involved in the process of putting the kits together, this is in keeping with the tenet, drug user involvement, of the harm reduction model. CHAPTER 4: LITERATURE REVIEW This section will outline the literature available regarding statistics, treatment, stigma and discrimination experienced by WLHA as well as how they are able to cope in the face of challenges they are presented with. 14 Statistics Globally, a staggering 18.6 million girls and women were living with HIV in 2015 making it a major public health issue for women with the United Nations (UN) noting that a general a lack of respect for women’s rights not only fuels the epidemic but, also, exacerbates its impact (UNAIDS, 2017). HIV is said to be the leading cause of death among women worldwide who are of reproductive age. In 2016 it was estimated that there were 63,110 PLHA in Canada which was a 5% increase over 2014; of this number, 16,880 was estimated to be WLWH (Challacombe, 2020). A further look at the statistics revealed that: Aboriginal women, who represent about 4% of the Canadian female population, accounted for 45% of positive HIV tests among women in 2007 (2). Black women, who represent a little more than 2% of women in Canada, accounted for about 20% of all positive tests among women in 2007 (3). A report published in 2010 estimated that 7.9% of the female population in federal prisons was HIV positive (4). Young women aged between 15 and 19 represented 57% of test reports for this age group in 2009 (Canadian AIDS Society, 2010). The 2018 surveillance report stated that there were 2,558 new cases of PLHA in Canada with the 30 - 39 years age group having the highest number and proportion of reported HIV cases (n=778, 30.4%). Those ≥50 and 20 – 29 years age group presented the second highest proportion of reported HIV cases at 22.5% for each age group (n=576 and n=575, respectively). This was followed by the 40–49-years age group (n=559, 21.9%) (Haddad et al., 2019). The treatment options for WLWH in the northern and remote areas tends to be limited or altogether nonexistent. Shafer et al. (2017) reported that approximately 16% of family practitioners 15 and 2.4% of specialists conducted healthcare services for PLHAs in remote areas. This is deeply concerning as the “Canadian AIDS Society recognized that women face a number of issues and determinants of health that affect both their vulnerability to HIV and their experiences accessing prevention, care, treatment and support” (Canadian AIDS Society, 2010). Treatment The HIV treatment cascade or cascade of care is a model that lists the steps of care that PLHAs go through from the day they were first diagnosed to the chance of achieving viral suppression - a very low level of HIV in the body (The HIV Treatment Cascade, 2019). It is said that the HIV cascade of care for women is improving, as more women are being linked to care and retained on treatment. In the third quarter of 2016, of an estimated 1,833 women living in British Columbia with HIV, 89% were linked to care, 73% were retained in care, 66% were on treatment, 58% were adherent and 47% were suppressed (The HIV Treatment Cascade, 2019). According to the 2005 annual progress report: The standard treatment for HIV is Highly Active Antiretroviral Therapy (HAART), which combines at least three drugs from at least two different classes of antiretrovirals. The aim of antiretroviral therapy is the long-term suppression of viral replication, which leads to improved CD4 counts and, in turn, prevents HIV-related illnesses, hospital utilization and AIDS-related mortality. Current treatment guidelines established by the BC Centre for Excellence in HIV/AIDS (BCCfE) recommend starting therapy when HIV-positive, asymptomatic individuals have a CD4 count of approximately 200 cells per cubic millimeter, or at any time if they develop an AIDS defining illness, regardless of CD4 count (Priorities for action in managing the epidemics: HIV/AIDS in B.C. (2003-2007), 2005). 16 In British Columbia, antiretroviral medications and other drugs for the management of HIV/AIDS are provided at no cost to medically eligible patients through the BC Centre for Excellence in HIV/AIDS (BC-CfE) Drug Treatment Program (British Columbia Centre for Excellence in HIV/AIDS, n.d.). As of August 2020, the number of PLHA’s on treatment in the Northern Health Authority is 221; of this number 185 are males and 119 females (British Columbia Centre for Excellence in HIV/AIDS, 2020). Adherence to HIV medications for PLHAs is critical to achieving viral suppression. As a result, the care team is often multidisciplinary to ensure that each area of the PLHA ’s life is supported; with a view increase their chances of adhering to the treatment regime. For example, their mental health needs are considered and met through contact with a psychologist or psychiatrist as may be required, their social needs are catered to by a social worker and medical needs by a practitioner. The primary aim of getting people tested and started on treatment is for viral suppression to be accomplished. As such, in 2013, the Joint United Nations Programme on HIV and AIDS (UNAIDS) issued an ambitious 90/90/90 goal for all countries around the world to achieve by the year 2020. That is to say, that by 2020, 90% of all people living with HIV will know their status, 90% of all people diagnosed with HIV infection will receive sustained Antiretroviral Therapy (ART) and 90% of all people receiving ART will have viral suppression (UNAIDS, 2014). “The only way to achieve this ambitious target is through approaches grounded in principles of human rights, mutual respect and inclusion” (UNAIDS, 2014). Stigma and Discrimination There are varying definitions for the word stigma with and there seem to be no concrete consensus as to how to adequately describe the term. Some have simply accepted and used the 17 dictionary definition of “a mark of disgrace associated with a particular circumstance, quality, or person” (Oxford University Press, 2013). Another definition offered that I liked and will subscribe to for the purposes of this review is that stigma is the negative attitudes and beliefs about people living with HIV. The preconception that comes with attaching labels to an individual as part of a group that is believed to be socially unacceptable (Centre for Disease Control and Prevention, n.d.) Stigma is not a singular concept voiced and experienced in a common way; however, it is a complex phenomenon expressed both subtly and openly (Fife & Wright, 2000). People tend to distinguish and label human differences with members of the dominant cultural group labeling other groups as undesirable placing them in distinct and separate categories from the nonstigmatized. As a result, individuals who are considered part of a labelled group experience status loss (Link & Phelan, 2001). Stigma and discrimination pose great challenges for PLHAs impacting their quality of life and treatment seeking behaviours in a negative way (Tran et al., 2019). This is especially so for individuals who engage in risky behaviours such as intravenous drug use or survival sex work, thus they will experience additional social stigma (Tallmer et al., 1990). Discriminating against positive individuals can take the form of ignoring the person, discouraging discussion and participation (Roth & Fuller, 1998), limited access to housing and employment and healthcare workers being unprofessional in their approach Tallmer et al, 1990). There is limited research on the impacts of stigma and discrimination in healthcare settings from the purview of the PLHA, but the current state of the literature suggests that they continue to face subtle and more overt forms of HIV-related stigma in health care settings (Gagnon & Marilou 2015). Some of the ways in which stigma is expressed by healthcare providers (HCP) includes: 18 (a) judgmental language; (b) blaming and humiliation; (c) mocking; (d) moral disapproval; (e) assumptions (i.e., route of transmission, lifestyle, sexual orientation, health practices); (f) inappropriate eye contact (i.e., avoiding making eye contact, staring and watching, giving the sort of looks that are judgmental); (g) inappropriate nonverbal behaviors (i.e., physical distancing, not entering the room, avoiding touch or contact altogether); (h) unnecessary precautions (i.e., wearing protective gear when it was not indicated, wearing extra protective gear, burning bed sheets); (i) visible discomfort; and (j) inappropriate reaction (Gagnon & Marilou 2015). This, also, takes the form of violence as some studies