Harm Reduction in Practice
How to Successfully Engage Individuals Experiencing Homelessness and who struggle with Mental Illness and/or Substance Use Amber Roth, MSW Director of Operations & Programs Homeless Health Care Los Angeles 2330 Beverly Blvd. Los Angeles, CA 90057 [email protected]
Vendome Palms-ACOF Harm Reduction Building
2330 Beverly Blvd. Los Angeles, CA 90057
Objectives • Brief overview of Homelessness, Mental Illness & Substance Use • Harm Reduction Approach • What is it? • Why do we do it? • What does it take?
• Applying Harm Reduction Interventions: • Outreach & Engagement
WHO EXPERIENCES HOMELESSNESS?
A National Look HUD Point-In Time Count-2016
Any Single Night 549,928 Approximately 86,492 experienced chronic homelessness https://www.hudexchange.info/resources/documents/2016-AHAR-Part-1.pdf
National LookIndividuals Experiencing Homelessness o Approximately 202,297 people have a struggle with a severe mental illness or a chronic substance use disorder. o 1 in 5 people experiencing homelessness had a serious mental illness, and a similar percentage had a chronic substance use disorder. People Experiencing Chronic Homelessness o Approximately 30% struggle with a serious mental illness o Two-thirds have a primary substance use disorder or other chronic health condition https://www.hudexchange.info/resources/documents/2016-AHAR-Part-1.pdf, https://www.samhsa.gov/homelessness-housing; Office of National Drug Control Policy
Understanding the Paradigm Shiftusing the Harm Reduction Approach….. BALANCING COSTS & BENEFITS
FOCUSING ON HARM
PRIORITIZING GOALS
o Accepting risk as part of the general human experience.. We don’t live in bubbles o Although some activity can generate risk – a lot of activities also have benefits
o Promoting safer options is often more realistic than trying to eliminate the behavior all together
Harm Reduction
Core Harm Reduction Beliefs oPeople know what they need oPeople will be truthful oAny step is progress oPower of relationships over technique oComplexity is good oAmbivalence and resistance are natural and useful
Harm Reduction How Does it Work & What Does it Take ? Framework for promoting positive change ◦ Client-Centered
◦ “Come as you are” ~Jeannie Little
◦ Acceptance ◦ Clients work toward their own goal(s)
◦ Progress is supported without judgment ◦ Collaborative partnerships, not confrontational
Harm Reduction How Does it Work & What Does it Take ?
oTailor interventions to the person oCuriosity, Respect and Acceptance
oPractice radical neutrality o Understand and accept challenging behaviors
oWorking in the “gray areas” oLower the threshold to accessing services
Harm Reduction & Outreach Outreach is client-oriented and community-based harm reduction method oDelivery of services in the community o Work with clients in their environment o Point of entry for a variety of services oLow Barrier Approach
Implementing Harm Reduction: Outreach & Engagement It All begins with--Relationship! Relationship! Relationship! oEstablish a Trusting Relationship oBe Empathetic
oBe Accessible, Consistent, & Flexible oBe a Positive Mentor/Role Model (Don’t Label) oRespect a Non-Traditional “Family” Support System Building a strong Alliance will anchor client in treatment/services
Implementing Harm Reduction: Outreach & Engagement o Support individuals in the beginning process of positive change •Where is the client at? •Are they ready for something different? oOffer a positive, supportive and healing relationship o“We don’t need to know the destination to begin the journey”Andrew Tatarsky, PhD
Engagement Skills o“Start where the client is” oActive Listening oSet aside your “agenda” oTry to put aside your presumptions oAddress issues of Trauma/Emotionally Overwhelmed oListen with Curiosity oEmpathetic Reflection oCreate a “Partnership” oInstill Hope (Reference: The Center for Optimal Living- Andrew Tatarsky, PhD)
Examples of Outreach Access Points & Harm Reduction Interventions oCoordinated Entry System oStreet Outreach (Multidisciplinary Team Approach)—C3 Teams oHealth Education/Wellness Fairs (Homeless Care Days) oDrop-In/Wellness Centers-low barrier approach oCriminal Justice Venues (Jails, prison, courts) Harm Reduction oHarm Reduction based treatment and housing programs
Integrated Treatment Program
Vendome Palms Apartments Harm Reduction Building
Other Successful OutreachHarm Reduction Interventions oSyringe/Needle Exchange Programs oMedication Assisted Treatment (MAT)
oOverdose Prevention Program/Peer Naloxone Distribution oDistribution of “Safer Sex Kits” for individual engaging in sex Work
What if We Don’t Use Harm Reduction? • Prevents people from getting help • Traumatizing/ Re-Traumatizing • Continued criminalization of very vulnerable populations • Applying a “one-size-fits-all” modelDoesn’t Work!
