Author: Nigel Brunsdon

It may seem odd to think of training or cross-training as have anything at all to do with handling escalated situations in harm reduction spaces, but in fact, it is invaluable for all staff to be trained and cross-trained on all the basic services provided by your organization; consequently, when escalated situations inevitably occur, everyone can handle everything, so if key staff are tied up, the site can continue to run as smoothly as possible.

This means that all staff should be familiar with the supplies and services that are provided, your service hours, and other details. It also means they should know exactly what supplies your organization hands out and the protocols for doing so.

“Trauma-informed care” is somewhat more complex in mobile harm reduction delivery because workers don’t have complete control over the environment in which they’re working. That said, it’s important for harm reduction workers to do many of the same things they would in any other environment regarding other people’s trauma.

Understand that it’s there; understand that it’s not personal; understand that people will be emotionally dysregulated sometimes because of it; understand that particularly in mobile situations in which you’re almost inevitably dealing with people who are unhoused, those people are, as a result of not having housing, automatically more traumatized and stressed out than the rest of the population.

OGs repeatedly report that ineffective management of supplies is the number one potential flashpoint for escalated situations during harm reduction services, because it can make people feel like they are treated unfairly. Because of this, and in the name of fairness, harm reduction leaders had the following special suggestions for managing services and supplies during mobile service delivery:

• Try and determine what the average number of shots are per day for the primary drugs of choice in your area and pack about a week’s worth, with related supplies, in a single larger bag like a paper lunch sack. This makes interactions, especially on foot or bicycle, much more fluid.
• As ever, the best way to understand what your participants need is to ask them directly.
• Make sure to meter out your supplies. This means thinking about your whole shift at the beginning of the shift and trying to retain some of the most sought after supplies for the end of shift. This can help ensure that folks at the end of your routes don’t feel shorted by you running out at the beginning of shift.
• As always, be transparent with participants about what you have, what you don’t have, and/or what’s for only special populations.

Using bikes, carts, or other alternative vehicles for outreach offers flexibility, low costs, and a smaller environmental footprint. While the core principles remain the same as other forms of mobile harm reduction, there are a few extra considerations to keep things rolling smoothly.

• Make sure the bags and/or trailers are packed leaving enough time for transiting to your locations.
• Make sure to carry basic bike tools, like a multitool and patch kit, in case there is a problem—nothing is more frustrating than desperately needing them and not having them.
• Invest in good raingear and sturdy tarps—outreach stops for nothing!
• Create and maintain internal area maps of participant location.

Home delivery can be one of the most meaningful and trusted forms of harm reduction—bringing care directly to people in the places they feel safest. It also requires a high level of discretion, respect, and planning to protect confidentiality and ensure safety for both participants and workers.

• Set up a VOIP number like a Google phone number so that several folks can take calls from those who need services.
• Be sure and ask the potential client about confidentiality. It’s especially critical to know who in their home environment knows or does not know about their use and how discreet you need to be. Some people are very open about their lifestyle and others are extremely closeted, so you will need to know those details in order to maintain their privacy and your credibility.
• The same goes for phones—be discreet and ask about boundaries, including whether it’s okay to leave detailed voicemail or texts.
• Set service parameters ahead of time. For example, you may limit services to your city or county.
• Leverage your home delivery participants as secondary or “satellite” exchangers. Home delivery participants often have contact with other PWUD who are unable or unwilling to come to get services directly. It is in the best interest of both your program and the community to capitalize on these key community members.
• Do delivery in pairs, especially the first time or two you go to someone’s place.
• Once a participant has been established, it is still a good idea to share location information as a team during home delivery.
• DO NOT act scared of your participants or treat them as if they may try and harm you.

Street outreach is one of the most direct and personal ways to connect with people who might not otherwise engage with services. Often done on foot and out of backpacks, this work requires careful preparation, deep respect for people’s space, and a strong sense of safety and teamwork.

• A convenient way to pack supplies is in pre-made kits that contain a set number of syringes or pipes and sufficient supplies for safer use.
• Limit the number of sizes of syringes you carry to two or three.
• Make sure the bags and/or vehicles are packed leaving enough time for transiting to your locations.
• Create and maintain internal area maps of participant locations.
• Outreach exchange should always be treated respectfully and as if it is a form of home delivery. This means that campsites and other temporary housing is treated as if it is a private residence. Harm reduction workers should always ask for consent to enter, especially the first time that they appear in an area.
• Because supplies are limited, make sure to manage supplies and participants’ expectations carefully.
• Only do outreach in pairs or triads and never leave each other’s line of sight.
• Think about using a wagon or rovers, like those sold by the Connecticut Harm Reduction Alliance, to increase the quantity of supplies you’re able to haul.