have shown repeated sexual and physical violence with a positive HIV result. One woman reported that her partner tried to throw her off the balcony breaking her arm in the process and prohibited her from seeking medical treatment for two days (Population-specific HIV/AIDS status report: Women, 2012). Behaviours or acts of discrimination shared by participants in one study included social isolation, gossip and public shaming especially when individuals are experiencing end stage effects of the virus, AIDS (Maman et al., 2009). It is very unfortunate that PLHIVs are so acutely marginalised and discriminated against, the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) captured it well when they stated that HIV is biologically complex but this pales in comparison to the social complexities involved in pushing the stigma and discrimination agenda (as cited in Mawar et al., 2005). Discrimination is said to be behaviours that result from stigma or the act of treating people living with HIV/AIDS differently from those who do not (Centre for Disease Control and Prevention, n.d.). Long-term anxiety resulting from stigma and discrimination may directly 19 increase WLWH’s vulnerability to poor physical and mental health (Krieger, 2001, Logie and Gadalla, 2009, Rueda et al., 2016). HIV-related stigma lessens access to HIV deterrence, early access to treatment, and retention in care (Parker and Aggleton, 2003). Research has shown that HIV-related stigma is linked to delayed access to HIV care, low social support, deprived physical and mental health, and low socioeconomic status (Logie et al., 2018). Also, studies conducted in Ontario, Canada reported that HIV-related stigma was associated with depression which had a direct effect on self-rated health especially among African, Caribbean, and Black (ACB) WLWH (Logie et al., 2018). Gender discrimination further compounds the challenges faced by WLWH as physical and mental health disproportions among women comparative to men are due, in part, to it and sexism. Gender discrimination restricts access to economic security for women internationally with particularly harmful impacts among WLWH (Logie et al., 2018). Older WLWH face biases including stigma, ageism, health care provider awareness, psychosocial issues related to aging. They may find themselves in a sandwich generation of caring for elderly parents as well as grandchildren and may be much more likely to be managing financial struggles secondary to diminished ability to work and the challenges of living on fixed incomes alongside rising health care costs (Durvasula, 2014). Colonialism and HIV One reason that can be attributed for many illnesses, including HIV, disproportionately impacting Indigenous Peoples is the systemic colonist and racist structures that exists in our society (Interagency Coalition on AIDS and Development, 2011, p. 2). The effects of colonization are far reaching and numerous, with breakage of a connection to land, forced 20 removal of families from community; environmental degradation of traditional lands; suppression of cultural and linguistic rights being some of its lasting effects. There were 22 residential schools in British Columbia, more than any other province. Here, individuals were taught to be ashamed of their culture and identity, and sexual abuse was rife leaving many female students to endure abortion of pregnancies (Pearce et al., 2008). Many WLHA today would have suffered intergenerational trauma as a result of the sexual abuse endured during that dark time in the history of Indigenous Peoples which increased their potential for negative health and social outcomes including HIV infection (Pearce et al., 2008). Although there is a scarcity of scientific data many scholars, Aboriginal and nonAboriginal, share a similar view point that as a result of post-colonial legacy, the prevalence of sexual abuse within Aboriginal communities in Canada is higher than in other communities (Pearce et al., 2008). Displacement from land and community has contributed to the poverty experienced by many women who are living with HIV. It has been well documented that there is a direct relationship between poverty and a risk of HIV infection; those living in poverty are far less likely to have access to education and health care, be food insecure, experience homelessness and have limited means for income generation (Interagency Coalition on AIDS and Development, 2011, p. 3). Resiliency and Coping However, some WLWH swim against the tide of negativity to overcome and thrive by engaging their coping skills/mechanisms. The term coping refers to the ways that people respond to and interact with problem situations (Zamble & Gekoski, 1994). WLWH are continuously presented with circumstances that can affect their physical or psychological well-being, as such, 21 the way they deal with these situations will determine whether they prevail or suffer a variety of undesirable consequences (Baqutayan, 2015). A study conducted to assess how positive women cope with the stress of the disease reported that engaging in religious activities, positive reframing of their situation and seeking social support by befriending others were some of the constructive coping methods employed (McIntosh & Rosselli, 2012). Other adaptive devices, namely coping skills training and group processing of personal issues may result in added gains for disease adjustment of HIV positive women (McIntosh & Rosselli, 2012). According to Siebert (2005) resilience is the ability to bounce back from stress and adversity. He further posited that: Resiliency refers to the ability to cope with high levels of ongoing disruptive change, sustain good health, and energy when under constant pressure, bounce back easily from setbacks, overcome adversities, change to a new way of working and living when the old way is no longer possible and do all these things without acting in a dysfunctional or harmful way ( p. 5). Being resilient draws on the inner strength of WLWH fostering personal growth and change. Masten (2001) coined it well when he said of resilience that it does not come from exclusive and superior qualities, but from ordinary everyday actions of individuals utilising the resources of their minds, brains, and bodies as well as relationships in their communities. Resiliency in WLWH is cultivated from triumphing over the many challenges faced day in day, day out (as cited in McLeish, 2015). Higgins (1994) posited that resilience underscores individuals do more than merely get through the hardships of life, instead they develop a stronger conviction and deeper fulfilment in 22 themselves. In being diagnosed with HIV some women choose to be optimistic about their future by educating themselves and accepting the new change. Arming themselves with knowledge, learning how to self-manage and cope positively with their diagnosis provides hope. Other WLWH cope by their faith and belief in God or a higher power as this provides a sense of calm, inner peace and comfort. Believing in something that is bigger than oneself helps to alleviate the mental pressure felt allowing for a firm hope that things will eventually get better, also the sense that you are not alone gives new meaning and purpose to life. Religion is said to be the “visible expression of beliefs” (Gilbert, 2000, p. 68) as such, WLWH can express themselves through prayer, meditation and spiritual journaling (Zapf, 2009). Praying for one’s health during an illness or recovery from same has been associated with high levels of optimism; fostering well-being. Religious coping such as seeking spiritual support and healing from God, can result in WLWH experiencing less distress and fatigue. Praying at least once daily can improve women’s quality of life fostering resiliency inevitably leading to better health seeking behaviours, being retained in care and adherent to the treatment regime. This is a simple and inexpensive way to engage in meaningful selfcare that will clear the mind and release feel good endorphins to sustain a positive outlook. Social Support Networks Humans were created to be social beings, hence it is important for successful functioning. One’s geographic location will likely affect the level of social supports available and the impact this will have on their overall well-being. WLWH who are located in rural communities in the north may experience some isolation save and except for the interactions they will have with family and close friends. Maintaining connections with family and friends is crucial for WLWH 23 as this contributes to their