The 4-C’s of harm reduction outreach were originally the 3–Cs, and were developed by Christian Crump, then of John the XXIII syringe access in Salinas, California, and later modified to include the 4th by Catherine Swanson and Roxanne Butterfield:

• Compassion—You wouldn’t be doing this work if you didn’t have it.
• Commitment—Make sure you have it and make sure you give it.
• Consistency—Times, services, supplies, location.
• Clarity—Understand what you are doing and why.
• Compassion—As with everything in harm reduction, it’s critical that people be treated with compassion in harm reduction spaces. We’re all imperfect beings trying our best and we all deserve a little grace as we do so.
• Consistency—Consistency is comprised of two practices: first, when services are provided, it’s extremely important that you make a commitment to providing services and do so when you say you’re going to. This builds credibility among people who depend on your services. Secondly, you must be consistent about the systems of services themselves. One of the biggest flashpoints harm reduction leaders consistently identified was discoordinate treatment of participants regarding services. Do not play favorites. Do not break rules inconsistently. Never let yourself be in a position of being accused of favoritism.
• Commitment—In essence, this is a longer-term version of consistency. Long-term harm reduction leaders will tell you that your commitment to a community will be rewarded tenfold if things escalate.
• Clarity—Clarity in this case refers to clarity of purpose. Everyone in the organization should be clear on the mission and values of the organization and be dedicated to them. It may sound irrelevant, but clarity about that mission can remove concerns staff may have about extraneous issues having nothing to do with their work