7/31/18. Justin McClenny, LCDC

Transcription

1 Justin McClenny, LCDC 1

2 Training Goals Learn basic Harm Reduction principles, philosophy and techniques to use with their clients and to incorporate into substance use services. Gain an awareness of our own comfort in discussing harm reduction with clients, friends or family members. Understand how basic Motivational Interviewing skills can be used to effectively help clients gain awareness and reduce their risks. Practice discussing topics like sexual risks and overdose risk in this safe environment. Acknowledge and celebrate our work. It s not easy. 2

3 What is my unique role Think of a few answers for yourself for the sentence below. I am a who. 3

4 Stigma refers to negative attitudes (prejudice) and negative behavior (discrimination). These attitudes and judgments can affect how we think about, behave and provide care to clients. people with substance use and mental health problems are not normal or not like us; that they caused their own problems; or that they can simply get over their problems if they want to. To put harm reduction into practice, it is important to convey acceptance and support individuals to become the experts in their own lives. 4

5 What is my comfort level with talking about sex? Rate yourself 1-5 How confident am I in discussing sex with a client who does not share my same sexual orientation or experiences? 1-5 How would I rate my knowledge of Harm Reduction? 1-5 How comfortable am I helping clients learn to use substances safer? 1-5 5

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7 Just eat one cookie... Drink but don t drive Just smoke weed but no more heroin Stop sharing needles or clean them if I have to share Only have condomless sex with people whose HIV status I know Keep going to my meetings even though I relapsed Get my HCV cured Start methadone treatment Other examples you can think of..? 7

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10 Harm Reduction Game Split into groups In your group choose one person to write, everyone else can yell (or whisper) answers. Fluids that transmit HIV nblood nsemen nvaginal Fluid nrectal Fluid nbreast Milk Routes of Transmission nanal or Vaginal Sex nsharing Injection Supplies nmother-to-child, Breastfeeding 10

11 nsex that involves fluid exchange (blood, semen, vaginal secretions, anal secretions) nsharing needles/syringes or other injection equipment (blood) nexisting STIs/STDs (blood, semen, vaginal secretions, anal secretions) nsubstance Use (could inhibit partner communication or increase likelihood of any of the factors already mentioned) 11

12 Trauma and Vulnerability Trauma: physical, emotional, psychological, or spiritual threats to an individual or group. Trauma and Vulnerability Trauma: physical, emotional, psychological, or spiritual threats to an individual or group. Trauma can continue to impact an individual or group for years or generations. 12

13 Trauma and Vulnerability Trauma Risky Behavior Trauma and Vulnerability How has trauma effected our clients lives and their health? 13

14 Trauma and Vulnerability How does secondary trauma in our work effect us in our lives? 14

15 Do I need to be an expert on sex and drugs to be helpful? How do our personal biases influence our counseling sessions? Have I ever had an open and frank discussion about sex and HIV? Is it possible to approach sex and substance use behaviors in a non-judgmental and supportive way? How can we discuss sex or needle use with our clients who are already living with HIV? Empathy Support Autonomy Roll with Discord Develop discrepancy Align with client Source: Miller & Rollnick, 2002 SAMHSA TIP 35 15

16 Partnership- Working in partnership with the client, where the key worker is supportive rather than persuasive. Acceptance- Four concepts: Absolute worth, Autonomy and support, Affirmation and, Accurate Empathy Compassion- As the helper we are trying to work with clients in a non-judgmental, non-blaming, non-shaming way. Evocation- To draw out of the client their own perceptions, goals and values. The resources and motivation for change reside in the client. Source: Miller & Rollnick (2012) Picture retrieved from: Four key skills for counseling sessions Open Ended Questions Affirmations Reflections Summarize Source: Miller & Rollnick,

17 Activity: Counseling Skills Practice Form pairs (you will switch off being the client and the counselor) Using MI skills, engage with a client and help them to address their risk in an open and supporting manner. What harm reduction messages might you share with your client before a relapse? Do you find it appropriate to discuss using drugs safer while discussing the possibilities of relapse? How might our messages change for people who are currently using or in a relapse? 17

18 Successful graduates of 28 day abstinence-based rehab programs are at the greatest risk for drug poisoning death of any population because of lowered tolerance. Dependent heroin users completing 28 day abstinence based treatment are 32 times more likely to die of overdose within the first 4 months after release than are dependent heroin users who receive no treatment at all. Mixing substances Variation in strength and content of street drugs (purity) Fentanyl & Carfentanil Tolerance changes Using alone Physical Health (liver functioning, weight loss, asthma, immune system problems, dehydration, malnutrition, etc.) 18

19 Loss of consciousness Unresponsive to outside stimulus Awake, but unable to talk Breathing is very slow and shallow, erratic, or has stopped For lighter skinned people, the skin tone turns bluish purple, for darker skinned people, it turns grayish or ashen. Choking sounds, or a snore-like gurgling noise (sometimes called the death rattle ) Vomiting Body is very limp Face is very pale or clammy Fingernails and lips turn blue or purplish black Pulse (heartbeat) is slow, erratic, or not there at all Medication that blocks uptake of opioid drugs at receptors in the brain. Reverses overdose. Can now be legally administered by a layperson without Rx. Standing orders for Naloxone are at Walgreens. Any Dr can write a Rx. 19

20 Sample Safer Injection Kit: 1. Condoms, assorted (with instructions) Needle Cleaning instructions (1 or 3) 3. Water-based lube 4. Bandage 5. Organization information Antibiotic ointment 7. Bleach 8. Bottle caps 9. Tourniquet 10. Short fiber cotton Sterile water 12. Twist-tie Antibiotic wipe 14. Alcohol wipe 15. Towelette Sample Safer Smoking Kit: Water-based lube 2. Condoms, assorted (with instructions) 3. Bandage 4. Smoking instructions 5. Mouthpiece 6. Vitamin C Dowel 8. Antibiotic ointment 9. Organization information 10. Moist Towelette Chore Boy 12. Alcohol wipe 13. Lip balm 20

21 Sample Safer Sex Kit: Organization information Insertive condom (with instructions) 3. Condoms, assorted 4. Water-based lube 5. Towelette 4 6. Condom instructions 5 7. Dental dam 8. Flavored condom 7 The Other Blue Pill. Pre-exposure prophylaxis, (PrEP), could prevent an estimated 185K new HIV infections in the US by 2020 a 70% reduction in new infections according to researchers at the CDC. CDC 2/24/16 21

22 What Harm Reduction methods or techniques might be relevant for your clients to learn? How an you bring a Harm Reduction Philosophy or approach into your current counseling style? What can my agency do to incorporate Harm Reduction messages into our sessions or groups? How can I help my agency to address the opioid epidemic and in particular opioid overdose? What inspired you today? (Inspiration is a key to creativity and an antidote to being overwhelmed.) What surprised you today? (This is about flexibility and resilience in response to whatever comes your way.) What challenged you today? (Challenge opens the door to mastery and reaching beyond the knowable.) What made you feel connected to others today? (This amplifies and puts a focus on moments of connection.) 22

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