IDU Outreach Project. Program Guidelines

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1 Ministry of Health and Long-Term Care Ministère de la Santé et des Soins de longue dureé Prepared by: AIDS Bureau Revision Date: April 2001

2 TABLE OF CONTENTS 1 Introduction Program Goals Objectives Principles Role of the Outreach Worker Program Components Client Services... 3 Outreach... 3 Counselling... 3 Support... 3 Education Peer Component Recruitment Orientation and Education Reporting Sessions/Meetings Community Development Community Advisory Component Accountability of Administering Agency Supervision and Support of the Worker Financial Reporting Activity Reporting Appendix I: Criteria for Proposal 5 Appendix II: Activity Reporting 1

3 1 Introduction: At the Canadian Association of HIV/AIDS Research Conference held in Ottawa in May 1997, results from studies in Vancouver and Montreal indicated a dramatic increase in HIV infection in the injection drug using communities. In response to this, in September 1997, the AIDS Bureau held a community consultation to find practical interventions to assist in preventing similar outbreaks in Ontario. The consultation with community-based representatives addressed ways in which AIDS Service Organizations could reach their local injection drug using communities. With a new allocation of $1 million dollars from the Ministry of Health, it was decided that 15 outreach workers, working with other community partners and complementing existing services, be strategically placed throughout the province. Using data from a report prepared by Robert Remis, The HIV Epidemic among Injection Drug Users in Ontario, a number of hot spots in the province was identified. Community-based agencies in these locations were then asked to develop a proposal for Prevention, Education and Support to the Injection Drug Using Community. The AIDS Bureau provided criteria for the development of these proposals. (Appendix l) These criteria, (see appendix 1), state that the program must be developed locally, contain a peer component, complement existing services and not duplicate other projects. The HIV Program at the Centre for Addiction and Mental Health will provide training to the program. As well, the program must involve other community services, assist in reaching people not presently accessing services, and work towards reducing the isolation of the IDU population. Using these criteria as a basis, the following program guidelines were developed in consultation with key stakeholders. The guidelines are meant to provide a framework for the development and implementation of the. The project is modelled on a community based approach to service delivery. The intent is that the project be client-driven with built in flexibility over time and between communities. The guidelines are meant to provide clarity and recognize that local conditions will determine service provision. It is expected that 80% of work time will be dedicated to providing direct client service to the IDU population to establish trust, provide harm reduction materials, make appropriate referrals and to provide continuing support as appropriate. This time will be balanced between street work and work at a fixed site. The additional 20% is expected to be dedicated to community development and the community advisory component. 1

4 1.1 Program Goals: The overall goals of the program are: To reduce HIV transmission in the injection drug using communities To reach out to injection drug users who are unable or unwilling to access services To work towards reducing the isolation of this population To be value added and complement existing services 1.2 Objectives: The following objectives will assist in meeting the stated goals: To deliver service from a harm reduction perspective, i.e. to reduce the harms associated with drug use To work with other services to assess the local situation To consult with service users in the development of outreach activities To be visible in the IDU communities 1.3 Principles: The is based on recognition of certain fundamental harm reduction principles. Drug use and substance dependence is recognized as a matter of health. Personal and social well-being is better encouraged through an approach to drug use that is free of moral judgement. The isolation and marginalization of injection drug users are acknowledged and services are provided to enhance the personal well-being of injection drug users and to increase the community s level of understanding and support. Services are provided in a non-judgemental and non-coercive manner, developing trust and maintaining confidentiality. The importance of long-term positive relationships between the outreach worker and clients is recognized. While outreach services are provided to emphasize accessibility and to develop trusting relationships, personal and professional boundaries are recognized as being in the interest of both clients and staff. 1.4 Role of the Outreach Worker: To implement the components of the project within the expectation that 80% of the work is dedicated to direct client service including the peer component and that approximately 20% is dedicated to community development and the community advisory component. Outreach workers must make direct client contact a priority. This can be accomplished by reaching people who are not accessing services, who are unable or unwilling to access fixed sites as well as those already accessing other services at fixed sites. 2

