CONTENTS Introduction ...................................................................................................................................................................1 Project Overview .......................................................................................................................................................1 Research Considerations ...........................................................................................................................................1 Results ...........................................................................................................................................................................2 Section 1: Concern About the Pandemic ...................................................................................................................2 How concerned are you about the COVID-19 pandemic? ....................................................................................2 Please share a bit about why you are or are not concerned about the COVID-19 pandemic ..............................3 Section 2: Needs During the Pandemic .....................................................................................................................4 What has been your greatest need during the COVID-19 pandemic? ..................................................................4 Have you experienced the following during the COVID-19 pandemic?................................................................5 How has your ability to access the following types of services changed during the COVID-19 pandemic? .........5 Section 3: Impact on Well-Being ...............................................................................................................................7 If you answered less access or more access to the above items, how has that change had an impact on your well-being? ............................................................................................................................................................7 How has COVID-19 affected your income? ...........................................................................................................8 How helpful have the following services offered during the COVID-19 pandemic been to your well-being? .....9 Section 4: Colliding Emergencies.............................................................................................................................12 How concerned are you about the housing crisis in your community?..............................................................12 How concerned are you about the overdose crisis? ...........................................................................................12 Would you access harm reduction housing if it were available in your community? ........................................13 Additional Comments..............................................................................................................................................13 Appendix 1: Survey Instrument ...................................................................................................................................15 Publication Details Project Team: Selkirk College Department of Applied Research and Innovation (Lauren Rethoret, Ryall Giuliano, Jayme Jones); Selkirk College Bachelor of Science in Nursing Program (Svea Menard, Ben Dowell, Jordan Sherstobitoff, Amanda Sigurdson, Bethany Grutter, Rob Tanner, Sargent Hayden, Tammie Clarke) Report Authors: Jayme Jones, Lauren Rethoret, Ryall Giuliano Publication Date: October 29, 2020 INTRODUCTION PROJECT OVERVIEW The following research has been conducted as part of the Rural Homelessness and COVID-19 project. This Selkirk College initiative is funded by the Natural Sciences and Engineering Research Council of Canada (NSERC), and delivered in partnership with social sector organizations operating in the region, including:  Nelson Community Services  Nelson Cares Society  Nelson Police Department  ANKORS  Trail United Church  Career Development Services (Trail). The intended purpose of this project is to improve the health and resilience of West Kootenay residents experiencing homelessness during the COVID-19 pandemic. The project has been further defined by the following three priorities: 1. Conduct research that allows partner organizations to make evidence-based decisions on how to prioritize and structure services, programs and policies designed to:  Help the target population meet its needs during the pandemic  Promote a culture of health and safety 2. Mobilize