sense of self, psychological wellness, and social competence (Sun et al., 2009). However, WLWH experience high levels of stigma and discrimination which can cause them to want to self-isolate, even from friends and family. This is as a result of trying to protect themselves from feelings of shame, guilt, embarrassment and even self-loathing which ultimately, affects their emotional, spiritual, physical and mental wellness. On the other hand, disclosure of one’s HIV status with family and close friends can reduce stress and anxiety levels permitting beneficial social supports, such as reminders and encouragement regarding medication adherence. This will, likely, result in outcomes of support for WLWH treatment with ART directly through illness-related support and indirectly through less anxiety, stress and depression (Vanable et al., 2006). Support from peers, especially other women who may be living with the virus, facilitates a sense of being a part of a group of people who knows intimately the nature of the struggles faced. Being a part of a HIV support group helps WLWH to realise that they are not alone allowing them to learn coping strategies from each other, being able to be vulnerable in the space knowing that no judgement will be cast. This type of support fosters learning, adherence to medication and clinic visits; causing these women to thrive. The multidisciplinary care team that offers services to WLWH plays a vital role in their support network at the various treatment sites. Women are supported by medical practitioners, social workers, psychologists, adherence counsellors and case managers to name a few. Being able to lean on the various categories of staff bolsters their efforts in trying lead positive lives successfully. When this is achieved the team can also celebrate creating a cycle of reciprocity. WLWH are also supported by staff at various agencies such as Positive Living North where they 24 are able to access the various services designed to help them on their journey to emotional healing, improved physical health and becoming social butterflies once again. Research has shown that social support plays a crucial role in the development of resiliency (Eamshaw et al., 2015). Social support received from professional agencies can enhance resiliency of WLWH by helping them to control their emotions and resolve their problems. Being linked helps women to develop strategies to respond to various challenges and are able to receive assistance with finding jobs and a place to live. Another benefit of being part of an agency is learning more about the virus, how to care for oneself and to be an effective change agent to peers and the wider society who are still ignorant about HIV; it’s transmission modes, management and prevalence. Improving their knowledgebase will help them to become advocates and activists empowering them to push beyond the boundaries of life with HIV. When women are able to find good support they can trust to disclose their status, it can positively impact on how they are able to live their lives as they will be able to express their worries, hurt, and even joys to someone who is genuinely invested in the process of helping them heal. Chapter 6: Practicum Experience In this chapter I share my experience at Positive Living North and how I was able to achieve set learning goals through collaboration opportunities from my perspective along with personal take-aways. Experience When I made the decision three years ago to pursue higher learning never in my wildest dreams did I ever imagine that I would be navigating life in a pandemic nor having to maneuver 25 the challenges this presented with completing a practicum. Nevertheless, I was excited to dive into the experience to see what working with vulnerable individuals during such a time as this would be like. I can positively say that I have appreciated every minute of this experience, learned creative ways of serving, but above all, this has been a journey of true self-discovery. In one of my early conversations with some of the staff members at PLN I asked them to use a metaphor to describe their organization to me as an outsider that is ignorant to its offerings and purpose. The best answer I received from one individual was that PLN is like a neighbourhood club house where children are able to escape their own homes, visiting with friends and being treated with food, love and extra attention by the mother of that one friend. This metaphor was deemed appropriate as Positive Living North offers members a safe place to escape the harshness of their lives on the street, providing hot meals daily as well as clothes, gloves, hand warmers etc. Not only are their physical needs met, but efforts are made to provide emotional support in a kind and empathetic manner. Members are allowed to be themselves, are not judged and can be reassured that their information and health status are treated with the utmost respect and confidence. PLN offers a family atmosphere to its members. At Positive Living North I was given the opportunity to gain experience in their support services department providing direct psychosocial supports to people living with HIV and dealing with complex barriers to the social determinants of health. I was able to engage clients at the Fire Pit Cultural Drop-In Centre as well as at the main office gaining skills around Indigenizing services and creating culturally safe services for street-entrenched people. Prior to engaging this practicum, my work with individuals who identify as Aboriginal has been very minimal, so this whole experience provided a great avenue for me to hone my skills of cultural competency and safety. 26 To fully achieve the learning goals I had set out for myself I had to get creative and the staff at PLN were very accommodative in this regard. I requested and was given the opportunity to visit some of the community organizations that works closely with Positive Living North and their members. As such, I visited Central Interior Native Health Authority (CINHA), Preventing Overdose Undoing Stigma (POUNDS), Crisis Intervention Centre and New Hope. In addition to my personal learning on these visits, I was asked to assess the services offered and make suggestions about how these services can be better streamlined between the organizations. Central Interior Native Health Authority (CINHA) CINHA in general provides medical services through doctors and nurses, cultural services offered through the office of the Elder, social services via the clinical and outreach social workers and support workers and addictions services through their addictions counsellor via the drug and alcohol program. The organization primarily offers services to Aboriginal Peoples, people living on or near the streets as well as those living with HIV/HCV and Tuberculosis (TB) to a lesser extent. The goal is to have vulnerable individuals access culturally safe healthcare, advocacy and support. In particular, my visit was to the team of individuals that runs the High Acuity Support Program (HASP). This team provides medication drop off services to members, collaborates with health team to conduct home visits for members who require dressing changes; also visits are conducted to provide food packages gathered from PLN or the Salvation Army. The team assists members with accessing services such as housing and linking them to the social worker for support services such as assistance with applications for various benefits. HASP also meets the basic needs of its members by providing hot meals daily, laundry services and a washroom for showering. The community is, further, served by providing harm 27 reduction kits to individuals requiring them to limit the incidence of overdosing and spreading of HIV/HCV through needle sharing. While with the HASP team, I discovered that there was an overlap of some services offered at PLN as well as members. Other notable programs and services conducted by the HASP team members are attendance to the Housing Intervention Program (HIP), providing HIV medications to members and supporting some members that has developed TB with their medication, blood tests and teaching them how to care for themselves during this time. Potential Collaborative Opportunities I believe both PLN and HASP would benefit from having meetings or case conferences monthly or bimonthly as there is an overlap with clients seen. This will facilitate better service delivery to members and a more efficient service from both organizations in meeting the needs of members; reducing the potential for