4/2/18. Integrating Harm Reduction and Homelessness Services. Outline. Objectives

Transcription

1 Integrating Harm Redction and Homelessness Services KIEFER PATERSON GOVERNMENT RELATIONS MANAGER HARM REDUCTION COALITION KACEY BYCZEK CAPACITY BUILDING SERVICES MANAGER HARM REDUCTION COALITION Objectives To nderstand the philosophical basis of "Harm Redction", the movement's historical roots, and how it relates to the homelessness field. To nderstand the synergy between traditional" Harm Redction programming and mainstream homelessness service delivery models. To leave with concrete "next steps" for integrating Harm Redction into yor programming. Otline 1. Harm Redction: Philosophy, History, and Practice 2. Sbstance Use Disorder, Opioid Use Disorder, and Homelessness 3. Integration of Harm Redction Services into the Homelessness System 4. Reframing Existing Homelessness Services Throgh a Harm Redction Lens 1

2 Harm Redction Coalition: Who We Are Fonded in 1994 to work with individals and commnities at risk for HIV infection de to drg se and high risk sexal behaviors. Committed to redcing drg-related harm by initiating and promoting local, regional, and national harm redction edcation, interventions, and commnity organizing. Offers specific expertise in how to best integrate the principles of health and safety promotion for people who se drgs. Some Qick Definitions Syringe Services Program: SSPs, which have also been referred to as syringe exchange programs (SEPs), needle exchange programs (NEPs) and needle-syringe programs (NSPs) are commnitybased programs that provide access to sterile needles and syringes free of cost and facilitate safe disposal of sed needles and syringes. SSPs also engage their participants into broader systems of care. PWID: People Who Inject Drgs PWUD: People Who Use Drgs MAT: Medication-Assisted Treatment (bprenorphine, methadone, or naltrexone the Gold Standard treatments for OUD) SUD/OUD: Sbstance Use Disorder/Opioid Use Disorder Some Qick Qestions How many otreach staff/programs are in the room? How many shelter staff/programs are in the room? How many rapid re-hosing staff/programs are in the room? How many permanent spportive hosing staff/programs are in the room? How many case managers are in the room? How many CoC or other systems staff are in the room? How many programs in the room operate from a Hosing First model? How many of yo work in a jrisdiction which has implemented Coordinated Entry? 2

3 What does the term Harm Redction mean? Harm Redction Is... " A set of practical strategies and ideas aimed at redcing negative conseqences associated with drg se. Harm Redction is also a movement for social jstice bilt pon the belief in, and respect for, the rights of people who se drgs." * Harm Redction can frther be defined as "a set of polices, programs, and practices that aim to redce the harms associated with the se of psychoactive drgs in people nable or nwilling to stop. The defining featres are the focs on the prevention of harm, rather than on the prevention of drg se itself, and the focs on and respect for people who contine to se drgs."* *Definitions paraphrased from the Harm Redction Coalition and International Harm Redction Association The Principles of Harm Redction Harm Redction... Accepts, for better or worse, that licit and illicit drg se is part of or world and chooses to work to minimize its harmfl effects rather than simply ignore or condemn them. Understands drg se as a complex, mlti-faceted phenomenon that encompasses a continm of behaviors from severe abse to total abstinence, and acknowledges that some ways of consming drgs are clearly safer than others. Establishes qality of individal and commnity life and well-being not necessarily the cessation of all drg se as the criteria for sccessfl interventions and policies. Calls for the non-jdgmental, non-coercive provision of services and resorces to people who se drgs and the commnities in which they live in order to assist them in redcing attendant harm. 3

4 The Principles of Harm Redction Harm Redction... Ensres that drg sers, and those with a history of drg se, rotinely have a real voice in the creation of programs and policies designed to serve them. Affirms drg sers themselves as the primary agents of redcing the harms of their drg se, and seeks to empower sers to share information and spport each other in strategies which meet their actal conditions of se. Recognizes that the realities of poverty, class, racism, social isolation, past trama, sex-based discrimination, and other social ineqalities effect both people's vlnerability to and capacity for effectively dealing with drg related harm. Does not attempt to minimize or ignore the real and tragic harm or danger associated with licit and illicit drg se. Continm of Use Experimental Use Sitational Use Physical Dependence Chaotic Use Social & Rital Use Binge Use Problematic Use/Abse Qestions? 4

5 Harm Redction is non-jdgmental and non-coercive. The term Harm Redction is generally sed to refer to... Harm Redction The philosophical and political movement, as well as the commnity which makes p that movement. The philosophy provides the fondation for a set of drg ser health interventions. H.R. Services A set of specific sbstance se, infectios disease, and health interventions typically associated with the movement. (h)arm (r)edction The application of the harm redction framework broadly in other contexts sch as smoking cessation, heart health, wearing a seat belt, etc. Harm Redction Means... 5

