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Tag: Hacks for Preventing Escalation

Hacks for Overdose, Overamp, & Medical Emergencies

Written by Nigel Brunsdon on . Posted in Essential Policies and Procedures for All Harm Reduction Sites and Services.

In addition to the necessity for policies for service and supply management, community agreements, grievance, and misconduct processes, another essential set of policies harm reduction leaders consistently recommended were protocols for dealing with potential overdose, overamp, and medical emergencies such as heart attack or stroke.

These are rare events, but as community health workers, many harm reduction leaders feel it’s necessary for harm reduction workers to be ready to respond to these kinds of emergencies.

For further guidance on OD and medical emergency protocols please see the section on De-Escalation In the Moment.

Hacks for Participant Grievance Processes

Written by Nigel Brunsdon on . Posted in Essential Policies and Procedures for All Harm Reduction Sites and Services.

At their most basic, grievance procedures provide a formal mechanism for your participants to have their concerns, grievances, and voices heard and taken seriously. Too often, participants are re-traumatized by the provider/participant power imbalance when provider perspectives are given deference—in other words, when providers are automatically believed.

Providing a mechanism for participants to level concerns in harm reduction programs is essential, because providing a formal mechanism for participants to share their concerns gives them power.

In addition to the strong ethical reason for such a mechanism, it’s also a good idea to have this instrument in place for liability concerns. This provides a safety valve that allows people a way to voice concerns before they rise to the level of liability to the organization.

With that in mind, it’s always important to consult with other stakeholders, including board members, legal counsel, and insurers, when making any decision about designing a grievance process, to ensure it conforms to their requirements.

Again, harm reduction leaders suggested involving participants or at least Community Advisory Boards, in making choices for how these processes work and periodically reviewing them to ensure participant buy-in to these important community standards.

For more information on grievance procedures please see the section on restorative and transformative justice.

Hacks for Community Member Agreements

Written by Nigel Brunsdon on . Posted in Essential Policies and Procedures for All Harm Reduction Sites and Services.

Community member agreements are shared agreements regarding behavior expected of everyone who participates in a harm reduction site or service. Harm reduction leaders were careful to say that these agreements should be simple and err on the side of some ambiguity in order to make room for a variety of different potential behaviors. The primary rule all harm reduction leaders talked about was the need to treat everyone with respect. Many referred to this as the “don’t be an asshole” rule. All said that one of the main rules community member agreements should include is something to the effect of “be respectful”.

Some nearly universal community member agreements in harm reduction spaces include:

  • Respect: Treat everyone with honesty, kindness, and respect.
  • Inclusivity: Ensure that the space is welcoming to people of all backgrounds, abilities, and identities. Avoid behaviors or language that could exclude or marginalize others.
  • Consent: Always ask for and respect personal boundaries. Obtain consent before touching people or their things, taking photos or filming, or sharing personal information with third parties.
  • Non-Violence: Maintain a peaceful and non-violent environment. Physical aggression, threats, or any form of violence is prohibited.

Other common agreements include:

  • Confidentiality: Respect the privacy of others. What is shared in the space, and whether you met or have seen each other at the site, is private.
  • Conflict Resolution: We address conflicts calmly and respectfully. Try to resolve things peacefully or seek help from a staff member.
  • Community Care: We look out for one another here. We all belong here and we’re all responsible for the space/service. Please clean up after yourself, keep music down, and take care of one another.
  • Accessibility: Please keep aisles and walkways clear, refrain from using heavy scents, tie up your dog or bike, and only take up one seat at a time to ensure enough for everyone.

Many programs find the need to add specialized agreements over time as situations arise. As one valued harm reduction leader quipped, “but they surprise you. I never would’ve thought I needed a rule about not having your genitals out in the drop-in, but here we are.”

Harm reduction leaders also suggested involving participants or at least Community Advisory Boards in making choices for the community agreements as well as periodically reviewing those agreements with those same bodies in order to ensure participant buy-in for these important community standards.

Hacks for Service and Supply Interruptions

Written by Nigel Brunsdon on . Posted in Essential Policies and Procedures for All Harm Reduction Sites and Services.

As with exceptions, supply interruptions can be handled with the same transparency and communication. Be explicit with people about why the interruption is happening and tell them when it might be over. Be sure to remain equivocal if you aren’t sure about things. Authentic ambiguity is preferable to disingenuous certainty.

Most of the people who utilize harm reduction services understand scarcity very well, so they will not be surprised if there are interruptions to getting what they need because your agency or group is struggling. Saying “we’re broke” is something that most of your participants will understand viscerally.

Leaders say one of the worst things you can do in such situations is try and stonewall. Instead, be open, even if you don’t know. In fact, that authenticity will grow your credibility with the folks you serve.

Hacks for Service and Supply Exceptions

Written by Nigel Brunsdon on . Posted in Essential Policies and Procedures for All Harm Reduction Sites and Services.

There are always going to be exceptions to the rule of thumb about consistency regarding service provision. At times, certain participants will need to be treated differently than other participants. For example, people who are pregnant may be treated differently, elderly people may be treated differently, people who are providing satellite exchange services to large community groups may also be an exception or have special privileges.

As with a lot of things regarding preventing misunderstandings and escalated situations in harm reduction service sites, the most important thing with exceptions is transparency and communication. For example, people can understand why whole categories of folks (e.g. people with HIV, elderly people, youth, people who just got out of jail, etc.) may receive special assistance or care, but will resent it if they feel it is unfair or favoritism.

Leaders say as long as you can be explicit with people about why exceptions are being made and what they mean, people are generally rational and can accept them. As for the few who cannot, long-term harm reduction leaders advise that they probably would have erupted about something else anyway.

