In order to meet the goals, the program is very broad-based and comprehensive. People often think of Streetworks as being only about needles. In many ways, the needles and condoms are a strategy to get people connected with the program so the staff can assist individuals with making positive changes. The following is a synopsis of services: Nursing Services: Nurses on the team do health assessments, testing (such as HIV and Hepatitis), screening (TB), immunizations (such as Hep B, pneumovax, flu shots), health education and advice, minor treatments, and emergency care. They also follow women through their pregnancies, and check on the chronically ill. Many people come to the program who are not needle users or sex trade workers, but simply individuals who want to see a nurse. Business Program: The program staff attempts to work with area businesses in keeping their establishments safer and healthier. This includes gas stations and convenience stores, taverns, hotels and others. Streetworks will provide resources such as sharps containers, posters, pamphlets and staff will also go into sites to do immunizations for staff and clientele. Natural Helpers: Staff is aware that many people take care of each other if they are street-involved, rather than accessing mainstream services. Often, people who come to the van do not use drugs themselves, but are exchanging for their friends or family who are involved with drugs or the sex trade. The Natural Helpers initiative is a strategy to help those care providers remain safer and healthier themselves, as well as ensuring that appropriate information and education reaches the hidden groups they are helping. This work goes beyond peer education in recognizing and strengthening health work in the community, which is at the grassroots level. See section on Natural Helpers. Ride-alongs: Physicians, nurses, social workers, outreach workers, and others from specific agencies come out on the van to provide services to people who have difficulty accessing services otherwise. They come out monthly in an effort to become known and trusted amongst the target group. Getting to know a worker from an agency through the van makes it easier for the clients to go into the agencies represented. Referrals: The Streetworks staff makes a large number of referrals to agencies such as physicians, treatment centers, Deter, legal services, social services, methadone clinic, STD Clinic, safe houses, mental health services, housing services, and others in order to help people make positive changes in their lives. Staff will often go with the clients to the place of referral. Supplies: Streetworks will provide individuals who are involved in drug use or the sex trade with the tools they may need to remain safer and healthier. These include needles, alcohol wipes, elastics, condoms, lubrication, tourniquets, vitamins, pregnancy test kits, Health for Two coupons, feminine hygiene products, first aid and general health supplies, water, food and clothing (when available), Crossroads Bad Date Sheet, and other items as they are available. Streetworks also supplies some agencies and businesses with sharps containers. Agencies and Organizations: Streetworks works with various inner city agencies providing education about Harm Reduction, HIV, HEP C, and Streetworks programming. Streetworks supports the staff and volunteers of these agencies and works towards integrating services. Health Education: All Streetworks staff provides information to agencies, groups or individuals on various topics such as HIV/AIDS, hepatitis, universal precautions, the Streetworks program, injection drug use, sexual health and others. As well, Streetworks develops culturally appropriate resource material for the target group. Advocacy: Staff will advocate for clients if the need arises. This may take the form of going with someone to an appointment, or working with agencies to help him or her become more effective in meeting the needs of street-involved individuals. Staff members serve on committees at the regional, provincial and national level. Prison Program: Streetworks works to assist individuals with criminal justice system involvement m helping them stay safer and healthier, both while incarcerated and after release. The staff sits on many committees, which address the issue of blood-borne pathogens and incarceration at both the local and provincial level. Research and Evaluation: There is very little information about the practices and social networks of injection drug users. Streetworks has been involved in many studies, which provide a clearer picture of the population and the challenges in working with them. Annual evaluations and statistic keeping are routine.