6 The History of Harm Redction "Nothing For Us Withot Us" As research demonstrated that contaminated injection eqipment was linked to the rapid spread of HIV/HCV among people who inject drgs (PWID), pblic health researchers and commnity activists rshed to open ndergrond syringe exchanges. US Harm Redction has its roots in the early days of HIV/AIDS activism At the same time, drg sers in Vancover, Canada were fonding the Portland Hotel Society, one of the first Hosing First programs jst one year after Pathways to Hosing was fonded. Harm Redction Services As a conseqence of the movement's origins at the start of the HIV epidemic, Harm Redction has become intrinsically linked to a variety of specific drg ser health & sbstance se interventions, namely: Syringe Services Programs Overdose Prevention/Naloxone Medication-Assisted Treatment Wond Care Clinics Peer Otreach/Navigation Maintenance Spport Grops 6

7 The History of Harm Redction "Nothing For Us Withot Us" Drg sers coming together to protect each other and to save the lives of their friends, families, and commnities, is the fondation of Harm Redction. They did this whether it was legal or not - even as society at large was content to let them die. Qestions? Opioid Use Disorder and Homelessness 7

8 Why does it matter? There are direct correlations between homelessness and sbstance se disorders (SUD). Individals strggling with an SUD are at increased risk for becoming homeless, have a harder time exiting homelessness, and are more likely to experience co-morbidities and high acity. Frther: Stdies among veterans sggest that the presence of an SUD may have the highest impact on relative risk for homelessness, even more so than bipolar disorder or schizophrenia. People strggling with a SUD are 10x more likely to experience homelessness than the general poplation. Comorbidities like HIV/HCV and mental/behavioral health isses are significantly heightened among people with SUDs. Opioid Use Disorder (OUD) in particlar poses significant risks... While HIV/HCV rates among all PWID have been increasing, among PWID experiencing homelessness those increases have been even more prononced. Homelessness correlates with riskier drg taking, inclding injection initiation and riskier injection practices increasing risk for infectios disease and complications like endocarditis. PWID who are also homeless bear a disproportionate brden of or nation s overdose crisis. There were 64,000 fatal overdoses in Of those, 53,332 were cased by licit or illicit opioids. Homeless adlts, 25-44, are nines times more likely to sffer a fatal overdose than their conterparts who are stably hosed. Research ot of Boston has fond that, among their chronically homeless adlts, overdose has srpassed HIV as the leading case of death. Fatal overdose now acconts for 80% of all sch deaths. Even being placed into hosing carries risks: overdose rates increase in the first year of hosing nless adeqate spportive services are provided. In the last year How many of yo know a participant who has been lost to an opioid overdose? How many of yor programs have lost a participant to an opioid overdose while they were staying in a site-based hosing program (whether shelter, transitional hosing, or spportive hosing?) How many of yo have been trained in overdose prevention? Feel capable of providing overdose prevention edcation to yor participants? Been trained to intervene dring an overdose and know how to administer naloxone? 8

9 Integrating Harm Redction Services with Homelessness Interventions "If HIPS cold do it..." Most harm redction organizations exist otside of the homelessness service indstry. As a reslt, many harm redction agencies are not integrated into their local Continm of Care. Distrst of harm redction philosophy from mainstream treatment providers with ties to the homelessness service indstry frthers that divide. Harm redction agencies have always served people experiencing homelessness often the majority of an SSP s participants are chronically homeless. Despite this fact, many people inclding harm redction activists and service providers strggle to view harm redction organizations otside of the framework of infectios disease prevention, since this component has largely come to define the domestic harm redction movement. Integration of Harm Redction Services Into The Homelessness System Many harm redction agencies serve almost exclsively homeless or hosing nstable clients. De to stigma, many PWID despite being chronically homeless and with significant health needs distrst mainstream providers and don't access services with them. Harm Redction Programs, sch as Syringe Services Programs, have connections to high needs homeless commnities that mainstream homelessness otreach providers can't reach or don't even know exist. The natre of syringe access otreach, person centered service delivery, and "meeting clients where they're at" make harm redction otreach programs perfect platforms from which to provide PATH or even ACT services. Case managers and commnity health workers at harm redction agencies can play a critical role in hosing navigation and maintaining service engagement to mainstream providers. 9

10 Integration of Harm Redction Services Into The Homelessness System Harm redction drop-in centers and maintenance grops offer alternatives to abstinence-based homelessness providers. Harm redction peer navigators are perfectly positioned to do assessment as part of mobile otreach in a coordinated entry system. Harm redction services integrate well with medical & behavioral health services, and the "Healthcare for the Homeless" model is already co-locating all of these systems to great effect. Syringe Services Programs can now be fnded sing federal dollars. The Department of Health and Hman Services is already laying the grondwork for the integration of Syringe Services Programs into "comprehensive service delivery systems", which is inclsive of homelessness/hosing. Homelessness programs receiving fnding from the Sbstance Abse and Mental Health Services Administration may be srprised to know that SAMHSA fnding can spport SSPs. Syringe Services Programs in Ohio Per the North American Syringe Exchange Network (NASEN) Ohio Valley Harm Redction Coalition Brooke & Hancock Conty, WV; Jefferson Conty, OH Project SWAP Canton, OH Cincinnati Exchange Project Cincinnati, OH Free Clinic of Greater Cleveland Cleveland, OH Safe Point Program Colmbs, OH Eqitas Health SafeTrade Greene Conty, OH Prevention Protection Newark, OH Prevention Not Permission Portsmoth, OH Portsmoth City Health Department Northwest Ohio Syringe Services Toledo, OH Qestions? 10