college resources to enhance the impact of regional COVID-19 response efforts targeting vulnerable populations 3. Promote collaboration between organizations and communities to transfer lessons, avoid duplication, and make best use of limited resources This report presents results from the initial phase of research, which involved surveying service users to help identify the most important needs being faced by people experiencing homelessness during the pandemic. The survey had the additional goal of assessing how beneficial services offered during the early stages of the pandemic were to the well-being of people experiencing homelessness. A person’s well-being includes their health, safety, and happiness. Results from this phase of the research will inform future project activities, including Selkirk College’s efforts to work alongside community partners to develop and deliver services that respond to the evolving context of the COVID-19 pandemic. RESEARCH CONSIDERATIONS Survey questions were developed by Selkirk College personnel and refined based on feedback from community partners. Selkirk College street nursing outreach teams (including students and faculty who have previous experience and relationships with the target population) conducted the service user surveys. Surveys were completed in Trail, Castlegar, and Nelson over a 4-week period beginning in early September 2020. The survey targeted individuals who experienced homelessness and/or who accessed social service programs during the early stages of COVID-19 pandemic. Participants were recruited during the delivery of regular outreach services and compensated for their time with $10.00 grocery store or restaurant vouchers. 1 RESULTS In total, 73 surveys were completed in Trail (n=40), Castlegar (n=4), and Nelson (n=29). The compiled results from each survey question are included below. Of all survey respondents, 1% identified as First Nations with status, 12% identified as First Nations non-status, and 10% identified as Metis. Reporting Limitations Due to the small sample size of surveys completed in the City of Castlegar (four surveys), survey results specific to Castlegar cannot be published to ensure confidentiality. The Castlegar survey results are included in the data for ‘All Communities’. SECTION 1: CONCERN ABOUT THE PANDEMIC How concerned are you about the COVID-19 pandemic? 50% 45% 40% 35% 30% 25% 20% 15% 10% 5% 0% 45% 36% 35% 28% 28% 15% 15% 13% 10% 7% 22% 21% 17% 7% 3% 0% 1 2 3 All Communities 4 Nelson 5 Prefer not to answer Trail Figure 1: Concern over COVID-19 pandemic (1 - not concerned, 5 - very concerned) 2 Please share a bit about why you are or are not concerned about the COVID-19 pandemic Figure 2: The most common words used when asked about concern about the COVID-19 pandemic The open-ended question asking why people were or were not concerned about the COVID-19 pandemic produced varied responses. It was almost even between those who were concerned and those who were not, with slightly more responses expressing no concern. For those who expressed concern, a common descriptor used was ‘scared’ (see Figure 2). The concern was evenly split between concern for self and concern for others. As an example of concern for self, one respondent indicated, “I am concerned because I cannot find sanitary places, housing or services needed.” Concern for both self and others was commonly centered on pre-existing health conditions. “I am worried about immunocompromised friends” expressed a respondent concerned for others. For those not concerned about COVID, the main reason given was that respondents have not heard of anyone they know having COVID. “[I] don’t know anyone affected by it [COVID] and it seems blown out of proportions,” expressed one respondent. Another common reason for lack of concern over the pandemic is the belief that COVID is not real and is some form of government control mechanism. Other reasons given for lack of concern were comparing COVID to other illnesses, living in a small community, and living outside where they are less likely to catch the illness. A few respondents were conflicted about their concern for COVID. They expressed they were not concerned about the illness directly, but were concerned about the side-effects of the pandemic, such as the need for social distancing and how that impacts interactions. “It is the travellers who are getting it [COVID]. The people with money. However, homeless people are getting discriminated because people think we, the homeless, will give them [the] disease,” indicated a respondent. 