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Author: Nigel Brunsdon

Hacks for Defining Your Physical Parameters

Written by Nigel Brunsdon on . Posted in Hacks for Physical Setup & Design for Harm Reduction Spaces.

Multiple harm reduction leaders talked about the importance of developing a sense of the physical parameters of your site.

This refers to the amount of territory around you that you’re willing to be responsible for in terms of cleanliness and/or de-escalation.

Many leaders said that, for physical locations, the block around them was about the only space that they felt like they could be responsible for, and some even limited it to outside their front door, or just a few feet away from their site. For leaders providing mobile services, those parameters were most reasonably set at “within sight range”.

It’s up to you to decide what you want those parameters to be, but you should do that upfront and advise harm reduction leaders. That way your community can be on the same page about what is, and is not, your responsibility.

Physical Setup & Design

Written by Nigel Brunsdon on . Posted in Hacks for Physical Setup & Design for Harm Reduction Spaces.

It’s important to think about the physical set-up and design of the space—be it a fixed site or mobile service—in order to minimize escalation. Harm reduction leaders and others identified two important lenses with which to view physical design and set-up:

  • Sensitivity to Trauma—“Trauma-informed” is basically a sensitivity to the fact that the population being served and the staff serving them are people who have experienced trauma, and that trauma experiences can be triggered in part by the physical set-up of a space/services.
  • Safety—This means being attentive to the physical safety of your participants and staff with regard to accessibility, injury, and violence prevention.

Harm reduction leaders made clear that all decisions made about the physical design and set-up of services should consider safety and sensitivity to trauma, and should err on the side of sensitivity to trauma when they are in conflict. This is because people who are in trauma response are often the least safe when they are agitated, so it’s essential that harm reduction organizations minimize trauma reactivity responses as much as possible.

These leaders also agreed that defining the parameters of the spaces was the most important first step in designing a harm reduction space.

Participant Advisory Boards Hacks

Written by Nigel Brunsdon on . Posted in Hacks for Organizational Boundaries and Policy Development.

In addition to traditional Boards of Directors, many harm reduction agencies have other bodies for democratic control of various aspects of an organization, especially ones where participants can share responsibility and power with the organization. These bodies—usually called participant or community boards or committees—can help with policymaking decisions and community responses to escalated situations. In some organizations or programs, these boards are even charged with making decisions about the restorative justice or transformative justice process. Bear in mind that escalated situations reach far beyond the individual people involved. Escalated situations are often loud and dramatic, which means that everyone in the community is involved and impacted. That impact means you need a larger community response that addresses the ways in which escalated situations often unmoor communities.

These kinds of boards help participants feel ownership and responsibility for the organization, as well. This helps keep those communities more secure and safe, ultimately because people feel more invested in them. Harm Reduction leaders reported that they often find these boards are invaluable assets when escalated situations arise.

Policy Creation Hacks

Written by Nigel Brunsdon on . Posted in Hacks for Organizational Boundaries and Policy Development.

Creating effective policies in harm reduction work means grounding them in your mission, being thoughtful about their impact, and ensuring they’re both practical and inclusive. The tips below offer a starting point for organisations looking to build policies that reflect their values, meet external requirements, and genuinely support the people they serve and work with.

  • Lead with your mission and values—Decide as an organization on your values and purpose and let those lead all of your policy decisions.
  • Don’t reinvent the wheel—Look at, and reproduce where appropriate, policies from similar organizations.
  • Double check the rules—Ensure your decisions can be upheld and meet all requirements by consulting experts such as lawyers, program officers, and/or insurers.
  • Get buy-in—Policies work best when they are supported by the people they impact.
  • Involve others—Whenever possible, ensure that the people primarily impacted by a policy are a part of creating them.
  • Be realistic—Make policies practical and reasonable in the context of the realities, time, and resources of those impacted by them.
  • Explain yourself—Explaining the reasons for a policy always ensures greater buy-in from the folks impacted by it.
  • Choose a time—Create policies during the time your organization sets aside to focus on internal activities such as retreats or planning sessions.
  • Be strategic—Choose what policies to enact and when, based on the needs and experiences of your organization.
  • Have foresight—Try to anticipate the policies most critical to your work. You can base this on your experience or the experiences of existing organizations.
  • Know your must-haves—Create the policies required by outside entities such as financial institutions, funders, or insurers.
  • Don’t overdo it—Don’t bother creating a lot of policies about things that have not, and may never, occur in your agency (unless you are required to do so to meet a legal or contractual obligation).