5 2 Program Components: There are 4 components within the program. These components are: Client Services: - Outreach - Counselling - Support - Education Peer Component Community Development Community Advisory Component Agencies administering this program are expected to assist the worker in the development of each component. The program may enlist volunteers to assist in any part of the program components. The above components are defined by the following: 2.1 Client Services: to provide harm reduction/prevention materials to facilitate access to service for IDUs to partner with other agencies in the provision of direct services including needle exchange when and if necessary Outreach: A strategy to engage individuals in their own environment to reduce marginalization and isolation. Clients may be reached at fixed sites where they tend to congregate i.e. Clinics, needle exchanges, bars, coffee shops, local malls etc. Counselling: to respond to client needs by providing supportive, emotional and health counselling and to negotiate appropriate referrals Support: to provide practical support in assisting clients to access basic needs e.g., food, clothing, housing, etc. to assist clients in accessing basic documentation e.g. help with completing forms for health cards, social assistance etc. 3

6 Education: To provide information in a way that is suitable to the clients learning styles, Is culturally appropriate and tailored to specific needs, e.g. safer injection and safer sex, health issues and community resources, etc. To provide harm reduction /prevention materials with instructions for use 2.2 Peer Component: The peer component is a strategy for reaching injection drug users within their own community and providing them with the resources to reduce HIV transmission, e.g. information on the administrating agency and its services, information on other services in the area, and harm reduction materials including needles and syringes in partnership with local needle exchanges. While peers are expected to respect the culture of the administrating agency, they should not be seen as representatives of the agency but rather as representatives of their own community culture. Some peers may wish to be more involved in the program. Those with a particular skill or expertise may be encouraged to sit on the advisory committee, make presentations to community groups etc. The peers are a bridge between the IDU community, the outreach worker and the agency. They will provide information to the IDU community and assist the agency in better understanding drug use, risk behaviours, and supplies and services needed etc Recruitment: The outreach worker will recruit members from the community to participate as peers. The manager/supervisor will assist and support the outreach worker with this task. Peers of the program are considered to be either active or ex-users. The peers will negotiate their time commitment with the outreach worker. This may be short term or long term. The peers may receive an honorarium for their work i.e. distributing materials, providing information about the program and providing peer support Orientation and Education: To ensure that the peers understand their own role, responsibilities and boundaries they will receive orientation to the agency and the outreach worker role. Orientation and education includes information about HIV transmission and prevention, harm reduction supplies, drug dependency, educational and communications strategies, and local services. Orientation and education may be provided either formally or informally as negotiated between the outreach worker and the peer. 4

7 2.2.3 Reporting Sessions/Meetings: The exchange of information between worker and peer is an important part of delivering appropriate service. The worker is expected to be available to the peers to share information either through regularly scheduled meetings or through informal meetings e.g. when peers come in to pick up supplies. Peers may also benefit from meeting with each other to exchange ideas. These meetings may be coordinated by the peers to occur at the agency or informally at a nearby location where peers feel more comfortable, e.g. coffee shop, pool hall, park etc. 2.3 Community Development: The community development component provides an opportunity for outreach workers to work collaboratively with other local services. This work may include the following: develop a resource network for clients and identify gaps in service work with other local services to identify training needs make appropriate links with agencies that provide the training, e.g., CAMH, Public Health, ASO, etc. work towards establishing a network of other outreach workers e.g. mental health, addictions workers, for support and information sharing. attend to administrative tasks required by the host agency maintain sufficient data to complete reports required by the AIDS Bureau 2.4 Community Advisory Component: The outreach project must be accountable to the community that it is designed to serve. Therefore, the worker and manager of the program will develop a mechanism for community members to provide ongoing advice and guidance to the outreach program. The advisory body will include service users and service providers. The group must develop Terms of Reference that clarify the purpose, objectives, responsibility and accountability. 5

8 3 Accountability of Administering Agency Administering agencies are expected to provide direct supervision and support to the outreach worker and to meet the reporting requirements of the AIDS Bureau. 3.1 Supervision and Support of the Worker: The agency will provide the worker with direct and supportive supervision on a regular basis to ensure that: the work is being done according to the guidelines professional and educational opportunities are made available to the worker the isolating and stressful nature of the work is addressed systemic structures are in place to support the worker the importance of self-care for the worker is recognized The agency is accountable to the AIDS Bureau for financial management and reporting requirements. 3.2 Financial Reporting: The administering agency must submit Ministry settlement forms and audited financial statements after the end of each fiscal year in accordance to the AIDS Bureau Financial Guidelines, Section 4, Financial Review. These documents, along with any others requested by the AIDS Bureau, will be submitted on or before the deadline provided by the AIDS Bureau. 3.3 Activity Reporting: (see appendix II) The outreach worker must complete all Activity reports in a timely fashion for review by the manager/supervisor of the project and the signature of the Board Chair. The signed reports must be submitted to the AIDS Bureau on or before the deadline provided by the AIDS Bureau. 6