3 SECTION 2: NEEDS DURING THE PANDEMIC What has been your greatest need during the COVID-19 pandemic? Figure 3: The most common words used to describe greatest need during the COVID-19 pandemic The open-ended responses to the question about the respondent’s greatest need during the pandemic showed a number of common needs with relatively equal weight. Access to a variety of services was mentioned the most. These services included transportation, courts, laundry, employment, and health services. Of these, access to health services was the greatest expressed need. “[I] need better access to medical services. It is easier to deal with street nurses,” stated a respondent. Housing and food were other common needs. Related to housing, access to hygiene was expressed multiple times, especially showers. Access to a variety of supplies was included in many responses. Examples of the needed supplies include masks, phones, medication, toilet paper, and computers. Other needs expressed included money and work. “I don’t feel I get enough money to survive,” expressed one respondent. “I can’t get a job,” expressed another. The need to interact with others was also conveyed by multiple people through descriptive words and phrases such as lonely, lack of social interaction, and companionship. A few respondents stated a related need for entertainment activities such as concerts and bars. Some other needs did not fit any category, but are worth mentioning. These include the need for freedom and hope. 4 Have you experienced the following during the COVID-19 pandemic? Figure 4: Experienced discrimination 70% 63% 60% 48% 50% 41% 40% 40% 28% 30% 17% 20% 24% 15% 10% 3% 10% 7% 1% 3% 0% 0% 0% No Less than before More than before Same as before COVID COVID COVID All Communities Figure 5: Experienced feelings of loneliness or isolation Nelson Prefer not to answer Trail 66% 70% 60% 49% 50% 43% 43% 37% 40% 30% 24% 20% 10% 4% 3% 5% 10% 7% 10% 0% 0% 0% 0% No Less than before More than before Same as before COVID COVID COVID All Communities Nelson Prefer not to answer Trail How has your ability to access the following types of services changed during the COVID-19 pandemic? Figure 6: Access to harm reduction services 70% 60% 60% 51% 50% 41% 40% 30% 20% 10% 24% 17% 12% 18% 20% 17% 15% 8% 8% 4% 0% 5% 0% Less access More access No change All Communities Nelson I do not use this type of service Prefer not to answer Trail 5 Figure 7: Access to food and nutrition services 70% 62% 60% 50% 40% 43% 38% 33% 30% 23% 20% 32% 26% 17% 14% 10% 4% 7% 3% 0% 0% 0% 0% Less access More access No change All Communities Figure 8: Access to housing services 60% Nelson 55% I do not use this type of service Prefer not to answer Trail 53% 50% 40% 40% 38% 28% 30% 21% 20% 8% 7% 10% 10% 17% 14% 10% 0% 0% 0% 0% Less access More access No change All Communities Figure 9: Access to mental health and addictions treatment services Nelson I do not use this type of service Prefer not to answer Trail 60% 50% 40% 48% 36%34%38% 37% 30% 30% 25% 18% 20% 8% 7% 10% 10% 5% 1% 0% 3% 0% Less access More access No change All Communities Nelson I do not use this type of service Prefer not to answer Trail 6 Figure 10: Access to healthcare services 80% 70% 68% 60% 50% 53% 40% 40% 40% 30% 25% 18% 20% 6% 10% 13%14%10% 10% 1% 0% 3% 0% 0% Less access More access No change All Communities I do not use this type of service Nelson Prefer not to answer Trail SECTION 3: IMPACT ON WELL-BEING If you answered less access or more access to the above items, how has that change had an impact on your well-being? Figure 11: Impact on well-being of less access to services for all communities (n=number of people indicating less access) 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 93% 89% 86% 79% 67% 22% 11% 7% 11% 3% 3% 4% 7% 3% 7% Harm reduction Food/nutrition Housing services Mental health Healthcare services (n=9) services (n=28) (n=29) and addictions services (n=29) treatment services (n=27) Negative impact Positive impact No impact 7 Figure 12: Impact on well-being of more access to services for all communities (n=number of people indicating more access) 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 100% 91% 84% 83% 17% 11% 9% 83% 5% 0% 17% 0% 0% 0% Harm reduction Food/nutrition Housing services Mental health services (n=11) services (n=19) (n=6) and addictions treatment services (n=6) Negative impact Figure 13: Overall impact of a change in access to services (n=number of people indicating more or less access) 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Positive impact 80% 55% 0% Healthcare services (n=4) No impact 76% 73% 51% 38% 35% 18% 17% 10% 9% 15% 9% 3% 6% Harm reduction Food/nutrition Housing services Mental health Healthcare services (n=20) services (n=47) (n=35) and addictions services (n=33) treatment services (n=33) Negative impact Positive impact No impact How has COVID-19 affected your income? 