Building Better Policies in Harm Reduction

Written by Nigel Brunsdon on . Posted in Hacks for Organizational Boundaries and Policy Development.

One of the most important steps when considering the development of harm reduction services is to think about expectations, including what boundaries you’d like to set for behavior. In organizations, these boundaries are often formalized as policy. Many of the harm reduction leaders interviewed talked about the importance of not having too many policies and involving your participants in the development of policies—especially those that impact them directly.

Too many policies, warn long time harm reduction leaders, are difficult to enforce, sets people up for failure, and ensures that policies are routinely broken.

Many harm reduction leaders articulated that it’s better to have fewer rules that are more broad, and which allow for flexibility and adaptability as the situation arises.

In harm reduction programs there are usually three components for creating policies, procedures, and programs: ethics, experience, and evidence.

To build policies in line with harm reduction best practices and ethics, they must always be grounded in the principles of harm reduction.

From these principles, harm reduction leaders can address some of the more ethically challenging aspects of providing services to vulnerable, stigmatized populations who have historically been the recipients of “services” that actually reinforce the structural violence they face.

Leaders in harm reduction report that testing policies and procedures against the Principles of Harm Reduction is a way to avoid reinforcing structural violence and to build programs in line with harm reduction best practices. As a part of these principles, ensuring that drug users and others receiving services are included in decisions is essential for policy creation in harm reduction.

After checking for alignment with the Principles of Harm Reduction, the next most important test of any potential policy or procedure is its basis in the practical experiences of folks working on the ground and the lives of participants. Policies should never be created that would exclude them from services, undermine the value they get from services, or cause undue hardship for those directly providing services because of the practical realities of service provision or participant’s lives. Put plainly, this means that policies in harm reduction organizations should be vetted by the opinions of both participants and staff who would be directly impacted by them.

Finally, the best policies and procedures in harm reduction rely on peer-reviewed evidence. Peer-reviewed evidence means that something has been evaluated and critiqued by researchers and experts in the same field before the information is published.

In harm reduction, of course, practice has always preceded research. Activists whose intuition told them that reducing harm was better than letting people die were handing out syringes before the research caught up to them. At the same time, harm reduction has also always followed research—for example, abandoning practices such as bleaching syringes that have not shown strong peer reviewed evidence of utility. Evidence from within the agency, in the form of program evaluation, is also used by harm reductionists to edit and improve programs and policies.

Other potential influences on potential policies include laws, insurers, funders, and/or board members, so try to ensure policies are in concert with their needs and expectations as well.

Types of Mobile Service Harm Reduction Provision

Written by Nigel Brunsdon on . Posted in General Space and Service Management Hacks.

Mobile harm reduction services come in many forms—each shaped by local needs, available resources, and the creativity of the people providing care. From backpack outreach to vans, bikes, and home delivery, these models offer flexibility, build trust, and reach people who may never visit a fixed site. This section explores the unique strengths and limitations of different mobile approaches.

