The Groupe d’Intervention Alternative pas les Pairs’ mission is the prevention of HIV, HCV and other STBBIs, as well as the reduction of risks associated with drug use and the street lifestyle among at-risk youths aged 12 to 30 in Montreal’s central neighbourhoods. The street experience is understood in a broad sense at the GIAP, and can include homelessness, drug use, involvement in the sex trade, subjection to judicial control, involvement in illicit activities and social exclusion.
By promoting an alternative intervention approach based on shared experiences and a comprehensive understanding of health among youth, the GIAP’s primary aim is to reach marginalized youth who engage in high-risk behaviours when it comes to their health. Prevention strategies focus especially on building self-esteem and self-affirmation in youth to facilitate the adoption of safe behaviours with regards to HIV, HCV and other STBBIs, drug use and their overall health. Youths reached by the GIAP receive, as needed, support in their efforts to take charge of their health. Along with this individual support, GIAP takes great pains to contribute to making downtown neighbourhoods more favourable to the adoption of safe behaviours, mainly by promoting positive social diversity. GIAP’s intervention approach is built on the guiding principles of respect, humanism, empowerment and harm reduction.
To this end, GIAP relies on a peer helper team, as well as the involvement of many partner organizations. These partner organizations, by welcoming one peer helper each, help widen the reach of GIAP’s alternative intervention approach and allow peer helpers to collaborate with workers and other professionals at these organizations.
The GIAP is made up of a team of six peer helpers. Peers, because at one point in their life, they also experienced life on the street, and helper, as they have the desire and capacity to use their personal experiences to accompany and support at-risk youths in finding solutions adapted to their situations.
The peer helpers’ ability to put their personal knowledge and experiences to good use in a support relationship requires a measure of distance from the street lifestyle. In order to adopt a broad sense of perspective regarding situations experienced by youth, peer helpers must have distanced themselves from the street lifestyle and their own personal struggles. Their experiences are important—they are integral to their intervention approach—but a certain distance must be achieved to adopt a comprehensive and alternative approach to intervention.
Of course, as peer helpers, they have a strong drive to help others, which is clear from the moment they arrive at the GIAP. At first, their potential to offer alternative intervention is found in their interpersonal skills more than their practical skills. Thanks to training, exchanges, coaching, clinical supervision and self-education, peer helpers take part in shaping a community of practice. The alternative approach, therefore, starts with the peer helpers and takes shape through the trust-based relationships they form with youths. Peer helpers use a range of mediums they are familiar with when working with youths, such as music, painting, sports or cooking, and use them to animate exchanges with youths, allowing them to achieve their prevention mandate.
Since the GIAP aims to reach marginalized youths in Montreal’s central neighbourhoods, peer helpers must be between the ages of 18 and 30 when they arrive at the GIAP. The proximity of shared experiences with the youth they work with necessitates being at similar places in their respective life paths.
The Peer-Based Alternative Intervention Approach
The GIAP’s peer-based intervention approach involves helping at-risk youths benefit from the life experience of former street youths. This is an alternative approach in several respects:
- Using the proximity of life experiences between peer helpers and the youth with whom they work is encouraged. This marks a break from a more traditional approach, where proximity between intervention workers and youth is considered detrimental to the support relationship.
- Trust is a driving force in intervention. Above all else, the GIAP’s peer helpers work to build trust-based relationships with youths. This particular trust is unique to peer helpers, as it is founded on shared experiences, lifestyle and language. These close links allow peer helpers to act as buffers between youth and the system. When youths live through unpleasant situations, such as spending the majority of their childhood under the guardianship the DYP, it is natural that they approach situations or professionals that rekindle these past memories with suspicion. It is through a foundation of trust that peer helpers can reassure youths, allowing them to seek services they may need.
- A unique understanding of prevention informs the GIAP’s peer helpers. Rather than specifically targeting behavioural changes in at-risk youth with the aim of preventing disease and infections, peer helpers approach prevention by developing self-esteem and self-care amongst youth in difficulty. Why take care of yourself if you feel your life is worthless? Developing and consolidating self-esteem among youth helps support prevention efforts and facilitates the adoption of healthier lifestyles.
- A comprehensive approach to health shapes the peer helpers’ action plan. For the GIAP, health isn’t only the absence of illness, and is not limited to the body and spirit. It also takes on a social dimension. Health is defined with regards to the self, those around us and the society in which we live. Working to improve the health of at-risk youth means, therefore, working toward their recognition as full citizens in our society, with rights and responsibilities, freedoms and the ability to become involved in their community. Defending people’s rights and the fight against social exclusion are therefore integral to the GIAP’s action plan.