45% 41%41% 40% 35% 30% 25% 27% 31% 30% 24% 40% 22% 18% 20% 15% 10% 4% 3% 5% 5% 1% 0% 3% 5% 4% 0% 0% No impact Less than before More than before More than before More than before COVID COVID COVID (work) COVID (other) (government benefits) All Communities Nelson Prefer not to answer Trail Figure 14: COVID-19’s impact on income 8 How helpful have the following services offered during the COVID-19 pandemic been to your well-being? (1 – not at all helpful, 5 – very helpful) Nelson Figure 15: Helpfulness of sanctioned encampment in Nelson 66% 70% 60% 50% 40% 30% 20% 10% 10% 3% 7% 10% 3% 0% 0% 1 2 3 4 5 I didn't use Prefer not this service to answer Nelson Figure 16: Helpfulness of food deliveries in Nelson 70% 59% 60% 50% 40% 30% 20% 15% 11% 10% 4% 4% 2 3 7% 0% 0% 1 4 5 I didn't use Prefer not this service to answer Nelson Figure 17: Helpfulness of service providersupplied cell phone in Nelson 70% 59% 60% 50% 40% 30% 20% 21% 10% 10% 0% 3% 7% 0% 0% 1 2 3 4 5 I didn't use Prefer not this service to answer Nelson 9 Figure 18: Helpfulness of temporary showers in Nelson 55% 60% 50% 40% 28% 30% 20% 10% 7% 10% 0% 0% 0% 0% 1 2 3 4 5 I didn't use Prefer not this service to answer Nelson Trail Figure 19: Helpfulness of extended shelter service in Trail 90% 80% 80% 70% 60% 50% 40% 30% 20% 10% 10% 8% 0% 0% 3% 2 3 4 0% 0% 1 5 I didn't use Prefer not this service to answer Trail Figure 20: Helpfulness of daytime supports at shelter in Trail 90% 80% 80% 70% 60% 50% 40% 30% 20% 10% 13% 0% 0% 1 2 5% 3% 3 4 0% 0% 5 I didn't use Prefer not this service to answer Trail 10 All Communities Figure 21: Helpfulness of temporary hotel housing 120% 98% 89% 79% 100% 80% 60% 40% 20% 11% 4% 0% 0% 0% 0% 11% 7% 3% 1 2 3 4 5 0% All Communities Figure 22: Helpfulness of pandemic prescribing 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Nelson I didn't use Prefer not this service to answer Trail 86% 90% 79% 0% 0% 1% 3% 0% 1 2 3 4% 1% 0% 18% 11% 8% 4 All Communities Figure 23: Helpfulness of temporary washrooms 0% 5 Nelson 0% I didn't use Prefer not this service to answer Trail 90% 78% 80% 70% 59% 60% 50% 36% 40% 25% 30% 20% 10% 15% 11% 7% 5% 11% 6% 3% 11% 7% 5% 6%7%5% 1 2 3 4 5% 0% 0% All Communities 5 Nelson I didn't use Prefer not this service to answer Trail 11 Other Services Survey respondents had the opportunity to indicate anything else that was helpful or not helpful during the pandemic. The following were rated as very helpful by at least one respondent: online banking, nursing/street outreach, social assistance, hotel workers, Salvation Army in Trail, Stepping Stones, and free hand sanitizer. Transit was listed as helpful. Work BC was listed as not helpful, and the Salvation Army in Nelson was listed as not helpful because it was closed. SECTION 4: COLLIDING EMERGENCIES How concerned are you about the housing crisis in your community? 70% 65% 60% 55% 60% 50% 40% 30% 20% 16% 21% 13% 10% 10%10%10% 1% 3% 0% 5% 3% 8% 7% 7% 5% 0% 1 2 3 4 All Communities Nelson 5 Prefer not to answer Trail Figure 24: Concern over the housing crisis in the community (1 - not concerned, 5 - very concerned) How concerned are you about the overdose crisis? 66% 70% 60% 53% 48% 50% 40% 30% 20% 15% 18% 10% 10% 7% 7% 8% 7% 10% 3% 10% 8% 7% 10% 7% 8% 0% 1 2 3 All Communities 4 Nelson 5 Prefer not to answer Trail Figure 25: Concern over the overdose crisis in the community (1 - not concerned, 5 - very concerned) 12 Would you access harm reduction housing if it were available in your community? 70% 62% 60% 50% 41% 40% 36% 34% 38% 40% 30% 23% 23% 20% 10% 0% 0% 3% 0% 0% Yes No All Communities I would be interested to learn more about it Nelson Prefer not to answer Trail Figure 26: Desire to access harm reduction housing, if it were available in the community ADDITIONAL COMMENTS The survey team did not ask questions beyond those included in the formal survey instrument. However, many respondents wished to share additional thoughts and to have those thoughts recorded. The comments received generally fit the themes addressed in the survey: housing, access to services, overdose crisis, food, hygiene, and income. Housing and access to services were the topics commented on the most, with the overdose crisis close behind. A general summary and snapshot of these comments is included below. Housing Twenty-two comments on housing were received. Most of these comments were related to the lack of available and adequate housing. Some comments include:  “Its difficult to get housing because of discrimination and availability - people think I'm just a ‘junkie’ and wont rent to me. We may have to move to another community to get housing.”  “Housing here is terrible. I live in an affordable housing situation. But I tolerate mold as there are no other options. If I was evicted today, I would have no place to go.”  “I would like to try to move but the cost is too much to find a place.”  “I know someone now that is living on the street. The shelters only give intermediate stay.”  “[It is] impossible to find a rental.”  “Temporary hotel housing was a god send." Access to services Twenty-two comments addressed some form of access to services. The vast majority of these comments were related to the need for more health care services. Some comments expressed increased access to services. Other comments expressed no or less access, such as no access to the library for internet and printing needs, difficult access to government offices, and no access to the Salvation Army in Nelson due to closure. Some specific comments include: 13  “[It is] hard to commute to harm reduction service centres.”  “[I have] more access to mental health and addiction treatment services… as doctors are now doing phone call appointments and I don't have to go to [another community] every day for my methadone like I used to.”  “Health care services are not good because they only do things over the phone. They diagnose you over the phone.”  “We need more access to mental health resources. It is really hard to get into 1:1 therapy. We find it best. It would be nice to have more accessibility to treatment programs.”  “[It is] difficult to access support services during COVID because you need a phone for everything.” Overdose Crisis Fifteen comments related to the overdose crisis were received. Many comments indicated personal connection to the overdose crisis, whether the respondent themselves had experienced an overdose, or had lost friends or family to an overdose. Some comments include:  “[I am] more concerned about overdose crisis than COVID”  “[I have] lost a lot of friends to the overdose crisis"  “I would like to see more help available for the overdose crisis. I have relapsed due to COVID. If there was more access I would have been able to get the help I needed. Food Eleven comments related to food access showed various perspectives. Some commented about increased access to food, others less access. One comment suggests that access to food changed through the pandemic from less access at the beginning to more access later on. Some comment examples include:  “[I have] more access to food because the food bank delivers now so its easier to get meals”  “Lunches have been given out but it's not the same as having social interaction.”  “The food and nutrition services are more limited.” Hygiene There were six comments related to hygiene. Of these, five comments addressed the need for more temporary washrooms. Although feedback from one person indicated they did not use temporary washrooms because there was no place to wash their hands. Another respondent indicated, “I worry about looking homeless. Looking homeless leads to increased discrimination, makes it harder to find housing or a job - access to showers more regularly would help.” Income Out of the four comments related to income, two expressed that COVID helped their financial situation. The two remaining comments related to concern over finances related to difficulty finding work or accessing benefits. 14 APPENDIX 1: SURVEY INSTRUMENT 15 Survey ID: _____________ Record the Survey ID on each page as follows: N , T, or C (Nelson, Trail, or Castlegar) – Date (ddmm) – Number (sequence from that day) e.g., N-2408-1. Survey: COVID-19 Impacts on People Experiencing Homelessness in West Kootenay Communities This survey asks questions about the impacts of the COVID-19 pandemic on people experiencing homelessness in West Kootenay communities. The aim of the project is to help researchers and service providers understand: 1) The most important needs being faced by people experiencing homelessness during the pandemic 2) To what extent people experiencing homelessness benefitted from new or modified services offered during the early stages of the pandemic. Survey results will be used to help the research team and the service organizations we have partnered with plan and provide services that respond to the most critical community needs. Project results will be shared with our partner organizations, but your individual data will be kept