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Tag: Hacks for Preventing Escalation

Hacks for Youth Participants

Like kids at site, the first thing to know about youth participants (12-18) is that most harm reduction workers are not mandatory reporters. This is not true of harm reduction workers who also happen to have certain kinds of licensure; however most people who work at harm reduction programs are not mandatory reporters, which allows them the discretion to not report if they see children in mandated reporting situations.

The knowledge that young people are using drugs would typically be such a situation. However, harm reduction organizations are not beholden to that standard. Instead, youth should absolutely be offered the most intensive services. Special referrals, education, and support should be offered to anyone under 18.

This very much includes drug education. These are the people that it is most critical to share information with around safer drug use so that they can set good habits as they move through their drug use and hopefully beyond.

Hacks for Kids at Site / During Service Provision

The first thing to know about having kids at site is that most harm reduction workers are not mandatory reporters. This is not true of harm reduction workers who also happen to have certain kinds of licensure; however most people who work at harm reduction programs are not mandatory reporters, which allows them the discretion to not report if they see children in situations that would trigger mandated reporting for some licensed professionals.

Many harm reduction programs struggle with this question because the desire to protect children is paramount. However, most harm reduction workers, and nearly every participant, knows someone who has been traumatized or abused by the existing foster care system. This complicates the ethics of whether or not to report to authorities that a child is living with drug users.

The way that most harm reduction organizations handle the question of providing services in front of the children of their participants is to ask people not to bring their kids if possible, with the understanding that they are not mandatory reporters, while at the same time ensuring that people who report being parents are offered appropriate attention, referrals, education, and support.

Hacks for System Building & “Proceduralization”

“Proceduralization” is a term coined by harm reductionist Haley Coles to describe the process of creating and, critically, writing down exact protocols for a variety of different tasks and services. These are step-by-step written instructions for how to do everything in the space, from passing out supplies to cleaning the restroom.

The front-end labor on system building is not insignificant, but the time, energy, and effort that this will save is invaluable, especially in any escalated situation where having procedures in accessible, documented places will make everything go much more smoothly.

One tip that long-term harm reduction leaders have for this is to make it a part of weekly meetings and to delegate responsibility for proceduralizing different tasks to the person most familiar with those tasks.

Hacks for Training & Cross-Training for De-Escalation

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.

The Sugar vs. Bass Hack

Another intangible hack offered by harm reduction leaders was the idea of what one called “sugar” and “bass”. What they meant was ways to use tone, inflection, and voice to help diffuse and reinforce the impact of enforcing community agreements or boundaries.

“Sugar” would purposely soften their words, while “bass” would drop their voice to convey firmness. Both techniques are deployed depending on the situation.

There are certain things that may not seem intuitive that, nevertheless, cleanup many harm reduction organizers felt were essential to creating harm reduction spaces and services free of escalation. These included cross-training and ”Proceduralization”.

Hacks for Setting the “Vibe” & Community Ambassadors

A less tangible quality leaders talked about that helped create de-escalated spaces was setting the “vibe of the space”—that is, setting the emotional tone as friendly, warm, and inviting. In addition to things as diverse as paint color and grievance processes, another critical suggestion from many harm reduction leaders is to have community ambassadors.

Ideally these are participants, though they can be staff members, who act as greeters and welcomers to the site. These site ambassadors can greet newcomers and explain things like the community agreements, the grievance procedure, and any way the site solicits feedback from participants. They can also welcome folks and generally act as the friendly front of the house.

Harm reduction leaders share that ideal candidates are participants who are naturally friendly and warm. In addition these ambassadors often make excellent eventual employees.

A Note About Mobile Trauma-Informed Service Delivery

“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.

Service and Supply Management Hacks for Mobile Services

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.

Hacks for Bicycle and Other Alt Vehicle Service Delivery

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.

Hacks for Harm Reduction Home Delivery

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.