staff burnout. A HASP team member sits on the Housing Intervention Program (HIP) which sees a group of critical stakeholders come together to work out best ways in which to help individuals with housing solutions. It is my belief that PLN could also sit on this committee or in lieu of that have its voice represented there through discussions held at the bi monthly meeting suggested above. Personal Take-away I thoroughly enjoyed my time being with the HASP team as I learned a lot about the roles and functions of the organization. I was encouraged to ask questions, brought to the various shelters that members are housed witnessing the delivery of medications, and afforded the opportunity to tag along on one home visit for a client requiring a dressing change from the nurse. I witnessed firsthand the levels of poverty that some people are forced to live through; I witnessed the side of Canada that is not shown on television. I never imagined I would see such 28 abject poverty, homelessness and dejection, but I am heartened by the fact that there is a team of people committed to working with these individuals to advocate on their behalf with a view to empowering them to not just survive, but thrive. Here, I was reminded that social work is heart work! Preventing Overdose Undoing Stigma (POUNDS) POUNDS was created to serve individuals who are underserved, have issues with accessing good health care and a safe space to use their drugs to prevent or limit overdose fatalities. The facility is very low barrier, in that it makes services easily accessible by minimizing paperwork and eligibility requirements, and offers individuals help with a plethora of challenges they may face such as housing issues, legal problems and basic health and wellness checks. Primarily, POUNDS offers substance users a safe and clean space to use their drugs where they can be monitored for complications such as an overdose. Each client is provided with a naloxone kit and trained in its use enabling them to adequately assist peers with their recovery in the event an overdose. Clients served are also provided with harm reduction kits to smoke or inject their drug of choice. Daily outreach walks are conducted but the nurse and a peer meeting the needs of clients as they arise. Care packages containing masks, hand sanitizers, gloves etc. are handed out to those needing them. Also, housing units at The National are run by the organization and as such they are able to provide low cost housing and jobs to some of their clients. Potential Collaborative Opportunities With the limited services being provided currently by PLN individuals on front desk duties may share with members information about utilizing the POUNDS space to get warmed up. 29 Also, direct individuals to use their drugs in a safe space, especially those who ask for harm reduction kits. Scheduled meetings with ED at POUNDS would be beneficial as some clients served are the same and some services such as outreach overlaps. Also, with POUNDS running a housing solution on a small scale it would be good to have conversations about how best members can benefit from their low cost housing. Personal Take-away I found the experience to be useful. It forced me to question my “whys” for service, examine my inherent biases personally and professionally, assess what my future practice in the field of social work will look like and ideally where it is that I want to be. Crisis Prevention, Intervention & Information Center for Northern BC This organization provides phone-line services 24 hours a day, seven days a week to individuals in crisis - any emotionally significant event or moment of risk in a person’s life. Each caller is guaranteed confidential, non-judgemental, quality service and are made aware of all options that are open to them. The center aims to empower callers to work through or find a resolution to their crisis through motivational interviewing techniques. The Crisis Centre for Northern BC is also a major community resource service - for anyone requiring information about community facilities or service they have over 2000 resource listings on major social services, self-help and support groups, health organizations, fraternal service groups, youth groups and activities, emergency services and more. These resources are available through their phone line services and in print via Community Resource Directory which is updated periodically. The organization is also a registered Applied Suicide Intervention Skills Training (ASIST) trainer and provides this service for fee to agencies or organizations desirous of training their staff. 30 Potential Collaborative Opportunities I believe it is a good idea to have future practicum students spend a day or two at this organization so as to have an appreciation for the work done there. Also, collaboration with the organization to have staff trained in ASIST would be an asset. Personal Notes and Take-away I found the experience to be eye opening and rewarding. Individuals being able to access such a low barrier service is critical especially in their times of need where they are at their lowest point. Being able to provide such a service definitely improves the social landscape of society. It was also, interesting to note that there are people who manipulate the system, but volunteers are trained to pick up on the cues of those individuals so that those calls can be kept at a minimum in an effort to keep the lines clear for individuals in genuine crisis or seeking information. Prince George New Hope Society New Hope operates as a drop in center providing women with a safe place to rest and get warm during the days, provides harm reduction kits, bad date reporting, food, clothing, hygiene and sanitary products. Women are assisted with referrals to relevant community services including, but not limited to: detox and addictions treatment, healthcare services, shelters and housing support, counselling services, RCMP Victim Services, HIV and Hepatitis C testing, treatment and support. The organization conducts Wellbriety Meetings, a 12-step substance use recovery program informed by Indigenous teachings, each Tuesday from 2PM to 3:30PM. Also, New Hope offers a wide range of workshops and programs, focusing on a varying topics such as healing and 31 empowerment, grief and loss and harm reduction strategies. These workshops are always developed and delivered in collaboration with members, and most include art-based activities. Potential Collaborative Opportunities There is potential for PLN’s Education Department to collaborate with New Hope by facilitating some of the educational group workshops adding topics such as HIV Basics, Healthy Relationships, HCV and TB awareness. Personal Notes and Take-away The work being done at New Hope is critical and necessary, but with only one member on staff it is difficult. I hope to be able to drop in from time to time as a volunteer to help provide support to the ladies that access the services. My time with the group of ladies was educational and inspiring. Learning Goals Doing practicum during a pandemic had me worried at the onset that my learning goals would not be adequately met. However, with some creativity I found I was able to sufficiently achieve what I had set out to accomplish; some experiences are outlined below. Strengthening my professional development. I was able to achieve this learning goal by being reflexive in my practice evaluating, each day, what went well or wrong and how to improve upon what was done. Additionally, I spent time examining my thoughts, feelings and actions, through journaling, weighing their impact on myself and members served. During my visit to CINHA, with the HASP team, I was afforded the opportunity to accompany one nurse practitioner on a home visit to the home of a client who was experiencing 32 a number of issues such as impending homelessness as the trailer home was deemed to be uninhabitable and was condemned by the City of Prince George as well as medical challenges which warranted a visit for the nurse. Upon entering the residence of the client it was immediately apparent why the decision was taken to have client evicted from the premises as the space was overly cluttered with odds and ends collected over the years and sanitation was an issue. Client was very happy to receive us into the space and did not seem to mind that I was new to the team of individuals on the care team. While the client’s needs were tended to by the nurse I observed the easy way in which she went about the task at hand not discriminating, but showing