  • Fixed Site Outdoor Spots—Fixed site outdoor syringe access services or other harm reduction supply services may offer services from a vehicle, out of a closet that opens onto an alleyway, or any similar situation. Very often, fixed site outdoor spots don’t offer very much more than HIV or other rapid testing and harm reduction supplies. Rarely, they may often offer low barrier medication assisted treatment and/or medical services; or they may partner with another provider to provide those kinds of services to harm reduction participants.
  • Outreach/Backpack/Roving—This is, essentially, walking-based provision of harm reduction supplies and/or syringes. Street outreach is one of the oldest forms of harm reduction, and offers few if any adjunct services like testing or access to MAT. Outreach-based harm reduction service is the original form of harm reduction service provision but is frequently limited in the kinds and amounts of supplies that can be provided. However, outreach can also reach people who simply cannot or will not come to a formal service site and it has the benefit of being more informal and personal, allowing participants to be more open.
  • Home Delivery—Home delivery is exactly what it sounds like. Harm reduction workers meet participants in their homes or another safe location such as a parking lot or cemetery. Home delivery is often described by the folks who do it as their favorite form of harm reduction service delivery because it winds up being so intimate and rewarding. One downside is that services are often limited to simply supply provision, but one of the strong upsides is that, because most people feel safer in their own homes, they are more likely to open up and ask for information and support.
  • Vehicular—Vehicular outreach is often the widely preferred method of harm reduction service delivery because it combines the flexibility of mobile outreach with the capacity to offer a wide range of services—often comparable to those provided at fixed sites. In fact, many vehicular outreach programs function as mobile fixed sites, returning consistently to the same locations—sometimes for decades—to build trust and provide continuity of care. Vehicular outreach can be loosely divided into large moving truck/RV, or small van or car, with services from the latter generally being the most flexible, and services from the former being most comprehensive.
  • Bicycle/Alternative Vehicle—A few programs across the country use bicycles—often with trailers—or other alternative vehicles to deliver outreach-based services in the community. Common challenges include the need for outreach workers to own and have the capacity to operate a bicycle, as well as traffic safety and liability concerns. As with all harm reduction service models, there are limitations—bicycle-based outreach typically covers smaller areas and may carry fewer supplies due to space and distance constraints. At the same time, the benefits, including flexibility, cost, and lower carbon footprint, make them attractive to some programs.

Types of Fixed Harm Reduction Service Sites

Written by Nigel Brunsdon on . Posted in General Space and Service Management Hacks.

When thinking about creating safer, more humane, trauma-informed harm reduction spaces, it’s important to begin by assessing the kind of space that you have. Not all harm reduction sites are the same, and each have their own challenges as well as assets to consider. They also, of course, provide different services. Some are more like permanent harm reduction supply access points, and others are places where people can wash their clothes, eat a meal, take a shower, or even safely use drugs.

  • Fixed Site SSP or HR Services—One kind of common harm reduction service site is a fixed site syringe access service or other harm reduction supply service. These sites only provide harm reduction supplies and/or syringes and few if any adjunct services like testing or access to MAT. Frequently this will be hosted at another location like a church, or bookstore, or in an office or storage locker specifically used for that purpose.
  • Embedded SSP of HR Service Site—This will often look like a clinic or other service site that offers additional harm reduction services, or a center with other services including harm reduction supplies. Some organizations operate a permanent harm reduction supply space in the front of their services site and then offer other/adjunct services in the back.
  • Drop-Ins—By definition, drop-ins offer more services than merely harm reduction supplies. They may offer services such as showers, lockers, hot meals, a hangout space, medical care, bathrooms, free clothing closet, assistance in signing up for benefits, medication assisted treatment, alternative medical treatment, services for sex workers, movie nights, pet care, educational seminars or classes, support groups, emotional healthcare, or other services that may be useful to the population served by the organization.
  • OD Prevention Sites—OD prevention sites have gone by many names over the years, but what they have always been are safe places to learn how to use, and use, drugs more safely. Overdose prevention sites have been the norm in Europe for many years, and the first one was opened in North America in 2001 in Vancouver, British Columbia. Overdose prevention sites have been proven time and again to reduce overdose events, and prevent disease transmission and injury from drug use.

Preparing for the Worst: Hacking NIMBYs

Written by Nigel Brunsdon on . Posted in Community Building.