References 1) Denning, Patt., Little, Jeannie. Practicing Harm Reduction Psychotherapy: An Alternative Approach to Addictions. New York City: Guilford Press, 2012. Print. 2) http://www.emcdda.europa.eu/best-practice/harm-reduction/opioid-injectors 3) The Center for Optimal Living- Andrew Tatarsky, PhD 4) https://www.hudexchange.info/resources/documents/2016-AHAR-Part-1.pdf, 5) https://www.samhsa.gov/homelessness-housing 6) Office of National Drug Control Policy
Vendome Palms-ACOF Harm Reduction Building
2330 Beverly Blvd. Los Angeles, CA 90057
Objectives • Brief overview of Homelessness, Mental Illness & Substance Use • Harm Reduction Approach • What is it? • Why do we do it? • What does it take?
• Applying Harm Reduction Interventions: • Outreach & Engagement
WHO EXPERIENCES HOMELESSNESS?
A National Look HUD Point-In Time Count-2016
Any Single Night 549,928 Approximately 86,492 experienced chronic homelessness https://www.hudexchange.info/resources/documents/2016-AHAR-Part-1.pdf
National LookIndividuals Experiencing Homelessness o Approximately 202,297 people have a struggle with a severe mental illness or a chronic substance use disorder. o 1 in 5 people experiencing homelessness had a serious mental illness, and a similar percentage had a chronic substance use disorder. People Experiencing Chronic Homelessness o Approximately 30% struggle with a serious mental illness o Two-thirds have a primary substance use disorder or other chronic health condition https://www.hudexchange.info/resources/documents/2016-AHAR-Part-1.pdf, https://www.samhsa.gov/homelessness-housing; Office of National Drug Control Policy
Understanding the Paradigm Shiftusing the Harm Reduction Approach….. BALANCING COSTS & BENEFITS
FOCUSING ON HARM
PRIORITIZING GOALS
o Accepting risk as part of the general human experience.. We don’t live in bubbles o Although some activity can generate risk – a lot of activities also have benefits
o Promoting safer options is often more realistic than trying to eliminate the behavior all together
Harm Reduction
Core Harm Reduction Beliefs oPeople know what they need oPeople will be truthful oAny step is progress oPower of relationships over technique oComplexity is good oAmbivalence and resistance are natural and useful
Harm Reduction How Does it Work & What Does it Take ? Framework for promoting positive change ◦ Client-Centered
◦ “Come as you are” ~Jeannie Little
◦ Acceptance ◦ Clients work toward their own goal(s)
◦ Progress is supported without judgment ◦ Collaborative partnerships, not confrontational
Harm Reduction How Does it Work & What Does it Take ?
oTailor interventions to the person oCuriosity, Respect and Acceptance
oPractice radical neutrality o Understand and accept challenging behaviors
oWorking in the “gray areas” oLower the threshold to accessing services
Harm Reduction & Outreach Outreach is client-oriented and community-based harm reduction method oDelivery of services in the community o Work with clients in their environment o Point of entry for a variety of services oLow Barrier Approach
Implementing Harm Reduction: Outreach & Engagement It All begins with--Relationship! Relationship! Relationship! oEstablish a Trusting Relationship oBe Empathetic
oBe Accessible, Consistent, & Flexible oBe a Positive Mentor/Role Model (Don’t Label) oRespect a Non-Traditional “Family” Support System Building a strong Alliance will anchor client in treatment/services
Implementing Harm Reduction: Outreach & Engagement o Support individuals in the beginning process of positive change •Where is the client at? •Are they ready for something different? oOffer a positive, supportive and healing relationship o“We don’t need to know the destination to begin the journey”Andrew Tatarsky, PhD
Engagement Skills o“Start where the client is” oActive Listening oSet aside your “agenda” oTry to put aside your presumptions oAddress issues of Trauma/Emotionally Overwhelmed oListen with Curiosity oEmpathetic Reflection oCreate a “Partnership” oInstill Hope (Reference: The Center for Optimal Living- Andrew Tatarsky, PhD)
Examples of Outreach Access Points & Harm Reduction Interventions oCoordinated Entry System oStreet Outreach (Multidisciplinary Team Approach)—C3 Teams oHealth Education/Wellness Fairs (Homeless Care Days) oDrop-In/Wellness Centers-low barrier approach oCriminal Justice Venues (Jails, prison, courts) Harm Reduction oHarm Reduction based treatment and housing programs
Integrated Treatment Program
Vendome Palms Apartments Harm Reduction Building
Other Successful OutreachHarm Reduction Interventions oSyringe/Needle Exchange Programs oMedication Assisted Treatment (MAT)
oOverdose Prevention Program/Peer Naloxone Distribution oDistribution of “Safer Sex Kits” for individual engaging in sex Work
What if We Don’t Use Harm Reduction? • Prevents people from getting help • Traumatizing/ Re-Traumatizing • Continued criminalization of very vulnerable populations • Applying a “one-size-fits-all” modelDoesn’t Work!
References 1) Denning, Patt., Little, Jeannie. Practicing Harm Reduction Psychotherapy: An Alternative Approach to Addictions. New York City: Guilford Press, 2012. Print. 2) http://www.emcdda.europa.eu/best-practice/harm-reduction/opioid-injectors 3) The Center for Optimal Living- Andrew Tatarsky, PhD 4) https://www.hudexchange.info/resources/documents/2016-AHAR-Part-1.pdf, 5) https://www.samhsa.gov/homelessness-housing 6) Office of National Drug Control Policy