genuine care and empathy to the circumstances of the client. On the other hand, I found that I was struggling to quiet my mind in the moment as I was constantly keeping a check of myself, willing myself to not allow my true feelings to show. Truth be told, I was very uncomfortable being in the space as I was not prepared for the scene that was in front of me; it ran counter to everything that is portrayed on the media about quality of life in Canada. This experience allowed me to draw on my knowledge of our code of ethics recalling the very important principle of acknowledging the dignity and worth of individuals. I was able to remain respectful of the client, not openly showing my discomfort. In reflecting on that experience in my journal I was reminded to be kind to myself as, even though I have seen a lot during my seven years of social work practice, I am still learning and will encounter things that will challenge my preexisting conceptions. I was also able to seek advice and council from my supervisor as well as other members of the HASP team to brainstorm the best course of action for client’s housing issue especially considering that there was resistance on the client’s part to 33 move from the only place known as home for many years. In following up with the situation sometime after I learned that collaboration between social workers at various shelters and gentle consultations with client eventually led to housing being located and accepted. Prior to the tightening restrictions in British Columbia the doors at PLN’s main office were still open to members; observing the physical distancing and hand hygiene measures established. I, therefore, had the opportunity to participate in the Positive Talk sessions held for members on Wednesday afternoons. During this time I was able to meet with members who came in for the afternoon meal, collecting their food hamper and sharing how their day or week was going. I enjoyed these interactions as it afforded me the opportunity to actively listen to members offering any input if solicited. One particular member always appeared to be so happy and content; chattering away about what was going on. This buoyancy was infectious, often seeing others who did not come in as lively leaving the space in a visibly better mood. I was able to help that member identify a strength that was not previously looked on or considered; this as I am constantly operating from a strength’s perspective. I believe this observation and utterance empowered this WLHA. My presentation and public speaking skills were further challenged and developed as I conducted a presentation to staff informing them about Tuberculosis (TB) and the relevance of being knowledgeable about it in light of the population we serve. Many people living in British Columbia have never heard of TB while others have, but think that it does not exist here. The simple fact is that there are between 250 - 300 new diagnoses of active TB disease each year in the province (BC Centre for Disease Control, n.d.). In the context of the work PLN does with 34 PLHIVs 86% of people living with active TB knew their HIV status with 1 out of 100 being positive (BC Centre for Disease Control, n.d.). I, also, sat in on presentations conducted by staff in relation to HIV basics, healthy relationships and Sexual Orientation and Gender Identity Expression (SOGIE). These presentations were conducted at High Schools within Prince George, Adult and Youth Detox Centers as well as the Adolescent Psychiatric Assessment Unit (APAU) at the University Hospital of Northern British Columbia (UHNBC). Presentations done at the latter location was conducted over zoom due to Covid-19 restrictions at the facility as a result, staff had to be creative in engaging the youth to hold their attention to maximize potential for learning. Games, such as Jeopardy, were often developed to provide education in a fun and engaging way. I was able to help in the creation of some Jeopardy games in relation to teaching healthy relationships which was a unique experience. Assessments at the end of the presentations revealed that learning had taken place which is the best result one can hope for given the limitations of how information is now disseminated. Increase knowledge of HIV/AIDS. I was given multiple opportunities to sit in on presentations given by staff in the education department on HIV basics and treatment options which further expanded my HIV awareness knowledge base. Also, I was introduced to the Canadian Aids Treatment Information Exchange (CATIE) website which has a plethora of information on everything to do with HIV/AIDS/HCV in Canada. CATIE seeks to strengthen Canada’s response to HIV and hepatitis C by bridging research and practice by connecting healthcare and community-based service providers with the latest science (Canadian Aids Treatment Information Exchange [CATIE], n.d.). One important 35 aim of CATIE is to promote good practices among community members and organizations for prevention and treatment programs. An essential aspect of the CATIE website is that of the eduCATIE courses that are available to be taken by anyone that wants to improve their knowledge of HIV basics and treatment. As such, I took the opportunity to challenge myself to take the free self-directed courses online; improving my capacity to work with PLHIV. EduCATIE courses completed were HIV Basics covering topics such as HIV epidemiology, transmission, prevention and long term impacts of the virus, HIV Treatment which is geared towards frontline service providers working with PLHA and Hepatitis C Basics which covered foundational knowledge of the virus specifically for persons working with vulnerable populations who are at risk for contracting and transmitting the HCV. I also subscribed to journals such as Academia and Science Direct for academic articles covering issues associated with HIV/AIDS. As a result, I am much more informed about HIV/AIDS/HCV now than when I first started my journey of peeking into the world of men and women who are living with these viruses. Develop understanding of services provided by PLN to help PLHAs to lead positive and productive lives. Positive Living North has as vision of promoting the wholistic well-being of individuals and communities in Northern British Columbia (Positive Living North, n.d.) and a mission to utilize a harm reduction model to educate all about HIV/HCV and related issues and challenges. Further to this, they wish to empower those served in the creation of opportunities for healthy 36 living to be realized at the individual, family and community levels supporting them through a continuum of care that is grounded in respect and compassion (Positive Living North, n.d). The Frontline Warriors program serves as a tool to empower members to share their stories boldly with others taking back their power from those who seek to discriminate and stigmatize. This program has helped women living with HIV/AIDS/HCV to have a voice, take back their rightful place as valuable members of society and to rise above labels imposed on them. The Positive Talk program also provides members the opportunity to come in and have a chat with staff as well as a hot meal and, in general, a space to be able to get warm for those who are living on the streets. One member had this to say about the following to say about PLN and its Positive Talk program: “I enjoy coming to PLN every day, as they are like a second family for me embracing me for me and not seeing me as my status. Life gets challenging sometimes and I slip back to substance use, but with the help from PLN I am able to bounce back pretty quickly. I am just glad I have this place and everybody supports me. They never push me away.” (P.P, personal communication, October 29, 2020). Prior to COVID-19 restrictions PLN often organized and coordinated a myriad of activities geared toward improving the quality of life for members. All outings and activities are substance-free and promote a healthy lifestyle. Supporting the nutrition of members is also another critical way in which PLN provides for WLHA as they are often experiencing chronic poverty and require additional nutritional intake. As such, all members are eligible to access food hampers weekly on a Wednesday, daily meals at the Fire Pit Drop-In Centre as well as lunches 37 on Wednesdays and Thursdays at the main office. In addition, members are provided with breakfast items of fruit, nutrient bar, oatmeal and a hot drink of their choice (hot chocolate/coffee/apple cider). Annually, members are treated to a