Embed Size (px)
Citation preview
+Getting Ready for Harm Reduction
2010 Street Outreach Workers Conference Austin, TXKevin Irwin
June 21, 2010
+Objectives
Convey a personal and agency definition of harm reduction
Describe the evidence base for harm reduction
Dialogue with people with varied understandings and beliefs about harm reduction
Describe the current status of Texas laws relevant for harm reduction practices (e.g. paraphernalia law).
Identify possible community-level barriers to implementing harm reduction measures and develop strategies for building community support to overcome these barriers.
+Policy Pathways
The lifting of the Federal Ban on the funding of needle exchange programs on December 19, 2009 – what does it mean?
In 2009 Senate Bill 308 passed by a 3/1 margin and cleared the House Public Health committee by better than 2/1. It seemed likely that the bill would have passed the full House had the legislative term not ended before it could come to the floor.
+Objectives
Convey a personal and agency definition of harm reduction
Describe the evidence base for harm reduction
Dialogue with people with varied understandings and beliefs about harm reduction
Describe the current status of Texas laws relevant for harm reduction practices (e.g. paraphernalia law).
Identify possible community-level barriers to implementing harm reduction measures and develop strategies for building community support to overcome these barriers.
+Principles of Harm Reduction
Being clear about Harm Reduction
Harm reduction is a set of practical strategies that reduce the negative consequences of drug use experienced by individuals and communities.
Harm reduction approaches incorporate a spectrum of strategies from safer use, to managed use, to abstinence.
Harm reduction strategies engage drug users, identify their needs, and work towards goals that are attainable.
+Harm Reduction in 1842
“Is it just to assail, condemn, or despise them? Men ought not in justice to be denounced for yielding to it in any case, or giving it up slowly, especially when they are backed by interest, fixed habits, or burning appetites.”
+
Abraham Lincoln, 22 February 1842
Address before the Springfield Washington
Temperance Society
+
“If tobacco suddenly were unavailable and was as expensive as heroin and cocaine, I think you would find that the behavior of some tobacco addicts would be very much like the behavior of some addicts of heroin and cocaine.”
+ C. Everett Koop
Surgeon General
1982-1989
+Harm Reduction Definitions
Harm reduction is NOT “whatever happens, happens.”
Harm reduction is NOT “anything goes”
Harm reduction is NOT simply “meeting the client where the client is at” (it’s helping them to change behavior)
Harm reduction is NOT “Helping a person who has gotten off drugs to start using again.”
Harm reduction is NOT condoning, endorsing, or encouraging drug use.
Harm reduction is NOT Legalization
+Compassionate Pragmatism
Harm Reduction is a philosophy, integrated into a variety of practices
There is no one right way
Most life changes are gradual
All chronic conditions are challenging
Reducing harm is the fundamental objective of responses to all chronic conditions
Abstinence is a state
Any Positive Change
+The A-word
Are abstinence and harm reduction compatible?
HOW are abstinence and harm reduction compatible?
Harm reduction and abstinence are highly congruent goals.
Harm reduction expands the therapeutic conversation, allowing providers to intervene with active users who are not yet contemplating abstinence.
Harm reduction strategies can be used at any phase in the change process.
+Harm Reduction and Behavior
Safer Driving – speed limits, seat belts, intoxication limits, air bags, defensive driving, alternatives to driving……
Safer Sex – condom use, avoidance of risky sexual practices, abstinence……
Safer Drug Use – reduced use, avoidance of risky routes of administration, drug substitution, safe using partners (designated driver), abstinence…..
+Principles
Accepts, for better and for worse, that licit and illicit drug use is part of our world and chooses to work to minimize its harmful effects rather than simply ignore or condemn them.
Understands drug use as a complex, multi-faceted phenomenon that encompasses a continuum of behaviors from severe abuse to total abstinence, and acknowledges that some ways of using drugs are clearly safer than others.
Establishes quality of individual and community life and well-being - not necessarily cessation of all drug use - as the criteria for successful interventions and policies.
Calls for the non-judgmental, non-coercive provision of services and resources to people who use drugs and the communities in which they live in order to assist them in reducing attendant harm.
+Principles, cont’d
Ensures that drug users and those with a history of drug use routinely have a real voice in the creation of programs and policies designed to serve them.
