Tag: Featured

Types of Mobile Service Harm Reduction Provision

Written by Nigel Brunsdon on July 17, 2025. 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.

Hacks for Developing Internal Community

Written by Nigel Brunsdon on July 17, 2025. Posted in Community Building.

Building internal community means building relationships based on your shared values as a part of a harm reduction organization, such as:

Compassion
Non-judgment of people and their behavior.
Reducing shame, bias, and stigma, especially related to drug use and other marginalized activities.
Science and peer-reviewed evidence.
Recognition that the impact of trauma and cultural barriers (such as racism, sexism, and classism) impact people’s relationships with drugs.
Cultural humility and competency.
Equity
Service
Recognition of personal autonomy.
Meaningful empowerment.
Transparency
Shared responsibility.

Practicing these values with everyone you meet will build trust and the kind of community you will need in order to build the services you want for your participants.

Some suggestions from OGs for building community are to:

Define mission and values—People commit to ideals and values they feel good about, so an important first step in building a strong internal community is defining the core mission and values. This includes involving your participants in the process, or at least ensuring they know and understand those values.
Share power—Making sure that various stakeholders such as staff and participants have a real say in the program helps people feel connected and committed to the community.
Cultivate strong leadership—Identify and cultivate people who can take leadership positions that build and sustain your community. Please note this absolutely includes participants. This doesn’t mean “putting them in charge”, lest anyone’s liability insurer gets upset; but why not let participants have a say in what’s on the walls, how the furniture is arranged, what services the program provides, and even how to handle escalated situations after the fact? This builds trust and community which long-term harm reduction leaders attested, time and again, is one of the most protective factors for escalated situations. It also has the added benefit of being an evidence-based best practice.
Practice equity—Make sure all policies and procedures are followed impartially, fairly, and universally. If there need to be exceptions, make sure those exceptions are transparent around why they exist.
Create a culture of clear feedback—Create a community culture in which giving and receiving honest, kind, and constructive feedback is normalized. This prepares everyone when escalated events take place, and hearing negative feedback may be vital to de-escalation.
Assume positive intent—Assuming other people mean well lightens moods, lowers stress levels, and quite often throws people off guard in positive ways during escalated situations.
Be accountable—Be willing to openly recognize your inevitable shortcomings. We are ALL works in progress with flaws and issues. And remember that very little shows integrity more than apologizing before you are prompted.
Be transparent—Being as honest and transparent as possible with regard to the organization and its workings helps build trust.
Be reliable—Being an organization that people can count on is essential in harm reduction.
Have follow-through—Follow through on all your commitments to your community, even if it is just to explain why you can’t do what you wanted or hoped. One lesson a lot of leaders have learned in this regard is that failing to communicate is a sure way to undermine or fracture any good will you have built. It is far better to be honest and transparent.
Be equivocal—If you’re not sure the organization can achieve something, say “maybe”.
Be a team—Act and think in terms of being a team—that is, a collective unit in pursuit of a common goal, with a common identity, and a need to support one another in order to achieve that goal.

Creating and Defining Community

Written by Nigel Brunsdon on July 17, 2025. Posted in Community Building.

Over and over, harm reduction leaders interviewed for Space Hacks centered the creation of community as central to their efforts to create safe, humane harm reduction spaces services that are trauma-informed and minimize the potential for escalated situations.

People, leaders noted, who are protective of their community will help ensure potentially escalated situations are diffused before they become an issue. Ergo, working at creating community is an essential component in ensuring safer services.

Community minded spaces and services also attract participants who are in need of services because they help folks feel safe enough to engage with other services such as getting safety supplies, medical care, MAT, or other services.

Community can be defined as having the following features:

A Sense of Shared Values
Support and Cooperation
Inclusivity and Diversity
Communication and Interaction
Sense of Belonging
Mutual Responsibility
Celebration and Tradition
Empowerment and Participation

Many organizations fail to consider the question of creating/maintaining community when they do strategic and program planning, leaving it to emerge organically. This strategy sometimes works in community-driven grassroots CBO’s, but not as well in large organizations, health departments, or those in which a preponderance of staff do not live or work in the community they are serving.

For the purposes of the Hacks, “community” can be divided into internal and external community. Your Internal community are the folks “inside” your organization—your staff, volunteers, Board members, participants, and donors can be thought of as your internal community—folks already vested in and committed to your work. Your external community is everyone else in the regional area where you live.