Christmas meal, but with the restrictions this year that had to be tweaked. Members were still treated to a turkey dinner, but take out style. Also, they were gifted with a special Christmas Hamper containing all the trappings to make a Christmas dinner, boxes with a multiplicity of cookies were nicely presented in gift boxes, lastly each person received gift cards valued at a $100.00 to shop at Walmart, Save On or Superstore. Members expressed their appreciation for gifts received as well as the love and warmth expressed from staff to them in cards received. PLN offers each member a food hamper once per week with Wednesday being the main day for pick up. This service caters directly to the nutritional needs of clients as HIV causes changes in their nutritional status, including loss of appetite, weight loss and malnutrition. Thus, HIV can compromise the nutritional status of infected individuals and consequently worsen the effects of the disease. Therefore, better nutrition means a stronger immune system, less opportunity for comorbidities and better health. Healthy WLHA are stronger, creating a greater likelihood of productivity which may lead to break in the cycles of poverty and hunger in a sustainable way (Haddad et al., 2001). Snippets from Female Members about Food Hampers & Gift Cards “It helps me out a lot because it gets me out of the house and it’s something to look forward to. It not only helps me food wise, but helps me socialize” (M. L, Personal Communication, October 28, 2020). 38 “It’s affected me greatly because I know that I will be able to eat, and eat good food. The Boost also gives me the nutrients that I need. Food prices have gone up and this allows me to eat nutritional food” (L. G., Personal Communication, October 29, 2020). “I utilize this program and having HASP I continue the medicinal adherence programs with gift cards helped me be healthy and have what I need. I hope the gift cards continue. They’re a really big help” (C. P., Personal Communication, October 29, 2020). “I have faced food insecurity many times in my life, I’m on disability and it’s really tough and because of this program I have a chance at healthier meals. It helps so much. I really don’t know what I’d do without it. And the staff rocks! They are all so kind and loving and caring” ( (R.L., Personal Communication, November 19, 2020). “It helps get the food when you live in a motel and helps you in this time of need” (C. F., Personal Communication, November 23, 2020). “I wouldn’t be alive without them. I was 137 lbs. when I first started accessing services. I’m now over 250 lbs. My income to how much I spend on food has always allowed me to not go hungry because of the food hub programs. It has helped me when I’m sick too since it’s the only thing I could keep down and when I was homeless because it has all the nutrients & vitamins” (G. S., Personal Communication, November 23, 2020). “They help so much, without food hub, I’d go hungry. Thank you PLN” (C. f., Personal Communication, January 28, 2020). 39 Refine clinical practice skills This particular learning goal was the only one that was difficult to achieve at PLN as counselling is not currently one of its offerings. As a result, I had to think outside the box about how to achieve this goal which led me to review online videos of counseling sessions as well as reading journal articles about Cognitive Behaviour Therapy (CBT) and Eye Movement Desensitization and Reprocessing Therapy (EMDR). The latter was unknown to me prior to engaging my practicum at PLN, but was introduced to me by a member of staff who had experienced the efficacy of this therapy firsthand. Curious, I ventured to learn about this kind of therapy discovering that it is a phased and focused approach used in treating individuals suffering from trauma, anxiety and Post Traumatic Stress Disorder (PTSD) by helping them to replace negative thoughts associated with traumatic event with positive ones (Riddle, 2020). I also, completed a certificate in Psychological First Aid offered online by Johns Hopkins University. I found this course to be relevant to meeting this objective as it provided teachings on how to effectively work with individuals who have gone through a life altering, traumatic event with empathy and care. When a woman is given a diagnosis of being HIV positive it can be traumatic event and it is for sure life altering. It is, therefore, critical for the counselor working with this newly diagnosed WLHA to build rapport, being mindful of their feelings and above all giving them hope. Core tenets of the course taken were reflective listening, assessment, prioritization, and intervention. I found that these reminders served to strengthen my knowledge base and will work as guide to future practice with vulnerable groups experiencing acute trauma. My visit to the Crisis Centre was also useful to the development of my clinical skills as I was able to observe a psychologist in action for the day answering many calls, counselling each 40 based on the need presented at the time. Though counselling here is fast paced and often times a one off opportunity the fundamentals of confidentiality, active listening, rephrasing and empathy are all very much still observed and practiced. A personal challenge of mine is self-doubt. I often question myself on whether what I am doing is correct and I sometimes feel that I am not an effective counselor. So, it was a beneficial experience for me to see this individual at work as it confirmed for me that I have been doing well in my professional role as a counsellor over the years. Case management is a way of helping people, especially the vulnerable, to access, navigate and be linked to resources which will aid in the improvement of their quality of care (Frankel, 2019). This process is conducted at PLN, but less so now during the pandemic period when members are not being allowed inside the building. Case management now looks like phoning members to check in on them and, depending on need, home visits with food items and documentations for taxes or government aid such as Canada Emergency Response Benefit (CERB); all physical distancing protocols observed. I had the opportunity to make calls to clients to follow up on their wellbeing and to update their files with new addresses, telephone numbers and employment status. One WLHA expressed her appreciation for the phone call beaming throughout about the progress she has been making over the past year. She shared that she got the opportunity to restart her education through a First Nations grant, has stable housing and is working part time which she finds to be fulfilling and rewarding. I congratulated her on her accomplishments, wished her all the best with all her undertakings and was happy to extend to her a Christmas gift certificate and hamper. Moments 41 like these in a social worker’s life add a new dimension of satisfaction with the chosen career path. That phone call made my day. As a new person in the office placing these calls to clients, most of whom I had never met, was a little daunting. I had to convey genuine interest and a welcoming persona over the phone, for the most part, I believe this was achieved. Not all members were as chatty as the individual mentioned above, but I was able to gather the required information as well as share the Christmas gift offerings for the season; this made a lot of people happy. As a result of this activity, I observed that the current system of filing member information needed updating and perhaps digitized. I shared this with my onsite supervisor who agreed wholeheartedly, plans were subsequently made and project was completed in February. Learn the Indigenous approaches that may be employed. Indigenous worldviews see the whole person physical, emotional, spiritual, and intellectual as interconnected to land and in relationship to others (Cull et al., 2018). While at PLN I had the opportunity to experience this wholistic perspective through the art work, posters with encouraging nuggets, treats for member and the staff wellness days that were held. I got to take part the age old tradition of beading with one Indigenous member of staff who was creating little breast pocket pins for members in celebration of World AIDS Day on December 1, 2020. Having never undertaken a task like that before I was a little nervous as well as excited to be engaging in the process; at first I was a poor student, but I soon got the hang of it. My teacher was very patient with me calmly explaining and showing me what I needed to do to complete my work. She explained that when doing such tasks it is good to remain calm and think good thoughts so that the piece will bring positive energy to the wearer. 