Affirms drugs users themselves as the primary agents of reducing the harms of their drug use, and seeks to empower users to share information and support each other in strategies which meet their actual conditions of use.
Recognizes that the realities of poverty, class, racism, social isolation, past trauma, sex-based discrimination and other social inequalities affect both people's vulnerability to and capacity for effectively dealing with drug-related harm.
Does not attempt to minimize or ignore the real and tragic harm and danger associated with licit and illicit drug use.
+Objectives
Convey a personal and agency definition of harm reduction
Describe the evidence base for harm reduction
Dialogue with people with varied understandings and beliefs about harm reduction
Describe the current status of Texas laws relevant for harm reduction practices (e.g. paraphernalia law).
Identify possible community-level barriers to implementing harm reduction measures and develop strategies for building community support to overcome these barriers.
+20+ Years of Research…
SEPs are associated with reductions in HIV/AIDS transmission
SEPs do not encourage or increase rates of drug use in their communities (and may lead to decreases)
SEPs do not increase crime in their communities
SEPs do need increase needlestick injuries in their communities
SEPs are associated with significant financial savings
The Highest risk IDUs can be reached by SEPS
SEPs are associated with increased access to, and utilization of health and social services, including drug treatment, primary care and housing
SEPs are facilitating lower mortality due to overdose
SEPs do not support drug use, they support people who use drugs
+Major Endorsements
National Institutes of Health (1997)
American Public Health Association (1997)
US Surgeon General (2000)
Department of Health and Human Services (2000)
Institute of Medicine (2000)
Centers for Disease Control (2002)
National Institute on Drug Abuse (2002)
+SEP Best Practices into PolicyCharacteristics of Effective Programs
Ensuring low threshold access to services Maximize access by number of locations and available hours Ensure anonymity of participants Minimize the administrative burden of participation
Promotion of Secondary Syringe Distribution Training and support of peer educators Do not impose limits on number of syringes
Maximizing responsiveness to characteristics of the local IDU population Planning activities and service modalities adapted to subgroup needs
Provide or coordinate the provision of essential health and social services
Include diverse community stakeholders in creating a social and legal (e.g. paraphernalia laws) environment supportive of SEP
+SEP Best Practices into PolicyPractices to Avoid
Supplying single-use syringes
Limiting frequency and number of syringes
Requiring one-for-one exchange
Imposing geographic limits
Unnecessary caps on syringe volume
Requiring identifying documents
Requiring unnecessary data collection
+Objectives
Convey a personal and agency definition of harm reduction
Describe the evidence base for harm reduction
Dialogue with people with varied understandings and beliefs about harm reduction
Describe the current status of Texas laws relevant for harm reduction practices (e.g. paraphernalia law).
Identify possible community-level barriers to implementing harm reduction measures and develop strategies for building community support to overcome these barriers.
+Group Work
+Objectives
Convey a personal and agency definition of harm reduction
Describe the evidence base for harm reduction
Dialogue with people with varied understandings and beliefs about harm reduction
Describe the current status of Texas laws relevant for harm reduction practices (e.g. paraphernalia law).
Identify possible community-level barriers to implementing harm reduction measures and develop strategies for building community support to overcome these barriers.
+Texas Law
+Objectives
Convey a personal and agency definition of harm reduction
Describe the evidence base for harm reduction
Dialogue with people with varied understandings and beliefs about harm reduction
Describe the current status of Texas laws relevant for harm reduction practices (e.g. paraphernalia law).
Identify possible community-level barriers to implementing harm reduction measures and develop strategies for building community support to overcome these barriers.
+Advocacy - when you want to:
Promote public health objectives.
Overcome barriers that restrict public health opportunities.
Promote the importance and relevance of prevention including increases in funding.
Protect human rights.
Ensure a better quality of life.
Be responsive to needs, but be balanced with providing innovative proactive strategies.
Be oriented towards outcomes for public health.
Aim for empowerment of disadvantaged individuals and groups.
Challenge stereotypes and stigma.
+Advocacy
Check your facts
Plan and promote for small wins
Have an advocacy path
Get the timing right
Be open to windows of opportunity
Make issues local and relevant
Create and maintain partnerships
Accentuate the positive!
Framing your message
Be passionate and persistent
Be prepared to compromise
Know your adversaries
Keep your eyes on the prize
Have some tricks up your sleeve
Commitment to Continual Assessment
Be Inclusive
Create champions
Enjoy yourself!
