Historically, LGBTQ people have not been made to feel comfortable to talk about their lives and experiences while accessing support in health care and social service settings. To this day, many people suffer from abuse, bullying, harassment and discrimination because they are LGBTQ-identified. This certainly also happens in health care settings. Existing services are not designed with LGBTQ people in mind and health care providers are not receiving the proper training to meet the needs of this population. In response, Faith and Tim started Pieces to Pathways (P2P), a peer-based harm reduction program for queer and trans folks.
P2P started as a conversation between Faith and Tim, two friends who met in recovery. The two got sober with the support of 12-Step programs, and this lived experience as sober queer and trans people combined with their histories of grassroots community development inspired the development of the program.
Faith and Tim, who are vocal about their own experiences with addiction and recovery, would regularly get friends or mutual acquaintances sent their way when they struggled with substance use. They would meet with these individuals, often in coffee shops, to discuss their stories and share what had worked for them to get sober and stay sober. When it came time to make a referral to social or health services that were queer and trans affirming, Faith and Tim discovered that there were very few places they felt comfortable referring people to.
In the summer of 2014, Faith and Tim started P2P and in December 2014, they were successful in securing government funding from the Toronto Central LHIN (Local Health Integration Network) to conduct a community based needs assessment. By the end of March 2015, a full literature review analyzing 115 peer-reviewed articles was conducted, 28 different social service providers were interviewed, 640 LGBTQ youth were surveyed, and 5 focus groups were facilitated with 48 participants. The findings, compiled into a final report, echoed Faith and Tim’s experiences:
- 65% of survey respondents said that provider and/or client orientation towards their LGBTQ identity negatively impacted their service use experiences.
- Past year substance use prevalence rates among queer/trans youth in Toronto ranged from 1.19 to 57.2 times higher than those of the general Canadian population.
- 37% of survey respondents would like to or were actively trying to reduce or eliminate their alcohol use.
- 44% of survey respondents would like to or were actively trying to reduce or eliminate their drug use.
Many queer and trans youth use alcohol and drugs to cope with the daily oppression they face in their lives and many use substances just to survive. When this population thinks they might have a problem with their use, they are unsure if existing services will be able to meet their needs as an LGBTQ person. When this population actually goes to get help and access services, 2 out of 3 have a negative experience because of their queer and trans identity. Survey respondents reported not feeling safe disclosing their identity, not being accepted for their identity, and being actively mistreated by health care providers. This results in an unfortunate situation where queer and trans folks must either access services that may be harmful to them, or completely disengage with services altogether.
To respond to these realities, P2P was envisioned as a peer based program – with all frontline staff being queer and trans identified and having their own lived experiences with substance use and recovery, however defined by each individual. In this model, lived experience is used both as an intervention strategy and as a tool to build community for people that are facing similar struggles. The program is currently housed at Breakaway Addiction Services and, as a harm reduction program, offers 1-to-1 support through case management, hosts 3 community drop-in nights and co-facilitates dialectical behavioural therapy (DBT) groups.
Throughout P2P’s work, the access needs for gender variant individuals in health care settings have been made clear.
Top three needs
All-gender bathrooms, inclusive in-take forms, and respect for an individual’s pronouns.
When these needs are not met, patients/clients report feeling like they are not respected or understood for who they are, which can result in them discontinuing treatment or not accessing health care in the future.
10 Tips for Engaging and Supporting LGBTQ Youth
- If you don’t know or understand a particular concept, “Google It” or ask a colleague.
- Avoid making assumptions about peoples’ gender, sex and sexual orientation.
- If you’re unsure about a person’s pronouns, ask them.
- If facilitating a group environment, incorporate a “pronoun go-around” and also ask if participants have any access needs.
- If you make a mistake, it’s okay. Apologize and make it right next time.
- Show that you support the LGBTQ community.
- Know your limitations in supporting someone and if necessary, refer to a colleague or another organization.
- Stay up to date and keep yourself informed about historical and contemporary LGBTQ issues. If you have learned something, share it with others.
- Ask the person what they want, what they need and how they want their experiences defined.
- Understand that not all queer and trans youth have the same experiences.
 12-Step programs are community based supports where individuals who identify as addicts and alcoholics meet to mutually support one another.
 Located in the Parkdale area of Toronto
 The drop-in spaces include an abstinence night on Monday, a harm reduction space for racialized youth on Tuesdays and a harm reduction night on Thursdays. P2P regularly works with many addiction, harm reduction and mental health service providers in Toronto by providing LGBTQ and harm reduction advocacy, education and training. Once a month, P2P hosts a community harm reduction kit making event that is open to everyone, where participants can make safer use kits for crack use, injection drug use, crystal use and partying, as well as kits for injecting hormones and safer sex practices. P2P regularly attends drop-ins of partnering organizations and parties to do harm reduction outreach and to hand out kits.