42 I tried to remain calm and focused on the task at hand. Throughout the process I mused on the life lessons that could be drawn from the experience. I realized that, like my thread, life can sometimes get knotted, but with patience and perseverance I can undo some of those knots. Also, it is not so much about what the finished product looks like, but the quality of the journey in getting there. My journey as a graduate student has certainly been knotty, but I have persevered. Another cultural activity I participated in was on one staff wellness day in February 2021 where we each encouraged to make a medicine pouch. However, upon the arrival of one of PLN’s elders she advised us that only medicine men/women have the honour of creating and wearing medicine pouches, so we did not get to call our creation such, instead each person could name their pouches. I chose to call mine Can Do Pouch simply because I doubted my ability of creating it in the first place. Front Line Warriors circle time was held twice before the doors of PLN were closed a fact of which I am grateful for as this gave me the privilege of being a part of this cultural activity. During this circle time a sharing stone was passed around to each member present to express whatever they were comfortable to reveal. It was such an intimate moment with others being vulnerable and trusting that their utterances would be respected and be held in strict confidence. A short prayer was said to the Creator/God and then each person got to enjoy the lunch prepared by PLN staff. Being able to experience activities that I learnt about in the classroom setting has been phenomenal as it brings to life that which was only an obscure figment of my imagination. I remember hearing the word smudge for the first time during one of my classes at the university and conjuring up thoughts of painting! Little did I know that was the farthest thing from the truth 43 and so when it was explained I had a better grasp. However, full understanding of what a smudge is came when I witnessed the process firsthand during my day visit with the ladies at New Hope where I was invited to participate, but respectfully declined due to respiratory issues. An alternative to have the sage placed in the palm of my hand to rub and smell was presented to me which I accepted. The experience of watching the ladies participating in the cleansing of a smudge was eye opening, I witnessed the change in their body language from one of tension to relaxation. There was also a reverent like hush in the space as each person took part in the session; respect and regard was shown toward each woman. My non-participation, or partial one, was not frowned upon instead I was made to feel welcomed in the space and as such I too experienced the peaceful calm which permeated the room. Planned circle times for staff was implemented almost at the end of my practicum and I am happy to have been able to participate in one of them prior to my departure. Again my health concerns were respected and I was accommodated in the space by the leader choosing to use a feather to do the cleanse instead of doing a smudge. I am humbled by the level of respect shown for each person allowing us the opportunity to express ourselves in a confidential space. In the moment, I was able to focus my energy on just being present in the space and enjoy the sense of calm and peace. During the circle time my mind went to the river visualising the flow of water over the rocks and hearing the sound of the rapids; this action surprised me as it is not a typical response for me. Nonetheless, I enjoyed the experience of the serenity and could easily see the benefits of this activity for clients suffering from anxiety. 44 Expand on knowledge of PLN’s practice environment and agency structure. The organizational chart above shows the levels of staff at Positive Living North with members at the heart or centre signifying that all services offered revolve around their needs. During my time at PLN I had the opportunity the work alongside all levels of staff on various occasions which enriched my experience. I, also, took the time to briefly peruse the policy documents which guides practice and target interventions at PLN such as the consolidated Strategic Information Guidelines for HIV in the Health Sector, Greater Involvement of People Living with HIV/AIDS (GIPA) and Health and Safety Manual. 45 On the first day of my practicum I was introduced to and asked to sign the confidentiality policy document which is critical to the protection of the privacy of members’ health information and status. As a social work student and practitioner I understand fully the importance of confidentiality in our work as well as the implications of a breakage of same. Members should feel free to come to us for service with full confidence that their information will be protected. PLN does not divulge any member’s information to another organization unless compelled to do so legally or given written consent. During the intake process members are advised that PLN has an ethical duty to warn the public if there is a clear risk of harm to an identifiable person or group, the harm is significant and the harm or danger is imminent. Another activity that took place on day one that is key to working at PLN is that of learning how to administer a Narcan Injection to a member who displays signs of being in active overdose. I was introduced to the Naloxone Kit and its contents that each staff member is given to carry on their person at all times, given a crash course on the classes of drugs and their effects, taught how to recognise the signs of an overdose and how to use the injection to revive an individual while calling and waiting for ambulance help to arrive. I am thankful that during the course of my practicum I did not personally encounter anyone during an overdose to use this new skill. Chapter 7: Practicum in A Pandemic This chapter will review the challenges experienced, opportunities for growth and recommendations for service offered in this pandemic. 46 Restrictions The government of British Columbia has been working assiduously to keep the number of COVID-19 diagnoses at a manageable level for the various health regions. This, therefore, meant that organizations such as PLN had to make adjustments to the delivery of services to its members such as limiting the number of individuals allowed in the building. When I began my practicum in mid October 2020 members were still being allowed in the building with the expectations of wearing their masks and sanitising hands. The same was expected of staff with the additional responsibility of ensuring that high touch areas and surfaces were cleaned multiple times per day. This extra cleaning added to the workload of staff, each individual went about this without complaint. In November, more restrictions had to be implemented due to a rise in COVID-19 cases and concerns for the safety and wellbeing of staff and members. As such, the hard decision was taken to close the doors of PLN and reduce operations to window service only which has been hard on members. Losing the ‘Club House’ that they have been used to coming to daily for social interaction, a place to eat a hot meal in a warm environment and a spot to sleep has meant that many has had to endure the harshness of winter on the streets or couch surfing. This change consequently disrupted and limited the chances I had to interact with members as well as staff due to the implementation of a rotation system with staff coming in for a maximum of three days weekly; working from home the other two days. The only interaction I got to have with members was during front desk coverage when they would come by the window to collect their, breakfast, Boost, or food hampers. As well as, members will call to check in for their mails or any messages, or just to provide updates about their social or medical situations. 