9 4 Appendix I: Criteria for Proposal PROPOSAL FOR OUTREACH WORKERS TO PROVIDE PREVENTION, EDUCATION & SUPPORT TO THE INJECTION DRUG USING COMMUNITY Background At the Canadian Association of HIV/AIDS Research Conference held in Ottawa in May 1997, results from studies in Vancouver and Montreal indicated a dramatic increase in HIV infection in the injection drug using communities. To date, the rate of infection is not as high in Ontario. However, the AIDS Bureau, Ministry of Health recognizes the potential for a serious outbreak in this vulnerable population and is working towards finding practical interventions to prevent such an outbreak in Ontario. Dr Robert Remis' 1 recent report, "The HIV Epidemic Among Injection Drug Users in Ontario", estimates that there are approximately 30,000 active injection drug users in Ontario. The number of AIDS cases in the IDU population has progressively increased over the past 13 years "going from 0.8% for the period , through 3.6% in , to 5.4% of cases diagnosed in ". This report further estimates that "approximately 1,800 IDUs have been infected with HIV since the early 1980's of whom about 400 have died... Thus, about 1,400 IDUs are living with HIV infection in Ontario, with an overall prevalence of about 4.7%". In response to this recent information, in September 1997, the AIDS Bureau held a consultation meeting with community-based representatives to further discuss the role of AIDS Service Organizations in reaching the injection drug using community. It was decided that 15 strategically placed outreach workers working with other community partners and complementing existing services was necessary. Site Selection Process: Dr Remis' report identifies a number of "hot spots" in the province. Using this data and in particular the population and the number of injection drug users in the area, certain locations are identified as needing additional resources to more adequately address the issue. These locations include Ottawa, which will have 2 workers, Toronto, which will have 4 workers and 9 other areas in the province, which will each have 1 worker. This funding will be allocated to agencies with a demonstrated history of leadership and expertise in HIV/AIDS and will serve to support the existing infrastructure in being a value-added initiative. 1 Remis R.S., Millson M., Major C. The HIV Epidemic among Injection Drug Users in Ontario: The Situation in Prepared for the AIDS Bureau, Ontario Ministry of Health, July 1997 i

10 Program Implementation: Selected agencies will be required to conduct a brief "environmental scan" of the local issues. This will involve a review of present and future community resources and interviews with key stakeholders e.g. Public Health, Treatment Centres, ASOs. This preliminary step will be used to assist the agency in developing an appropriate outreach program tailored to their area's particular needs. This process should be completed in 1-2 months. Following the development of the program and approval by the AIDS Bureau, an outreach worker will be hired shortly thereafter. Criteria for Program/Proposal Development 1. The agency will develop a local program in consultation with existing services, e.g. treatment programs, needle and syringe exchanges, and other related local programs. 2. The program must include a peer component. Ambassador programs and peer support programs are recognized as valuable and effective tools to reach those at risk. Needle sharing partners and sexual partners of IDUs are easier to reach through peer outreach. Counselling and support are important components of such programs. 3. The program must complement existing services and not duplicate other projects. 4. Each site must access the HIV Program at the Addiction Research Foundation for training. The HIV Program offers a variety of workshops to both ASOs and treatment centres. Training needs of staff are discussed and tailored to those needs. There are 5 consultants in the province able to provide this training on site. 5. The agency must define and demonstrate mechanisms for the involvement of other community services. The outreach worker must be defined as a front line worker. While some committee work may be essential, the worker's main role is service delivery and should not be consumed by committee work. As well, proposals should illustrate mechanisms that would prevent undue dependency on the outreach worker by other agencies using the worker as the sole referral source. 6. The program should assist in reaching those not presently accessing services. 7. Staffing and hours should be flexible so as to accommodate the needs of the community. ii

11 8. The program must work towards reducing the isolation of this population. At present, it is agreed that the IDU community is somewhat fragmented. While this population does organize around specific drugs and access to drugs, in general, the different cultures developed in this way remain separate and apart. Working with the various cultures, the outreach worker will facilitate community development to respond to political issues directly affecting the community. 9. A comprehensive orientation plan for the worker must be included. 10. An outline of a support mechanism for the worker must be developed. 11. The program must contain an evaluation component. Most importantly, the program must demonstrate that it will be "value added", will not duplicate or replace existing services and programs. 5 Appendix II: Activity Reporting Please see attached document. iii

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