No matter how friendly we are and how good our intentions, there may be people in the community who are hostile to the work we do with people who use drugs and other marginalized community members. Therefore, it’s imperative that in addition to being warm, friendly, inviting, and transparent as much as possible, we also prepare for the worst.

In the case of many harm reduction organizations, this has been largely at the hands of community members who are sometimes derogatorily called NIMBYs, for “Not In My Backyard”. These are community members who do not want services for marginalized people in their communities. Hostile community members have disrupted harm reduction across organizations, counties, cities, and even whole states. To be clear: Space Hacks is not an exhaustive treatment of the problem; to give them fair treatment would require an entirely new edition of the Hacks. But here are a few excellent tips:

  • Keep good notes—Many organizations, especially those in communities more hostile to harm reduction, make it a practice to keep notes about both allies in the community and people or organizations that are challenging. These notes are invaluable for keeping a clear idea of allies who can be counted on in the larger community and can offer insights into how to avoid or resolve challenges. These notes should be kept confidentially by key members of the organization such as the executive director, key staff, and/or Board members. This is also an invaluable resource in case of sudden or unexpected leadership transition.
  • Get a lawyer—Look for a lawyer before you have an issue. You can find more tips for finding lawyers in the original Hacks. Even if you can’t get your own lawyer, connect with values-aligned communities of lawyers including your nearest National Lawyer’s Guild Chapter. Get to know the landscape of legal services in your area, with an eye out for services that might be relevant to your organization or your participants. While you’re at it, connect with your nearest ACLU Affiliate and ask if you can pick up Know Your Rights handouts for your participants and staff..
  • (Where possible) Make friends with LEO—This may seem counterintuitive to many folks who’ve traditionally mistrusted law enforcement, but when and where possible it’s a good idea to reach out to local law enforcement leaders. Give them the same information you might give your neighbors—tell them about your services and how they benefit the community—so that they get a sense that you and your organization are legitimate community partners. It is essential to emphasize the question of “where it’s possible” here; there are many harm reduction organizations that exist in jurisdictions in which law-enforcement is entirely hostile to their efforts. SO PLEASE BE JUDICIOUS. In these or other communities it may not be a good idea to try and work with law-enforcement outside of carefully vetted circumstances. If you’re not sure how they might respond, look for allies and partners who have experience with local law enforcement and ask questions before approaching them for support. Keeping an open mind and a “trust but verify” attitude is always prudent. Only you know your community and your risk tolerance. NEVER give law enforcement information about participants, colleagues, or other people unless you are legally required to. If law enforcement asks you about an event or a person, tell them you cannot share that information. If they continue to pressure you, ask if you’re free to go. If they say no, then you are under arrest. Say, “I will remain silent until I have spoken with my attorney.” Then, most importantly, don’t say anything else.
  • Learn to advocate for your folks—Brush up on the legislative process, learn to build coalitions, and lobby for or against issues that impact the folks your organization serves and the work you do. Remember, people who work in nonprofits can spend about 20% of their time doing this kind of work on behalf of the people they serve. And anyone who works in government is free to do, in their spare time, whatever they like. For more information see the original Hacks on advocacy, or the resource section.
  • Learn some non-violent direct action skills—When in doubt, non-violent direct action is another tool for social change that has served the harm reduction and other activist communities for decades. Please see the resource section for more information on those skills.
  • Find allies—Part of the importance of doing community outreach and working on your outer community is finding allies in that community. Try to identify community members who are on your side. These can be people in positions of power, but it can also just be average citizens. Those people can create their own coalition to support you.
  • Join forces—Look to the larger harm reduction community for support and other strategies for dealing with hostile community members. It’s important that you join local and statewide action and affinity group meetings. Go to regional and national conferences and network—meet and connect with other folks who have dealt with similar issues.

Being Neighborly: Right Outside Community Relations Hacks

Written by Nigel Brunsdon on . Posted in Community Building.