The primary focus in terms of community with regard to creating safer harm reduction services and spaces is on cultivating the internal community. Especially the community between staff and participants.

It cannot be over-emphasized how essential it is for harm reduction service providers to create a sense of camaraderie and shared community with their participants. Not only will this ensure better services are provided and thus more lives are saved, but it will also ensure that, in the event that something begins to escalate, community members will be much more likely to intervene on behalf of staff and to contribute to de-escalating the situation rather than making it worse.

Harm reduction leaders provided dozens of anecdotes of participants who, because they were committed to the organization’s community, insured the safety and security of that community. Conversely, they also provided examples where organizations that did not create community found themselves with serious issues.

Edie Springer’s Worker Stances for Clients Who Use Drugs & Harm Reduction Worker: Best Practices

Written by Nigel Brunsdon on July 17, 2025. Posted in Big H, Big R Harm Reduction: Practicing Harm Reduction with Others.

Edith Springer has often been called the grandmother of American harm reduction. In February 1988 she had a chance encounter with Allan Parry who was a harm reduction activist, social worker and former drug user from the United Kingdom. She later visited Parry in the UK to watch harm reduction services in action. Her experiences there and with Parry and his colleagues were transformative—both for Edith Springer and for American public health.

Harm reduction immediately resonated for Edie, who was herself a former drug user and methadone patient. Faced with the devastation of HIV’s impact on drug-using communities, Edie fully embraced harm reduction and trained hundreds of harm reduction workers who have carried her legacy with them. She developed these worker stances in 1996 and they have been shared among many of us in the harm reduction community for generations, spearheaded chiefly by Mona Bennett, longtime harm reduction activist and resident of Atlanta Georgia. Though some language has changed a little in the last 30 years, her instructions remain as salient today as they did in 1996.

Worker Stances for Clients Who Use Drugs

[These are also great Worker Stances / Best Practices for Participants who Sell Sex, are Homeless, etc.—Mona Bennett, 2016 ]

Show clients unconditional regard and caring. Acknowledge her or his intrinsic worth and dignity.
Be a real person. Let the client see you as you really are. “Blank screens are for movie theaters”.
Don’t get caught up in the client’s urgency; take your time—practice mindfulness.
Be non-judgmental toward the behaviors of the client.
Be consistent with setting limits: control oneself, not the client.
Empower the client.
Work through one’s behavior or enabling: When is it positive? When is it negative?
We are not responsible for rescuing the client who is responsible for his or her own life. We are responsible for the intervention process: the client is responsible for the outcome. Trust the client’s strength and ability.
Never take away defenses until alternatives are developed. Introduce new coping strategies and shore up those used previously.
Avoid the expert trap, especially if you aren’t one. Use the client as a consultant and collaborator. Act out of a place of humility.
Explore one’s own values about drugs, drug users [and sex and sex workers, homelessness and the homeless…].
Be mindful of the stages of change. Set the table. Provide options non-judgmentally and non-coercively. Any reduction in harm is a step in the right direction.
Reinforcement is more effective than punishment. Use incentives when available.
Use supervision to process emotional responses and attitudes.
The agenda for change belongs to the client; the worker facilitates—rather than implements—the agenda.
Consider the client’s relationship with drugs [and sex…]—the positives and the negatives, rather than judging the use itself. Focus on behaviors.
Quality of life and well-being are the criteria for measuring success, not reduction in the consumption of drugs.