confidential. If you agree to complete the survey it should take about 15 minutes. The surveyor will ask you questions and record your answers. Your participation is voluntary. You may withdraw at any time. If you complete the survey, we will provide you with a $10 gift card. There are no known risks if you decide to participate in this survey. If you have any questions about this survey, please contact Lauren Rethoret at lrethoret@selkirk.ca. The Selkirk College Research Ethics Board has approved this research study. If you have any ethical concerns, please contact Paula Vaananen at pvaananen@selkirk.ca. ***Check this box to confirm that you understand this informed consent statement and agree to participate: 1. On a scale of 1-5, with 1 meaning not concerned, and 5 meaning very concerned, how concerned are you about the COVID-19 pandemic? 1 2 3 4 5 Prefer not to answer 2. Please share a bit about why you are or are not concerned about the COVID-19 pandemic. Summarize and read response back to respondent to confirm accuracy 3. What do you feel has been your greatest need during the COVID-19 pandemic? Summarize and read response back to respondent to confirm accuracy □ Survey ID: _____________ Prefer not to answer Same as before COVID More than before COVID Less than before COVID Have you experienced the following during the COVID-19 pandemic? No 4. Discrimination Feelings of loneliness or isolation Harm reduction services (such as the Opioid Agonist Treatment (OAT) clinic or harm reduction supplies such as foil kits) Food/nutrition services (such as the food bank, community dinners, or food deliveries) Housing services (such as shelters or subsidized housing) Mental health and addictions treatment services (such as counseling, groups, detox, residential addictions treatment programs) Healthcare services (such as doctors, nurse practitioners or the hospital) Harm reduction services Food/nutrition services Housing services Mental health and addictions treatment services Healthcare services Prefer not to answer No impact Positive impact If you answered less access or more access to the above items, how has that change had an impact on your well-being (health, safety, and happiness)? Negative impact 6. Prefer not to answer I do not use this type of service No Change More Access How has your ability to access the following types of services changed during the COVID-19 pandemic? Less Access 5. Survey ID: _____________ 7. How has COVID-19 affected your income? No change Less than before COVID More than before COVID due to government benefits More than before COVID due to work More than before COVID for other reasons Prefer not to answer 8. On a scale of 1 to 5, with 1 meaning not at all helpful, and 5 meaning very helpful, how helpful have the following services offered during the COVID-19 pandemic been to your well-being: 1 2 3 4 5 I didn’t use this service Prefer not to answer Nelson Sanctioned encampment Food deliveries (to encampment, hotel-based housing, or hamper deliveries) Cell phones provided for personal use Temporary showers Trail Extended service at the emergency shelter (i.e., beyond seasonal operations) Daytime supports at the shelter (food, clothing, showers, etc.) Both Temporary, hotel-based housing ‘Pandemic Prescribing’ i.e., hydromorphone/Dilaudid, Dexedrine Temporary washrooms/port-a-potties Other (please describe)_______________________ 9. On a scale of 1-5, with 1 meaning not concerned, and 5 meaning very concerned, how concerned are you about the housing crisis in your community? 1 2 3 4 5 Prefer not to answer Survey ID: _____________ 10. Would you access harm reduction housing if it were available in your community? (Harm reduction housing is a judgment-free place to live where people who use substances could live safely and receive extra support services). a. No b. Yes c. I would be interested to learn more about it d. Prefer not to answer 11. On a scale of 1-5, with 1 meaning not concerned, and 5 meaning very concerned, how concerned are you about the overdose crisis? 1 2 3 4 5 Prefer not to answer 12. Do you self-identify as indigenous? No Yes, First Nations, status Yes, First Nations, non-status Yes, Metis Yes, Inuit Prefer not to answer 13. If you answered ‘Yes’ to the above question and you would like to participate in future research specifically about the experiences of indigenous people experiencing homelessness during the COVID19 pandemic, please provide the surveyor with your name and contact information. Record this information on a separate piece of paper Thank respondent. Provide gift card. Fold survey and place into envelope.