11 Reframing Existing Homelessness Services Throgh a Harm Redction Lens Even if yor program isn't ready to begin offering syringe exchange, or yor area doesn't have an established harm redction program, there are still ways yo can reexamine yor programming and systems to make adjstments throgh a harm redction framework. Across the System: Qestions to Consider What proportion of yor hosing stock is Hosing First? Are yor Hosing First programs actally able to sccessflly work w/ individals who are actively sing? Does yor system have brdensome eligibility or entry reqirements? Is abstinence-based hosing the defalt program model within yor system? Is yor system focsed on linkage-to-care & otreach, or are PWUD reqired or expected to come to yo? Does yor system have partnership with mainstream harm redction providers like Syringe Services Programs? Within Yor Programs: Qestions to Consider Are yor policies oriented towards keeping people hosed, or do they facilitate exits into homelessness? Do yor policies focs on de-escalating conflict and finding collaborative soltions? Or do they focs on pnishing participants who violate the rles? Are all staff trained in, and committed to, a harm redction approach? Is yor staff trained in overdose intervention? Does yor staff carry naloxone?(from front desk to maintenance staff) Is the goal of yor Hosing First or low-barrier services that participants will eventally become abstinent? Or is the prpose of adopting Hosing First or harm redction approaches to help participants exit homelessness and maintain their hosing? 11

12 Within Yor Programs: Qestions to Consider Do yor case managers view their role as working with participants to help them achieve the participant s goals or the case manager s goals? Do yor case managers view their role as exposing lies or to separate the worthy vs nworthy participants? Do yor staff view their role as serving their participants, or are they enforcing program compliance? Does yor staff believe that PWUD can lead flfilling, self-directed lives? Do they believe PWUD have expertise in their own lives and lived experience? If yo mst exit a participant from yor program, are there other options realistically available to them? Low Barrier Emergency Shelter Low barrier shelters shold: Evalate whether or not they are trly sheltering those most in need of shelter, and if not, determine why that is. Make entering into shelter easy, with as minimal docmentation as possible. Be trly low barrier don t reqire sobriety to stay in the shelter. Examine bilding layot and client flow that may be hindering service tilization. Offer both abstinence based AND maintenance/harm redction based sbstance se conseling or grops. Low barrier shelters shold not: Kick clients ot of their program or ban people from entering as a means of resolving conflict. There are only three legitimate reasons to bar a client from services: The client has committed violence against staff or another shelter resident. The client has committed significant property damage against the shelter. The client has engaged in serios theft from the program or other participants. Permanent Spportive Hosing & Rapid Re-Hosing PSH / RRH Providers Shold: Remember that Hosing First is spposed to be low barrier of entry and high barrier of exit. Remember that wrap arond spportive services need to be both accessible and cltrally competent. Remember that the spportive services component shold never be mandatory. Participants shold not be pnished for opting ot. Train all staff on how to recognize an opioid overdose and train them in the se of naloxone to reverse overdose. PSH / RRH Providers Shold Not: Reqire abstinence for contined hosing, nor se relapse as an excse for termination of services. Make sbstance se cessation an integral part of a client's case plan nless they prioritize it for themselves. Forget to provide overdose prevention edcation to all participants, and targeted edcation to those at high risk for overdose. Use waiting lists, instead of acity scales, to prioritize hosing decisions. 12

13 Otreach Providers Otreach Providers Shold: Utilize progressive engagement models like PATH, and meet their clients where they're at in their jorney. Be patient and willing to navigate the instability of chaotic drg se. Do otreach to drg corners, open air drg markets, shooting galleries, and crack hoses. Either train staff ntil they are comfortable arond individals who are high or are able to manage their discomfort. Distribte naloxone and provide overdose prevention edcation. Otreach Providers Shold Not: Involntarily invite law enforcement into their client's lives. Reqire homeless clients to become abstinent, while still on the street, before providing hosing navigation or placement. Force clients into crisis psychiatric nits or detox programs except in extraordinary, life or death circmstances. Forget that their clients, whether drg sers or not, are hman beings who are experts in their own lives and deserving of dignity and respect. Harm Redction hosing honors the inherent dignity and agency of people experiencing homelessness and/or sing drgs. Qestions? Comments? 13

14 Thank yo for attending! After the break we ll help programs assess their readiness to implement harm redction! Kiefer Paterson (313) Kacey Byczek (212)