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Striving to end LGBTQ youth homelessness

CAMH Discovers: News from CAMH Research and the Campbell Family Mental Health Research Institute
Scientists at Work​​

​Striving to end LGBTQ youth homelessness

Over the past 10 years, Dr. Alex Abramovich has been working – as a researcher and a passionate advocate – to end homelessness among LGBTQ youth in Canada and internationally.

“Homelessness is a serious issue among LGBTQ youth across Canada,” says Dr. Abramovich, post-doctoral fellow in CAMH’s Institute for Mental Health Policy Research. A 2013 City of Toronto study found that young people who identify as LGBTQ make up 21 per cent of individuals in youth shelters. “We have reasons to believe that number is actually higher, because a high proportion of LGBTQ youth do not access shelters due to safety issues, and many LGBTQ youth do not feel safe coming out as LGBTQ to those conducting surveys,” says Dr. Abramovich. LGBTQ youth are also at increased risk of mental health and substance use challenges. (See below, “A new substance use support program for LGBTQ youth.”)

Dr. Abramovich's work has contributed toward monumental milestones during the past year. The Alberta government approved all six key recommendations in a strategy report he prepared for the Alberta government to prevent and end LGBTQ youth homelessness, and committed funding for specialized housing and provincial staff training. "It's the first time a provincial government has stepped up in this way," he says. And supported by a significant investment from Toronto City Council, Canada’s first transitional housing program for LGBTQ youth, the YMCA Sprott House, launched in January. Dr. Abramovich played a key role in helping to develop Sprott House.

Still, cautions Dr. Abramovich, “there’s a lot of work to be done.” Building evidence to support further change, both at home and abroad, is driving several research initiatives underway.

Dr. Alex Abramovich 

Evaluating Toronto's new specialized housing

This spring, Dr. Abramovich will kick off a study with the newly opened Sprott House. The 25-bed residence for youth ages 16 to 24 years provides a safe and supportive environment for up to a year. The specialized residence protects against the violence and discrimination that Dr. Abramovich has found many LGBTQ youth experience not only on the streets, but also in many shelters, which frequently lack staff training and other supports to assist LGBTQ youth.

In his study, Dr. Abramovich will conduct one-on-one interviews and surveys with two groups: residents who begin living at Sprott House and people on Sprott House's wait list. For both groups, he will examine a range of factors, including anxiety, depression, risk of suicide, family connectedness, community involvement and self-esteem. After a year, he will conduct the same assessments with each group. "Our goal is better understand the benefits of specialized housing for this population of young people," says Dr. Abramovich.

With Sprott House breaking new ground in Canada, he adds, "we need to evaluate it so other services can operate from an evidence-based model."

Sparking conversations using film

In another project, he developed a 30-minute documentary film, called Nowhere to Go: A Brokered Dialogue. This film is the outcome of an innovative research method known as brokered dialogue. Developed by two scientists at St. Michael's Hospital in Toronto, brokered dialogue is a "qualitative, film-based, participatory research method that focuses on an issue that has tension, and features participants who would not normally engage with each other," says Dr. Abramovich.

In this case, the participants are three LGBTQ youth with lived experience of homelessness and mental health challenges, the City of Toronto's General Manager of Shelter Operations, Toronto Councillor Kristyn Wong-Tam and a child and youth psychiatrist.

Dr. Abramovich conducted an initial one-on-one interview with each participant to learn "where you stand with the issue of LGBTQ youth homelessness and access to mental health services for LGBTQ youth experiencing homelessness." He then worked with a community artist to create a film that captured each participant's key points, and shared it with participants to spark a larger conversation. Next, he recorded a second interview in which each participant responded to the different perspectives in the film, as well as specific questions. Participants approved the content they shared at every stage of the project, including in the final documentary.

"Film helps people understand complex issues in a different way," says Dr. Abramovich. "There are very clear solutions outlined at the end of the 30-minute film.”

He has submitted the film for consideration for this year's Inside Out LGBTQ film festival, and is planning to screen the film locally. He is also completing a research report as part of the project.

International and national collaborations

At the international level, Dr. Abramovich is in discussions to collaborate on research in Cuba. Last November, he led a roundtable discussion about issues facing LGBTQ youth with Mariela Castro Espin, director of Cuba’s National Center for Sexual Education (Cenesex) and a longtime advocate for LGBTQ rights in Cuba. (Castro Espin is the daughter of Cuban President Raul Castro.) A possible research collaboration, including the University of Havana, is at very early stages of discussion and would establish measures to better understand the experiences of LGBTQ youth in Cuba.

In Canada, "I hope at CAMH to continue working with different levels of government in order to develop a national strategy to end LGBTQ youth homelessness," says Dr. Abramovich.


A new substance use support program for LGBTQ youth


Recruitment poster for Pieces to Pathways pilot groupsPieces to Pathways (P2P) is an initiative to create Canada’s first substance use peer-support program for youth 16 to 29 years old in Toronto who identity as LGBTTQQ2SIA (lesbian, gay, bisexual, transsexual, transgender, queer, questioning, 2-spirit, intersex and asexual). Breakaway Addiction Services is leading the project, which is funded by the Toronto Central Local Health Integration Network (LHIN).

The project began in early 2015 with a multi-pronged research study involving a literature review, surveys of community agencies and individuals aged 16 to 29 who identify as LGBTTQQ2SIA and focus groups.

The project team found that "the population has rates of substance use substantially higher than those of the general population, experiences distinct psychosocial challenges, expresses consequent treatment concerns, and displays a greater frequency of unmet treatment needs," according to the research report. For example, "65 per cent of those that accessed formal support indicated that provider and/or client orientation toward their LGBTTQQ2SIA identity negatively impacted their service use experiences."

Out of these findings, the team proposed a specialized program offering case management for individual support, a drop-in/walk-in space so that people could build community with one another, and two peer support groups: one focused on harm reduction and another on abstinence from substance use. A pilot session of each support group ran at the start of the year.

As the next step, the project team will submit a report to the Toronto Central LHIN this spring, outlining key findings from the tested and evaluated pilot groups and a refined program model.

"P2P is ready to deliver services to support queer and trans youth with their substance use,” says Geoffrey Wilson, Co-founder of P2P, along with Tim McConnell. “Our initial observations revealed that program participants really appreciated having a space to talk about their substance use as it relates to their gender and sexuality, while also knowing that the facilitators were queer and/or trans and had their own experiences with addiction, substance use and recovery. We try our best so that queer and trans youth get the support they want and have their experiences affirmed, not denied."

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