Finally, when and if people on your team do transgress boundaries or play favorites, DO NOT brush it off as “no big deal”. Harm reduction leaders warned that the conflicts most likely to result in violence are those around supply and services. As such, take these incidents—even if nothing occurs as an immediate consequence—very seriously when training and talking to staff.

Hacks for Service and Supply Management

Written by Nigel Brunsdon on . Posted in Essential Policies and Procedures for All Harm Reduction Sites and Services.

Many of the harm reduction leaders that were interviewed for Space Hacks talked about how critical it is to effectively manage services, supplies, and inventory in order to maintain community tranquility. It may not feel intuitive, but OGs report that ineffective management of supplies is the number one potential flashpoint for escalated situations during harm reduction services. Some general tips for all service and supply management are to:

  • ALWAYS be scrupulously fair with your distribution of supplies. There is nothing more likely to cause conflict than your participants feeling like they’ve been treated unfairly.
  • Be consistent in how supplies are distributed and managed across team members and locations.
  • If applicable, have folks form lines and find ways to ensure that it is respected.
  • Ensure cross-team communication and that everyone is committed to the same policies and expectations.
  • NEVER make exceptions to boundaries without transparent, explicable parameters.
  • Be a steady regular presence in the community—show up, and if you can’t, communicate why.
  • Be transparent about your services and supplies—what is available and what isn’t.
  • Explain yourselves—let participants know why you provide certain supplies, services or services a certain way. People are always more likely to follow rules or expectations if they understand why it is important.

Misconduct Prevention Hacks

Written by Nigel Brunsdon on . Posted in Hacks for Policy Violation Prevention.

When talking about misconduct, which includes violence, threats of violence, theft, vandalism, or otherwise harmful, antisocial or even criminal acts in harm reduction organizations, it’s important to view them from a slightly different lens than is typical.

In traditional organizations that are solely based on traditional models of power, it’s common for there to be serious concern with “security”. Harm reduction leaders see this as somewhat misguided. Many reported seeing some criminality as inevitable when working with desperate people who may not be completely in touch with reality.

Given that reality, rather than be angry or even surprised with people they serve when they behave in expected ways, harm reduction leaders prepare for that kind of behavior and respond appropriately without a lot of personalization or reactivity. OGs shared that personalizing the actions of desperate individuals is detrimental to one’s own mental health and should be avoided.

At the same time, there are practical steps that many harm reduction leaders recommend for preventing misconduct:

  • Respect and Fairness—As discussed in the section on Big H, Big R Harm Reduction, treating people with respect, dignity, and fairness is the most important thing you can do to prevent policy violations.
  • Furniture—OGs recommend that furniture, while comfortable, should also be either very light, or very heavy and difficult to pick up. Outdoors, this may mean using light plastic furnishings, which have the benefit of also being easier to transport. Another alternative would be furniture that is bolted in place; Most harm reduction leaders do not recommend this as it is reminiscent of institutional settings.
  • Locks & Doors—With regard to locks and doors, there is more information in the section on bathrooms and showers, but any spaces where participants might go for privacy must be accessible (i.e., able to be unlocked) from the outside due to potential medical emergency or injury concerns. If possible, all doors should be securable and all doors should be accessible from the outside in case of emergency. Keyed locks are fine although, as a practical matter, electronic locks can be more convenient for organizations to manage.
  • Alarms & Cameras—It’s important to have alarms and security cameras in place at fixed-site locations, especially ones pointed towards the outside that cover any areas where there are storage facilities or vehicles. Cameras should never be placed inside private areas like bathrooms or counseling rooms. Cameras can be placed throughout your harm reduction space. To increase community credibility, OGs recommend being transparent, with signage about where and why you have cameras.

Misconduct: A Word About Words

Written by Nigel Brunsdon on . Posted in Hacks for Policy Violation Prevention.

It is challenging to describe behavior that may be outside of social norms, unethical, or dangerous without entirely stigmatizing the person doing the behavior. The very language itself is designed to describe these behaviors entirely in moral terms. Simplistic reductionism does very little to describe behavior that is often not planned nor intentional, and may be based entirely on desperation, ignorance, or mental health issues which may be beyond the control of the person engaged in the behavior.

For example, while it may be true that someone stealing is simply greedy or malicious, they may instead, or also be, desperate, honestly confused, compelled by forces you cannot perceive, or even, as one OG pointed out about one of their former participants, using a coping mechanism that isn’t working in the setting they are now in.

Language, as discussed previously, shapes perception. When challenging behavior is only spoken about in a moral binary, it becomes difficult to humanize the actor and create a plan for restoration that is  consistent with an individual’s unique behavior or circumstances, a cornerstone of restorative and transformative justice. As a consequence, we struggled for a long time with what language to use to describe this kind of behavior and decided that “policy violations” or “misconduct” were the most neutral words to accurately describe these kinds of behaviors.

Universal Precautions: For Droplet or Airborne Pathogens

Written by Nigel Brunsdon on . Posted in Hacks for Accident Prevention in Harm Reduction Services & Spaces.

During air- or droplet-borne disease outbreaks such as COVID, harm reduction staff or volunteers are required to follow all normal universal precautions and wipe down all surfaces used by more than one person, including pens, clipboards, chairs, desks, cabinet fronts, floors, doors, steering wheels, and so on, at the beginning and end of each shift with a broad spectrum anti-microbial surface cleaner.

Masks, Goggles, and Attire for Droplet or Airborne Pathogens

During an outbreak of air- or droplet-borne disease, harm reduction workers are required to wear N95 masks during harm reduction shifts, and cloth or other masks at most other times. In addition, harm reduction workers may also be required to wear goggles during harm reduction shifts and, under unique circumstances, harm reduction workers may also be required to wear paper gowns or lab coats to protect themselves.