Your neighbors adjacent to your sites are some of the most important allies to develop. These folks can be an asset, or a liability, and the choice is partially predicated on how you approach them and how responsible a community member you and your organization are in the community where you set up shop.

Many harm reduction organizations opt for setting up sites in depopulated light industrial or commercial areas, which is an excellent choice, but no matter the area, it is extremely important to try and be allies with the people around you.

  • Introduce yourselves—Make it a priority to go out and physically meet folks in your neighborhood. Describe your services and what you’re doing for the community. Tell them how to get a hold of you and that you hope to be good neighbors. This will start to build trust around your organization.
  • Have an open-house specifically for your neighbors—Set people’s minds at ease by showing them that harm reduction service centers are often more like well-organized garages rather than whatever preconceived notion they may have had.
  • Give your neighbors direct access to someone in your organization via text or email in case there is an issue, if possible—to be a good neighbor you need to be especially responsive to issues around your site to avoid conflict, so having a direct line of communication for those near your site(s) is a wise choice.
  • Have services that benefit all community members like community cleanup of bio-waste on demand. Not only does this alleviate public anxiety, it quells any possible accusation of being poor community partners. At the same time, introduce the general knowledge that pathogen transmission risk from discarded syringes is so low that no cases of HIV or HCV have been attributed to accidental needle sticks outside of medical settings.

Hacks for Developing Larger/External Community

Written by Nigel Brunsdon on . Posted in Community Building.

Your external community is made up of the larger community around you, such as neighbors and other community members. It is imperative that you make allies with people in your larger community, city, county, health jurisdiction, and/or your state, to help ensure that things do not escalate with the larger community either.

Most of the best practices for building internal community, such as being transparent and accountable, are equally true for building your external community, but there are some specific skills for building external community. These include:

  • Map your community—Starting from the central location where you provide services, make a map of each block in the surrounding area. Look for community assets (schools, churches, stores, community organizations, clinics, parks, etc.), places where there might be potential participants, and issues you or your participants may encounter. If you can, walk these blocks and talk to folks about the neighborhood, your work, and any services that might be available to them, such as community cleanup of bio-waste.
  • Offer tours or open houses—Offer regular tours to community members. This helps with transparency and builds community trust while demystifying harm reduction services. NOTE: Many organizations choose to do this during a time when they are not providing regular services in order to protect participant confidentiality.
  • Practice public speaking—Find community groups like Toastmasters or other ways to practice public speaking and connect these opportunities to the leaders you cultivate. Telling your and or your organization’s story can be critical in so many ways.
  • Build a presence in social and other media—Make sure your organization has a social media presence and, where useful, one in the regular media as well. Where possible, it is most useful for you to post things that are constructive, educational, and/or helpful to the community. Never miss an opportunity to broadcast about your achievements, no matter how small.
  • Create the position of community relations liaison—Have someone at your organization ready to act as a spokesperson if a reporter approaches you for comment on current events impacting your clients, and make sure local journalists know that person is available, along with contact information.
  • Have regular events—Holding regular events to celebrate successes, get to know constituents, and raise funds helps build your organization’s public profile and external community.
  • Be compassionate with everyone—It’s essential that harm reduction organizations extend the same compassion to everyone they come in contact with, in order to build community trust—even among those they may have a knee-jerk negative response to. Not only do you not know who might become an ally, it’s important to ensure that you can never be accused of bias towards people who might become problematic to the organization.
  • Be positive—People are more attracted to organizations that are positive and uplifting, so try to build a positive message into everything that you do. It can be tempting to be cynical or reactive, OGs warn, but a temporary good feeling of righteousness can lead to years of headaches.
  • Look for organizations and coalitions with aligned values—Seek out organizations and coalitions with values that are similar to yours when building alliances or partnerships.
  • Participate in professional and national organizations—Participate in professional organizations to get ideas, access to resources, build alliances, and credibility.