Best Prac*ces Model for Harm Reduc*on in Bri*sh Columbia: Community Involvement Authors: Despina Tzemis, Lianping Ti, Margot Kuo, Jennifer Campbell, Jane Buxton and the HRSS CommiAee Harm Reduc*on Program BC Centre for Disease Control 2011 Public Health AssociaHon of BC Conference, Richmond, BC November 28, 2011
Background • Harm Reduction Program – BC Harm Reduction Program transferred to the BCCDC (2003) – Mission and vision • Program – Harm Reduction Strategies and Services (HRSS) committee – Provincial harm reduction supply distribution and tracking – Webpage and training resources – Strategies Newsletter 2
Objective • To describe the HRSS committee • To describe the tools & initiatives of the HRSS to facilitate best practice harm reduction knowledge translation in BC 3
HRSS committee • Representatives from all 6 BC health authorities – Includes : • BC Ministry of Health • BCCDC • HR health authorities • Local and regional service providers • Community members • Clients from across BC 4
HRSS committee Guiding principles: – Patients as Partners – Community-Based Participatory Model: • Participatory: mutual code of collaborative working relationship • “Co-learners” • Empowering process • Balance between research/policy and action • Accountability Guiding documents: – “Nothing About Us Without Us” – “How to Involve People who use Drugs” 5
Harm Reduction Strategies and Services Logic Model Vision: To ensure that all British Columbians receive evidence based harm reduction strategies and services Longer- Shorter-term Ultimate Activities Components Outputs term Inputs Outcomes Outcomes Outcomes Plan, distribute and monitor the provincial resources Health Authorities Increased evidenced Reduce incidence allocated for harm reduction supplies report based distribution of of drug-related Develop and present the business case for harm implementation of harm reduction supplies reduction strategies health and social best practice Decreased rate of Create and disseminate harm reduction best practices strategies and Fiscal harms, including deaths attributable Develop and keep up to date distribution and recovery services Increased access to low transmission of Resources policies illegal drug use threshold community- Identify current and emerging issues for consideration blood-borne Number and rate of based harm reduction based on evidence new cases of HIV and pathogens through services Decreased Improved Develop and recommend policy to Ministry and Health HCV among people equipment sharing Authorities incidence of HIV who use drugs health and Increased community and/or HCV Material Number of persons awareness of infections wellness prescribed substance use, risks attributable to Resources Facilitate access to low threshold harm reduction for British methadone and harms and the drug use services Columbian role of harm reduction Needle and syringe distribution, distribution of safer Number of illegal Promote and crack use supplies in both urban and rural settings opioid/stimulant- Decreased s facilitate referral to Engage people who use substances to provide advice induced deaths and incidence of STI’s at each stage of the planning process and in the key health and PYLL from such delivery of services Human attributable to deaths social services Health Authorities and unsafe sex Resources community partners are such as primary Reduced aware of harm reduction health care and Partner with mental health and addictions and primary Decreased philosophy as it pertains care to improve harm reduction strategies within premature addiction and hospital to illegal drugs and legal existing services Service utilization drugs such as alcohol. admission/ re- mortality, mental health Gather, assess and report statistical information from and referral statistics admission and Partnership services a range of sources to reflect current status and trends Health Authorities and morbidity length of stay related to harm reduction contracted agencies Distribution of Resources and attributed to needles and other incorporate sustained Support for social marketing campaigns (developed by harm reduction harm reduction training substance-related federal or provincial governments disability for new and existing staff Increase public supplies disorders Engage broad community participation in influencing awareness of harm social attitudes and responses to harm reduction Media messages to increase public awareness of harms reduction Increased access Technical related to alcohol, tobacco or cannabis by minors, and to primary care principles, policies for enforcement efforts Provincial and Reduced and and mental health regional data on and programs Identify and promote research opportunities Decreased burden on Knowledge substance use, risks and addiction Integrate human rights as a key element in the design of problematic use of and harms supports strategies the health Resources illegal substances Annual review and Use the power of personal contact and story telling to care put a human face on the issues including opportunities reporting of activities, Increased social for people in the community to have direct contact with outputs and data system Improve access to engagement and those who use substances sources Improved public economic HRSDPs for all Communicate with transparency provincial harm attitudes and reduction policy and activities within and across health participation of British Columbians behaviours towards authorities people with Health Authorities to empower those people who use substance use have substances to reduce harms communications problems associated with strategies developed Enhance awareness among providers about substance problematic and implemented to use Improved reporting by disseminate accurate public agencies on substance use Implement policies to shift attitudes, address systemic information to the substance use, risks and inequities Context and External Factors public. harms Enhance training, awareness and understanding about substance use and harm reduction among health and Strengthened evidence social service providers, policy planners, employers base for policy and throughout the province program effectiveness
Harm Reduction Strategies and Services Logic Model Vision: To ensure that all British Columbians receive evidence based harm reduction strategies and services Longer- Shorter-term Ultimate Activities Components Outputs term Inputs Outcomes Outcomes Outcomes Fiscal Resources • HA report Improved implementation of • Plan, distribute and Increased • Decreased health and best practice monitor the provincial evidenced rate of deaths wellness Material Reduce incidence of strategies and resources allocated for based attributable for British Resources drug-related health services HR supplies distribution of illegal drug use Columbian and social harms, • Number and rate HR supplies s • Create and including of new cases of disseminate HR best • Decreased transmission of Increased Human HIV and HCV practices incidence of blood-borne access to low Resources among people Reduced HIV and/or • Identify current and pathogens through threshold who use drugs premature HCV infections emerging issues for equipment sharing community- mortality, attributable to consideration based • Number of based HR morbidity drug use on evidence Partnership persons services and Resources prescribed disability methadone Technical and Knowledge Resources 7
HRSS committee • Communication – Meet face-to-face and/or remote (quarterly) • Objectives – Discuss successes & challenges of HR strategies from various perspectives – Share info re: HR supplies & distribution – Assess needs to maintain relevance (i.e. exchange vs. distribution) – Group decisions w/ regards to supplies & services – Networking & learning opportunities – Distribute funds to enable peer group meetings (+ $2000 funding) – Initiatives to engage clients in planning, design & evaluation 8
Engaging with clients • Attending peer group meetings – Between May and July 2011 – To evaluate new HR supplies (i.e. cookers & ascorbic acid) – To identify other needs by clients • Findings – Cookers & ascorbic acid are difficult to obtain at night – Preference for black sharps containers – Additional supplies requested (i.e. filters) – Printed/pictorial user guides in addition to HR service provider education 9
HR tools • HR supply distribution and tracking • Webpage and training resources • Strategies Newsletter 10
HR supplies and distribution • Supplies – Products including: • Condoms, lubricant, needles/syringes, tourniquets, cookers, water, ascorbic acid, sharps containers, alcohol swabs, mouthpieces, cutter, crack pipe screens, push sticks • Distribution • Tracking established in 2004 • 5 geographic HAs & 16 HSDA • 100 primary distribution sites • Multiple secondary distribution sites 11
HR supplies and distribution Needle Distribution 2010/2011 fiscal year (n = 5,133,100) 12
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