Practical Harm Reduction Strategies. NAEH Annual Conference July 2015

Transcription

1 Practical Harm Reduction Strategies NAEH Annual Conference July 2015

2 Outline of Presentation Harm Reduction: definitions and origins Harm Reduction in the broader society Typical Harm Reduction strategies employed with homeless individuals Harm Reduction strategies in housing with case examples Discuss audience examples

3 Overview of Harm Reduction: Definitions Harm Reduction: Reducing harm associated with high risk behaviors to improve quality of life

4 Where Can We Apply Harm Reduction Health Finances Social Relationships Mental Health Weight Loss Exercise Intimate Relationship Person Sets Priorities (and society offers support)

5 Harm Reduction in Everyday Life Protective equipment (optional to required)

6 Harm Reduction in Everyday Life Automobile Use/Abuse: Environmental/passive protections: highway guard rails, air bags Optional protections (possibly required): seatbelts, child seats, designated driver

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12 Harm Reduction: Substance Use is a set of practical strategies to reduce the negative consequences of drug use (and symptoms) incorporates a spectrum of strategies from safer use to abstinence

13 Overview of Harm Reduction: Origins 1920s British System and Rolleston Report 1960s -80s The Dutch Model, users unions, and needle exchange

14 Overview of Harm Reduction: Origins Early to mid-1980s The Mersey (Liverpool) Harm Reduction Model Mid to late 1980s US grassroots agencies start pursuing harm reduction models 1989-present Canada starts public policy based on harm reduction

15 Common Substance Use Concerns safety drug traffic/trade drug dealing intoxication

16 What Harm Reduction is not Passive Anything goes Don t Ask Don t Tell Enabling A hook to get people to treatment A direct path to abstinence

17 Why Harm Reduction? "My case manager doesn't judge me." "Even when I mess up, my CDP doesn't judge me...they just support me." Failure vs Small Successes

18 Harm Reduction with Client Buy-In Needle exchange Alcohol Monitoring Methadone (substitution therapy) Reducing amount used Condom use

19 Harm Reduction with Client Buy-In Using a screen or rubber tubing for crack use Getting off the bus two stops earlier and walking Paying Rent before buying substances Changing use patterns CD Groups/treatment with harm reduction focus

20 Harm Reduction without active client participation Medication distribution Case Management Education around safer use practices Protective Payeeship

21 Harm Reduction without active client participation Outreach/engagement Welfare checks Coordination of care with PCP Room inspections/chore services Narcan/naloxone

22 Harm Reduction example (with or without client buy-in)

23 Harm Reduction example (with or without client buy-in)

24 Harm Reduction example (with or without client buy-in)

25 Challenges for staff Client Trust/Staff Turnover Concern about endorsing substance use How to balance positive regard for individual vs. accepting the behavior Fear of doing the wrong thing The need to see measurable success Stress leads to desire for rules/structure

26 Case Study: James 49 years old, highly personable and cooperative HIV+, mobility impairment (has one leg) alcohol dependent, pattern of violent outbursts when intoxicated never hurts anyone badly, but over time creates increasingly stressful environment for all residents staff reaction varies and drifts from we need to keep him housed to he s not working hard enough universal concern about him being homeless given health and mobility problems

27 What do you do? A. Discuss priorities with staff: housing preservation vs. insisting on behavior change B. Wring hands and gnash teeth C. Make him homeless to teach him a lesson D. Teach assertiveness and limit setting to other residents E. Involve law enforcement F. Prevail upon James s sense of responsibility to the larger community, make him promise to do better G. Use money control H. Interfere with bingeing - alcohol management I. Ask James to help with projects J. Involve James in sober social activities

28 Case Study: Tammy 43 years old, spunky and friendly, well known to agency staff has schizophrenia, borderline PD, HIV, addiction to crack and alcohol trades sex for drugs; sells personal property brings predatory people into building frequently assaulted on street, possibly also in building usually refuses medical care

29 What do you do? A. Focus interventions on harm reduction B. Negotiate visitor agreement C. Develop protocol to follow when having visitors D. Eviction E. Provide STD education F. Tolerate behaviors G. Bolt TV to wall H. Appeal to men paying her

30 Resources Marlatt, GA et al. (Eds.). Harm reduction: pragmatic strategies for managing high risk behaviors. Guilford Press, Denning, P. and Little, J. Practicing harm reduction psychotherapy: An alternative approach to addictions. Guilford Press, desc.org/research.html