- Recognition of the positive aspects of the street experience informs the GIAP’s action plan. The weight of their own personal experiences allow peer helpers to recognize that the street experience is not negative in and of itself and that it can respond to certain needs at times, such as the need to get away or demonstrate resistance to social norms. The peer helpers’ non-judgemental humanistic approach allows them to grasp the global nature of the street experience.
- The originality of mediums used by peer helpers in their prevention efforts also helps shape the GIAP’s alternative approach. In fact, peer helpers “generally use mediums they know well, such as music, painting, sports, circus performance or cooking to animate exchanges with youths, allowing them to achieve their prevention mandate.” (Bellot et al, 2007 : 30). The activities the GIAP’s peer helpers develop are inspired by their personal interests.
The GIAP’s alternative intervention approach is based on the fundamental principles of respect, humanism, youth empowerment (or autonomy) and harm reduction. These principles shape the GIAP’s activities, the project’s management and its partnership structure.
Respect for others and the self is the foremost guiding principle in the GIAP’s plan of action. In their interactions and intervention work with at-risk youth, peer helpers must adopt an open-minded, accepting and non-judgmental attitude. Relationships built with youth operate within a framework of equality, as peer helpers are not in a position of authority over those they seek to help. These relationships also operate within a framework of reciprocity, although the peer helper’s role is to help youths, and not the other way around.
The humanistic approach requires seeing human dignity as paramount. It is principally defined through the notions of respect, responsibility, freedom, authenticity and experience. Intervention work undertaken within this framework is built around an individual’s place in life and identity, and centres on their goals and decisions, while considering the person’s capacity to achieve those goals. The humanistic approach necessitates accompanying an individual on their own path, at their own pace, and not according to a theoretical ideal. The GIAP’s unique understanding of prevention as the development of self-care, their comprehensive approach to health and the importance they accord to the defense of rights and the social inclusion of marginalized persons are notions that fall within the framework of the humanistic approach.
Empowerment is an approach that aims to support the struggles of individuals and communities so that they may take or regain control over their lives and increase their ability to take autonomous action. This involves recognizing the abilities of individuals to identify the problems they wish to address and find ways they may, themselves, reach their goals. This approach is applicable to youth as well as to the GIAP team. It is, therefore, not a question of “doing for,” but of “doing with.”
Harm reduction is an intervention approach that aims to reduce the negative consequences of a behaviour (or of social control surrounding that behaviour) on the individual, their circle and society at large, without seeking to eliminate it. Given the GIAP’s mission, in this context, it involves reducing the negative consequences associated with drug use, sexual activity and the street lifestyle. This approach is inspired by pragmatism and humanism. It is pragmatic in that it allows workers to reach drug users, whether they wish to stop using or not. It is humanistic in that it is an approach that considers improving the quality of life of individuals and what is important to them.
In addition to these guiding principles, which form the foundation to the GIAP’s alternative intervention approach, peer helpers hold their own code of ethics that ensures professionalism within the team.
The GIAP is made up of partnerships between several Montreal organizations that work with at-risk youths. More specifically, six organizations work with the GIAP: Dans la Rue, Cactus Montréal, l’Unité d’intervention mobile L’Anonyme and Projet Montréal de Médecins du Monde as well as one institution, the CSSS Jeanne-Mance. Please see our partners organizations for more information about these groups.
The GIAP privileges an empowerment-based approach, both individual and collective. This approach is reflected principally through the participatory management structure that characterizes its operation and through the role occupied by peer helpers. As depicted in the organizational chart above, peer helpers are at the heart of the GIAP; together, they share their reflections and assessments regarding the needs of at-risk youths, shape their alternative intervention approach, create tools that support this approach and decide on activities to organize according to the evolving street environment or the rise of new trends.
Peer helpers therefore form a genuine team, thanks to the two days per week that they meet to share their knowledge and experiences, work together on various prevention initiatives or develop new workshops. The GIAP’s peer helpers are therefore extremely involved in the daily management of their project, with most decisions being taken at the weekly meetings in which each peer helper participates. Peer helpers rely on the support of the intervention support agent, the project coordinator and their outreach partner. Furthermore, peer helpers benefit from training that allows them to develop the tools needed to use the knowledge gained through their experiences in their intervention work.