Edith Springer, 1996

Harm Reduction Workers: Best Practices

Remember that behavior change is a complicated process that happens over time. The key for the harm reduction worker is to develop a relationship with the participant so that there can be an open discussion about the complex reasons/motivations/and meanings surrounding the behavior. Trust is built over time. You are there to help the participant explore their feelings about their drug use, the meaning of their drug use, the roles played by the drug use, the costs and benefits of their drug use, and what would be missing if the drugs weren’t there. Workers can help customers envision the drug use life that they want and how to get there: “What would you like your drug use to look like?”
You are not there to “fix” anybody, the participant is in the driver’s seat and it is the participant’s job to develop strategies and solutions that work for them at their own pace. Don’t be attached to your desire for the participant to “change”—have your goals in mind, but let go of them and help the participant create their own goals and objectives. LET GO! You aren’t in control, ideally you are a facilitator. Have a “you can DO IT” attitude that acknowledges who is responsible for what—the person is their own boss, the person is capable of having goals, making changes. Change is a process, not an event—usually long-lasting changes are achieved through incremental baby steps.
It is healthy and normal for people to have conflicting feelings and be ambivalent—this is not “resistance”, it is part of the change process.
Don’t impose your personal beliefs about drug use—if a participant believes in a particular theory or intervention, SUPPORT THEM—what workers do in their private lives, what they believe in, what they practice, and what works for them, is IRRELEVANT to the participant.
Maintain a stance or compassion and openness—be SINCERELY interested in what the participant is saying—don’t be a “neutral” listener—be active and positive, caring about their feelings.
Concentrated listening is HEALING—people have the chance to heal when they feel listened to.
Participants deserve our attention and good will; they don’t have to EARN it.
You are playing a role—you act like a worker and not a friend, won’t be out there for your own emotional needs and will maintain your boundaries, and will set limits. This makes it safe for the participant—be fair and treat everybody the same—not saying no or setting limits is disrespectful—treating a person like a child and not helping them develop as people and grow, not helping them learn to work within the real world where there are rules/appointments.
Do not attempt to minimize the devastating impact substance use can have on individuals, communities, and families. Face it and stand with all the people affected by substance use “where they are at” and care about the next ten minutes (overdose prevention, disease prevention, healing moments a non-judgmental and compassionate attitude can have) and the next ten years (long-lasting behavior change, reduced emotional pain, linkages to HIV and other life-improving services).

Edith Springer, 1996

Resilience Building

Written by Nigel Brunsdon on July 17, 2025. Posted in Personal Escalation Prevention.

Because so many of us are so similar to the folks we serve, including the trauma we carry with us, and because it is now recognized that extreme stress impacts people who care for people experiencing that trauma nearly as much as the people directly impacted by that trauma, it is essential that people in harm reduction talk about resilience building.

Resilience building is different from “self-care”. Although self-care is a part of resilience building, resilience building is about developing the skills and calm necessary to maintain balance, even in the face of stress and difficulty.

“Self-care” is often rightly seen as relatively shallow because activities like getting a massage or taking a hot bath are often suggested. And although such activities can help with stress, they are not long-term solutions to the deep physiological response cycles experienced by many of us carrying and witnessing trauma regularly. Moreover the concept of “self-care” usually places the responsibility for dealing with the stressors that cause burnout and vicarious trauma entirely on the individual when in reality individuals are not in real control of the circumstances of their work that produces the stress they are experiencing.

The best we can do as a long-term solution for that stress is to build resilience skills to help us regulate mood, amygdala activity, and maintain balance when our stress cycles are triggered.

The following are evidence-based stress reduction and resilience building techniques that help mitigate stress, trauma response, and compassion fatigue:

Connection—Meaningful connection to friends, family and other loved ones.
Intention Setting—Setting intentions or plans for the future, especially with regard to self-care and service.
Ritual or Container Building—Creating rituals that allow us to fully transition from one part of our life to our work.
Healthy Boundaries—Establishing personal boundaries is essential to stress reduction.
Narrative Reconstruction—Deciding what parts of our culture or upbringing to carry with us.
Play—Creative and fun endeavors.
Gratitude—Recognizing the positive things in our lives.
Savoring—Spending time paying attention to positive experiences.
Mindfulness—Meditation and related practices shown to reduce stress.
Exercise—Moving the body in ways shown to reduce stress.
Therapy—Talk therapy is useful for anyone doing direct service work.
Supportive Community—Connecting with spiritual, therapeutic, or other support communities.
Neurofeedback—Neurofeedback is a technique that can help train reactive brains to be less so.

Personal Boundaries

Written by Nigel Brunsdon on July 17, 2025. Posted in Personal Escalation Prevention.

The most important first step when it comes to preventing escalated situations is having a good sense of personal and professional boundaries when doing the work.

As we reported with the original Harm Reduction hacks, Harm reduction leaders continued to report that having good boundaries is key to many areas of their success. Most saliently, they help prevent escalated situations in harm reduction spaces because they prepare one for what happens when boundaries are transgressed,

Many harm reduction leaders talked about the need to have healthy boundaries around their work life and the things they will and will not accept. Many spoke to the fact that boundaries did not come naturally to them but that learning them had been critical to doing their best work. Some tips for developing better boundaries include:

Learn to recognize your own needs and listen to your intuition.
Know your values and what integrity looks like to you.
Recognize that knowing and communicating your boundaries shows respect for self and others.
Let your values and intuition help you define your boundaries.
Set consequences for folks who transgress your boundaries.
Communicate your boundaries.
Stay the course and be consistent.
Recognize that other folks’ crises and issues are not yours and let them go.
When possible, work with a professional like a coach or therapist to help you develop better boundaries.