47 One WLHA called while I was manning the front desk to share information with us about her partner’s medical emergency and expressed that she was feeling overwhelmed with the magnanimity of the situation. I was able to have a meaningful conversation with her, almost like a mini counselling session to provide her with some support, reassuring her that she did not have to face the situation alone. This is yet another way in which the limited window service has impacted the lives of members as had the doors still been open she would have been able to come in for social interaction and peer support. Nevertheless, we have all been working as best as possible within the restrictions, so I apprised the Support Services Manager of the situation and the team has been working to support the couple through this time of crisis since then. Masks and Messages Mandatory wearing of masks came into effect in November 2020 which meant that those of us that had chosen not to wear them prior no longer had the option to do so whilst in an enclosed area. While masks are useful for reducing the spread of the Corona Virus it has added another layer of barrier to how we communicate with each other. I have found that while wearing a mask the sound is muffled making it more difficult to hear what the member is saying and vice versa. In communicating with members at the window several other factors worked as additional barriers to the already muffled sound of the mask i.e. noise of vehicular traffic from the street, the hum of the printer inside the office which is right next to the window and the fact that the window is not at eye level. With the service window at PLN being low one is forced to bend to speak with the member to hear well what is being said, as such, being able to look at the individual’s eyes which may help to guide expression in this mask wearing society is lost. All this was extremely frustrating at times especially for the client who had to be standing in the cold 48 for an extended period of time. I can recall many times when I wished I could just remove my mask and be done with it, but mindfulness of safety for members, myself and family kept me in check. Talking loudly has never been my strong point, but I have had to work hard at doing so to communicate and be heard members and staff alike. That pushed me outside of my comfort zone. This method of communicating however, has the potential to ruin the highly esteemed confidentiality agreement between PLN and members, social workers and clients as others may now be privy to hearing information that is not meant for their hearing. This could lead to status disclosure generating issues of stigma and discrimination which may cause issues of guilt, shame and re-traumatisation. In addition, to all that was stated above, I fear that this new level of service may be communicating, unintentionally, undertones of stigma and discrimination to our members. I find that having to stand on the street to access food, articles of clothing, harm reduction packs and general social assistance may be dehumanizing for some of our members. PLN has made it mandatory for staff to wear gloves when serving members through the window which I believe could be interpreted as us being scornful of them. For individuals who have struggled daily for years to be accepted by those around them this could potentially be harmful to the way they perceive themselves and us, undoing years of hard work to build capacity, rapport and esteem. Service, though, is still with a smile even if it cannot be seen we hope our eyes and voices communicate it and the warmth that we endeavour to share. We know this is not ideal, but we also know that some service is better than no service at all and members have expressed their appreciation for what they are still able to receive. 49 Opportunities for Growth Completing my practicum during this pandemic has pushed me to think and work creatively unearthing skills I did not realise I possessed. I have expanded my networking skills and capacity in the downtown area as I am now acquainted with key stakeholders in the social service arena, talking at a louder than normal decibel has forced me to be more confident in what I communicate and learning to do about turns with a particular method of service delivery in an ever changing, face paced pandemic world. Being at a non government organization has helped me to learn how to do grant writing to seek needed funds for programs and services, also, I have embarked on taking an online course to strengthen this new skill. I have been trained on how to deliver a naloxone injection to someone experiencing active overdose, and I have learned more about the culture of Canada’s Indigenous population. The weekly meetings I had with Dr. Christina Dobson, my Clinical Supervisor, was always a learning opportunity. We engaged in various discussions such as ethical implications for practice with the Harm Reduction Service Model, being aware of and owning my biases, and the art of continuous learning. Dr. Dobson is like a fountain of knowledge from which I was able to draw strength, inspiration and confidence. After our meetings, I was always left feeling more empowered and reflected a lot on the salient topics of the day. I entered graduate school with a firm decision that I would not engage the clinical side of social work and as such sought out a practicum that was aligned to this thought process, but I have come to realise that I missed this aspect of my work. This realisation struck me as odd, but if I have learned one thing over the past year it is that life is full of surprises. I leave PLN more 50 focused, driven and poised for work with women and men in need of a listening ear and helping hand. Conclusion My practicum experience has strengthened my professional knowledge base which will aid me to become a more rounded social worker in my future practice. I have been impacted personally and humbled to accept and appreciate the value of each person as we navigate our own spaces through life. I hope to learn to live, love, laugh and recognize the beauty of living positively despite the lemons that life may throw my way. 51 REFERENCES About tuberculosis, (.n.d.). BC Centre for Disease Control. 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Toronto, ON: Canadian Scholars’ Press, Inc. 58 Appendix Practicum Outline · Proposed start date – October 5, 2020 o Practicum to be completed on a part time basis Monday, Wednesday and Thursday from 8:30am to 4:30pm weekly for approximately 19 weeks. · Practicum committee members o Dr. Si Transken – Academic Supervisor o Dr. Tammy Pearson – Committee Member o Tia Ryder-Doersken – On-Site Supervisor (BSc. Psychology) o Dr. Christina Dobson – Consultant Supervisor (MSW, RSW) · Supervision Times o Weekly meetings with on-site supervisor o Bi-monthly meetings with consultant supervisor o Mid-term evaluative meeting with academic supervisor · Practicum Completion o It is my hope to complete this practicum experience by February 19, 2021 59 MSW Practicum: Learning Contract Student: Renee Haynes Agency On-Site Practicum Supervisor: Nicole West Practicum Supervisor: Dr. Christina Dobson Academic Supervisor: Dr. Si Transken Committee Member: Dr. Tammy Pearson Agency: Positive Living North: No khe̅yoh t'sih'en t'sehena Society Length of Placement: October 14, 2020 – March 11, 2021 Hours of Work: 9am – 4:30pm Goals Sub-Goals Department Plan Strengthening Being mindful Administration Front desk duties my professional of personal Collaborate with development. biases and staff and clients engaging in about various ethical practice approaches to in accordance behaviours with the -crisis intervention NASW/CASW -crisis resolution code of ethics’ core values and principles 60 Practice journaling to keep a record of all information being gathered so processing can be done. Increase Review of knowledge of Literature Education Shadow team -presentations HIV/AIDS. -weekly meetings Observe and work with staff and clients Develop Review Support Shadow one-on-one understanding organization’s Services meetings if of services vision and provided by mission Housing PLN to help statements Coordinator permitted Attend Positive Talk PLHAs to lead and hot meals with positive and members 61 productive Explore various Harm lives. intervention Reduction Learn about programs on referrals to other offer organizations Refine clinical Discover the Support Reach out to practice skills theoretical Services CINHS, NH, and perspectives Needle Exchange to such as discuss and learn strengths or about how systems that individuals with influence HIV reach out for interventions health services Learn about the intake processes utilized at PLN Learn the Take part in or Fire Pit & Spend a few Indigenous observe Support afternoons at the approaches that traditional Services Fire Pit activities to get 62 may be firsthand Participate in employed experience smudging’s, sharing Observe and circle, and Potlatch work with practitioners who may be working from a cultural framework 63 Certificates 64 65 66