Our partners each welcome one peer helper into their organization three days a week. Each partner organization assigns a worker to facilitate the integration of the peer helper into the organization and to help them acquire and develop their clinical reflexes. This individual is the outreach partner mentioned above. By fully integrating peer helpers into their teams and including them at staff meetings, partner organizations allow peer helpers to fulfill their mission, which is distinct from – yet complimentary to – that of the workers at the organization. While being consistent with the mission of their host organizations, peer helpers pursue the GIAP’s mission with regards to the prevention of STBBIs and the reduction of risks associated with drug use and life on the street. For a better understanding of the role our peer helpers have within each partner organization, please consult the partners section.
All those involved with the GIAP meet for a half-day once a year at the strategic forum. It is the most important forum about the project, and it is on this occasion that substantive discussions regarding the project’s direction take place. Our partners meet as a partner committee three times a year to discuss the project’s progress, the management of human and financial resources and the project’s future direction. The peer helper team appoints one member to chair the partner committee and ensure that the alternative approach at the heart of the GIAP’s mission be present in discussions.
Working in partnerships is a driving force for the GIAP. Welcoming peer helpers into their organizations has the particular advantage of allowing our partners to reach more youth, particularly those who are more isolated or less trusting of intervention workers. In return, peer helpers benefit from the evidence-based experience of workers at these organizations, and the dialogue that emerges through the convergence of different intervention approaches allows for solutions better adapted to the situations of at-risk youth. Working with partners also facilitates the referral process of youth to the GIAP’s partner organizations. Information sharing concerning, for example, new trends in drug use, is also facilitated through working with partners. Finally, working with partners gives the peer-based intervention approach greater reach, and therefore helps to further its recognition in the domain of intervention.
A Brief History
To understand the GIAP’s history, we must first think back to Montreal’s downtown in the early 1990s. The number of street youth was on the rise, intravenous drug use was all the rage and HIV was ravaging the downtown youth population. Specialized teams made up of healthcare professionals were deployed to intervene among this particular population, but their efforts were mostly unsuccessful in reaching street youth.
Thus, the idea of relying on informal help to reach this population emerged. On the initiative of workers at the St. Denis Youth Clinic, the “C’est dans la rue que ça se passe” program was created in 1993 and operated within four shelters. To this end, four street youths were hired as liaison agents at the Bunker, En Marge 12-17, the Refuge des jeunes and Passages. As liaison agents, through streetwork (outreach work), they were mandated to reach out to youth who did not seek out available services. It was, therefore, real employment for youth, and those interested had to meet specific employment criteria, mainly being between the ages of 16 and 18. They were remunerated through symbolic means. With its many ups and downs, the project lasted until 1995.
Some lessons were learned through this first foray, which helped in the development of the 1995 project “L’intervention pas les pairs, dans la rue, au centre-ville.” The workers involved in the project saw the necessity for a greater measure of distance from the street environment to stabilize the liaison agent team and avoid certain ethical pitfalls. It was in this spirit that the age range of agents was expanded to include youths between the ages of 16 and 20. Street work gradually gave way to work within partner organizations, mainly to avoid potential risks for agents who at times found it difficult to work in their own social environment. It was also at this time that the HIV prevention mandate aimed at youths between the ages of 16 and 20 took a more specific shape and that the liaison agents became veritable peer helpers. Eventually, shelters distanced themselves from the project one by one, and HIV prevention organizations took over.
After a difficult period marred with financial difficulties, the early 2000s gave new breath to the project, principally with the arrival of two significant grant providers. With a more clearly defined mission, participants established organizational guidelines for working in partnerships, and in 2005, the project took on the structure of a collective, the Collectif d’Intervention par les pairs, which placed peer helpers in a more central role than ever before.
In 2007, participants agreed to reconsolidate the organization as one group, whereas it had been spread out beforehand. This new structure had a significant impact on the project’s organization and the involvement of participants. The collective structure was adjourned until a new organizational structure was defined. The drafting process and adoption of a new agreement, done in partnership this time, was not without conflict. However, the tireless work of participants lead to the signing of a new partnership agreement in 2009, when the project took the name of the Groupe d’intervention alternative par les pairs.
With time, the GIAP has matured a great deal. The partnership structure has been established and the role of each partner is increasingly understood on both sides. The team, with the strength inherited from their predecessors, relies on well-established methods, effective techniques that incite meaningful participation, and feedback mechanisms that facilitate communication within the team and with partner organizations. The project continues to evolve, and will exist in a state of constant evolution as new peer helpers join the team, bringing each their own character and interests. The project will continue to work to ensure that the GIAP’s action plan continues to address the needs and interests of at-risk youth.