Trauma-Informed

Written by Nigel Brunsdon on July 17, 2025. Posted in Philosophical Orientations.

The term “trauma-informed” emerges from a growing understanding of the far reaching ways that trauma impacts health and well-being. Trauma is defined here, in keeping with the scientific literature, as a deeply distressing or disturbing experience(s) that overwhelms an individual’s ability to cope, and significantly impacts their mental, emotional, and physical well-being. Trauma has hallmark brain activity, including an overwhelming response, and hyperactivity, in the amygdala.

The amygdala helps with essential functions such as detecting and responding to threats, encoding emotional memories, and regulating emotional responses, and is fully activated during traumatic events. Trauma can result from a single event or from prolonged exposure to adverse conditions. The effects of prolonged exposure to stress hormones activated by trauma can be pervasive and long-lasting, and includes greater risk of depression, anxiety, chaotic substance use, unstable relationships, unstable work lives, and many poor physical health outcomes like increased risks for high blood pressure, heart disease, cancer, diabetes, etc.

“Trauma-informed” has emerged as language to describe the ways that service providers must adopt a mindset and approach that prioritizes understanding, empathy, and support for those who have experienced trauma. It involves creating environments and practices that promote safety, trust, and healing, while recognizing and addressing the complex effects of trauma on individuals and communities.

Ideally this means understanding that the population you serve is in need of:

Safety
People Who Are Trustworthy and Transparent
Peer Support
Collaboration and Mutuality
Empowerment and Choice
Recognition of Structural Inequalities

In practice this means:

Understanding trauma and its impact: Recognizing that trauma can result from various experiences, including violence, abuse, neglect, extreme poverty, incarceration, and systemic oppression.
Understanding the broad impact trauma can have on mental, emotional, and physical health.
Recognizing signs and symptoms: Being able to identify key signs and physiological symptoms of trauma in participants and others.
Integrating trauma knowledge into practices: Applying knowledge about trauma into policies, procedures, and practices. This means adopting strategies that minimize the risk of re-traumatization and that promote healing and recovery.
Resisting re-traumatization: Actively working to avoid practices and behaviors that could re-traumatize individuals. This involves being mindful of triggers and creating a supportive environment that minimizes re-traumatization and maximizes building trust and community.

Consent Culture

Written by Nigel Brunsdon on July 17, 2025. Posted in Philosophical Orientations.

The concept of “consent culture” emerged from the sex positive movement of the 1980s and 90s. It was a response to the concept of “rape culture”, a term that had been coined to describe the experience that many people—especially women, queer and trans people—have of sexual violence and harassment. Consent culture aims to create a society where mutual respect, communication, and consent are the norms in all interactions. This concept has also been applied to current training approaches around sexual health and sexuality.

The idea of consent culture is fundamental to harm reduction in many ways because harm reduction, like consent culture, is based on the idea that every person is an autonomous individual who should have complete control over their own body. This pertains obviously to sexual activity, but it also pertains to drug use. Consent culture also maintains the idea that people retain the ability to give or retract consent at any time during any interaction. Harm reduction equally maintains the idea that people retain the right to give or retract consent to services, to drug use, and/or to other behavior.

One model of consent that is quite popular is “CRISP”. CRISP (C=Considered, R=Reversible, I=Informed, S=Specific, P=Participatory) is an acronym that embodies the fundamentals of consent culture.

CRISP asserts that consent should be Considered, and that the individual considers their choices and understands that they’re making a choice; that the choice be Reversible—meaning that they can at any time retract consent; Informed—meaning that they understand the choices they’re making and the consequences of them; Specific—meaning that it’s specific to their circumstance and not in general; and finally Participatory—which means that they enthusiastically participate and aren’t just passively giving in to a behavior or activity.

Principles of Harm Reduction

Written by Nigel Brunsdon on July 17, 2025. Posted in Philosophical Orientations.