+Conditions that Facilitate or Deter Adoption of Harm Reduction Coalition building and community consultation are key to the acceptance and
sustainability of new interventions.
Leadership from politicians, public health officials, and program directors provide necessary authority, legitimacy, and access to resources.
Grassroots activists took initiative and risks in the face of opposition, but often lacked the resources to sustain their efforts.
Researchers played an important role in initiating interventions and legitimizing them by providing access to the scientific information supporting their safety and effectiveness.
Successful implementers worked with or avoided the opposition rather than creating polarized positions.
Lack of leadership in the political and public health sectors, and, indeed, fear of adopting or even discussing needle exchange because of perceived political opposition, were the biggest barriers to implementation of syringe exchange programs.
+Building Community Acceptance Coalition Building
Community Dialogue (Create Opportunities) Rapid Assessment Techniques (Inclusive)
Mapping Resources and Assets Local Policy and Practices Environment Local Sources of Capital
Develop an Overall Strategy
Media Strategy
Law Enforcement
+Develop an Overall Strategy
Master Plan (Gantt Chart)
SMART Goals
Specific: State clearly what the program is trying to achieve
Measurable: Can be measured without massive resources devoted to research and evaluation
Achievable: Challenging, yet not overly ambitious given the available human, financial and other resources
Relevant: Useful to the overall process of working towards the goal
Time-constrained: Identify a time limit within which it is to be achieved; otherwise the objective will be impossible to measure
+Media Strategy
Assign a Coordinator of Public Relations
Develop a Media Strategy Map Potential Outlets Media Releases, Press Conferences, Talk Shows, Articles
Develop a Communications Toolkit Clear and Concise Tailored for Audience and Locale
Build Relationships with Media
Educate Staff on Dealing with Media
+Media Musts…
Do your homework, know your stuff, and be prepared.
Anticipate all possible questions, both “good” and “bad,” easy and tough.
Practice in the “Hot Seat”
Know what message you want to get across in an interview: Prepare your key points and the specific details, examples and
illustrations that will support them and make memorable. Boil your message down into brief, clear, positive sentences
that are free of jargon or insider knowledge. Collect or prepare supporting material (media releases,
brochures, fact sheets, backgrounders and so on) that you can give to the reporter.
+Use Varied Strategies
Media release
Action alerts
Letters to politicians
Meeting with a politician
Interviews
Letter to the Editor
Radio grab
Television interview
+Working with Law Enforcement
Police Advocates
Have provided disposal of syringes found in the community; programs respond to any calls to clean up/dispose infected syringes
Program staff will come to precincts to provide roll call presentations, sharps containers, needlestick, and syringe disposal information
Syringe exchange programs teach IDUs how to inform officers they are in possession of syringes prior to being searched.
Programs request that participants respect officers and document badge number and precinct if syringes are confiscated.
Police can refer drug users to our services for medical care and drug treatment.
+Develop Dexterity
The Moral Paradigm
The Safety Paradigm
The Legal Paradigm
The Medical Paradigm
The Public Health Paradigm
The Social Good Paradigm
Prochaska & DiClemente’s Stages of Change
PRE-CONTEMPLATION
Not yet considering possibility of change.
DETERMINATIONOR PRE-ACTION
“I’ve got to do somethingabout this problem.”
“This is serious. Something
has to change.”
ACTION
MAINTENANCE
Identify Strategies and support to prevent relapse
RELAPSE
Help renew contemplation, pre-action, action without
giving up.
CONTEMPLATION
Considers change and rejects it.
Reasons for concern vs. justifications for concern.
Cost – Benefit Calculation
+Review
Convey a personal and agency definition of harm reduction
Describe the evidence base for harm reduction
Dialogue with people with varied understandings and beliefs about harm reduction
Describe the current status of Texas laws relevant for harm reduction practices (e.g. paraphernalia law).
Identify possible community-level barriers to implementing harm reduction measures and develop strategies for building community support to overcome these barriers.
+This year in the US…
8,000 people will acquire HIV from a contaminated syringe
15,000 people will acquire Hepatitis C from a contaminated syringe
20,000 people will die from an accidental overdose
6-8 million people who need drug treatment will not get it