These principles were developed over a period of about four years in the 1990s amid much debate among early harm reductionists, who came to consensus on these enduring principles of harm reduction:

Accepts, for better and for worse, that licit and illicit drug use is part of our world, and chooses to work to minimize its harmful effects rather than simply ignore or condemn them.
Understands drug use as a complex, multi-faceted phenomenon that encompasses a continuum of behaviors from severe abuse to total abstinence, and acknowledges that some ways of using drugs are clearly safer than others.
Establishes quality of individual and community life and well-being—not necessarily cessation of all drug use—as the criteria for successful interventions and policies.
Calls for the non-judgmental, non-coercive provision of services and resources to people who use drugs and the communities in which they live in order to assist them in reducing attendant harm.
Ensures that drug users and those with a history of drug use routinely have a real voice in the creation of programs and policies designed to serve them.
Affirms drug users themselves as the primary agents of reducing the harms of their drug use and seeks to empower users to share information and support each other in strategies which meet their actual conditions of use.
Recognizes that the realities of poverty, class, racism, social isolation, past trauma, sex-based discrimination, and other social inequalities affect both people’s vulnerability to, and capacity for, effectively dealing with drug-related harm.
Does not attempt to minimize or ignore the real and tragic harm and danger associated with licit and illicit drug use.

Harm Reduction Working Group, published 1997

Important Terms: Person First Language

Written by Nigel Brunsdon on July 17, 2025. Posted in Language.

Generally, it’s important to use “person first language” when describing people who are marginalized due to some part of their identity being stigmatized, such as folks struggling with their substance use, people who do sex work, and folks living outside.

Person-first language originates in the mental health consumer rights movement—a push by folks receiving psychiatric care to de-stigmatize and gain rights for mental healthcare consumers.

Person first language was initially developed because people with psychiatric conditions were previously described by clinicians solely in terms of those conditions. Mental health consumers wanted it acknowledged that no matter what people are dealing with, they are still a person before their label, and they deserve dignity, recognition, empathy, and respect.

“Addict” is also a word with immense negative connotations for many. Though the term is supposed to be clinical, if most of us are honest we have heard the term used, often alongside a drug, to explain misconduct or antisocial behavior—as if the problem creates that behavior—even though most of us also know people who use drugs who don’t behave in those ways.

There are also studies showing that using “addict”,” and even more pejorative language like “methhead” or “crackhead,” leads to folks getting dehumanized, reduced to their struggle, mistreated, and, of course, helps ensure they are then far less likely to move forward in change.

The term “addict”—though we acknowledge it is proudly reclaimed by many who feel like the word is an identity that they need to own for themselves—also feels to some people as though it reduces them to one facet of their lives and disconnects them further from other people, making change harder.

So, instead of calling someone an “addict”, Space Hacks will sometimes use the term “person or people who use(s) drugs (PWUD)” because we strongly believe that people who use drugs are, first and foremost, human beings who deserve dignity, recognition, empathy, and respect.

Finally, we would be remiss if we didn’t mention that some folks in the community have expressed a strong preference for people to use the phrase “people who use drugs”, rather than the acronym, PWUD—which we use in writing—in live conversation.

The Problem with PWUD: SUD and OUD vs. Chaotic Drug Use

One of the problems that arises with the term “people who use drugs” is that it is intentionally pluralistic in its embrace of ALL people who use drugs—from recreationally to deeply problematically. This makes using it to talk about the things that especially impact people who are using drugs problematically very difficult.

In light of that, and because this work is based on the Principles of Harm Reduction, throughout this document the phrases “chaotic drug use,” “person using chaotically,” and “problematic substance use,” will be used instead of “addict” or clinical terms gaining currency such as substance use disorder (SUD) and opioid use disorder (OUD).

The term “chaotic drug use” is based on a model of problematic drug use created by pioneering harm reductionists Dr. Patt Denning PsyD and Jeannie Little in their groundbreaking book “Over the Influence”.

They created this model because it has become clear from the literature, and the lived experience of drug users, that drug use is more like a continuum that ranges from complete abstinence to recreational use to total chaos.

This continuum model refrains from using the stigmatizing and binary language of “addiction,” with preference for the more accurate description of drug use as a relationship continuum from functional to chaotic, and people who use drugs as physically dependent or not.

This model acknowledges that folks use drugs for many different reasons ranging from spiritual to pathological, and concedes that people’s relationship with drugs depends on a variety of variables including physical health, emotional health, trauma history, age, and many others.

Finally, the harm reduction continuum model acknowledges that people’s use is naturally variable over time—not necessarily on a trajectory toward death. Since drug use is a continuum, we focus on the relationship that people have with their substances of choice at any given time.