2017 Presenters Sarah Chess Connecticut Coalition to End Homelessness Shawn Lang AIDSCT Christie Corrigan Hartford No Freeze Shelter House Keeping Because this is a webinar attendees are muted ID: 646866
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Slide1
Harm Reduction
June 13,
2017Slide2
Presenters
Sarah ChessConnecticut Coalition to End HomelessnessShawn Lang
AIDS-CT
Christie Corrigan
Hartford No Freeze ShelterSlide3
House Keeping
Because this is a webinar, attendees are muted
Please type any questions you have into the Questions or Chat Box
We are recording this webinar
and will send out the link to everyone who registered later
todaySlide4
Housing First,
Harm Reduction and Overdose ResponseSlide5
Housing First
Housing First is simple: Provide housing first, and then combine that housing with supportive services in mental and physical health, substance use, education, and employment.Pathways to Housing
founded in
1992
, with the creation of the Housing First model to address homelessness among people with psychiatric disabilities and addiction
disorders.Slide6
Housing First
Housing is provided in apartments scattered throughout a community. This scattered site model fosters a sense of home and self-determination, and it helps speed the reintegration of clients into the community.Housing retention rates have remained at 85 – 90 percent
even among individuals who have not succeeded in other programs
.
Housing First is cost-effective
. Providing homes and support
services costs less than the expensive cycling through of emergency rooms, shelters, jails, and psychiatric hospitals.Slide7
Housing First
Housing First fits perfectly into a Harm Reduction Model.Slide8
Guiding Principles
Low threshold admissions policyHarm reduction based policies & practicesSeparation of housing and servicesReduced service requirementsEviction
prevention program access
Consumer
education
Staff training and supportSlide9
Definitions
Addiction/dependence - is a diseaseInitial decision to try a substance is voluntary.Increased tolerance for the drug, may result in the need for greater amounts of the substance to achieve the intended effect. May become obsessed
with securing the drug and with its
use
Persistence in using the drug in the face of serious
physical, psychological and legal problems.
“Addiction is the only disease where we put people in jail instead of treatment.”Slide10
Definitions
Drug Use - a broad term to cover the taking of all psychoactive substances within which there are stages: non-use, experimental use, recreational use and harmful useDrug Misuse - “... any taking of a drug which harms or threatens to harm the physical or mental health or social well-being of an individual or other individuals or society at large, or which is illegal.”Substance use disorder(s) - (the most severe form of which is referred to as “addiction”) is a chronic brain disorder from which people can and do recoverSlide11
Harm ReductionSlide12
Harm Reduction
Harm Reduction is a perspective and a set of practical strategies to reduce the negative consequences of drug use, incorporating a spectrum of strategies from safer use to abstinence.Slide13
Examples of HR Based P&P
Harm Reduction approach and staff has a strong conceptual understanding.Program only terminates consumers who demonstrate violence, threats of violence, or excessive non
payment
of
rent
.
Program provides or requires ongoing training in harm reduction and crisis intervention for staff.Program doesn’t terminate clients for alcohol/drug use or alcohol/drugs in units.Slide14
Harm Reduction
Drug use exists along a continuum Abstinence is one of many possible goals Meet people “where they are at
”
Drug-related harm can not be assumed
Drugs can meet important needs
Drug users are more than their drug useSlide15
Harm Reduction
Harm reduction recognizes that the realities of poverty, class, racism, social isolation, past trauma, sex-based discrimination and other social inequalities affect vulnerability to, and capacity for, effectively dealing with drug-related harm.It does not attempt to minimize the real dangers associated with licit and illicit drug use, and how those issues impact lives.
Understands that relapse is not a sign of failure.Slide16
Harm Reduction
Designs & promotes public health interventions that minimize the harmful affects of drug use.Understands
use
as a complex, multi-faceted issue that encompasses behaviors from severe abuse to total abstinence
.
Focuses on behavior
– especially when related to housing, employment, parenting, and other relationships.Slide17
Harm Reduction – Efficacy and Outcomes
Syringe access programs are the most effective, evidence-based HIV/Hep
C
prevention tool for people who inject drugs
.
In cities across the nation, people who inject drugs have reversed the course of the HIV epidemic by using sterile syringes and harm reduction practices
.Syringe service programs are low threshold, and often the only contact that drug users have with providers.
SSPs provide in person contact for assessments, and referrals.Slide18
Challenges
Harm Reduction Housing is complex.Not all Harm Reduction Housing programs look the same.Barriers to full implementation are okay, but: It is important that they are recognized.
Strategies should be developed to work within limitations.Slide19
What Recovery Looks LikeSlide20
Language and Stigma
Person-first language and accurate health terminology.Avoid language that can be stigmatizing or inaccurate.We refer to individuals as people with a substance use disorder, instead of “addicts
.
”
We
would describe
individuals as abstinent rather than “clean.” We refer to methadone, vivitrol and buprenorphine/suboxone as medications rather than “drugs.”Slide21
Opioid Overdose
Identification and ResponseSlide22
Harm Reduction and Overdose Prevention
Overdose deaths can be prevented and lives saved.Laypeople and family members can prevent overdose deaths.Conversations about overdose prevention and reversal provide another way for providers and clients to connect and develop rapport.
Conveys that users’ lives are worth saving, gives hope.
PEPFAR, the UN, American Medical Association, the US Attorney General, and the New England Governors all view
Narcan
for overdose to be an
essential part of the treatment of drug users.Slide23
Opioids
Examples – Heroin, Oxycodone, Percocet, Fentanyl, Morphine, Codeine, Tramadol, Vicodin.Of the 20.5 million Americans 12 or older that had a substance use disorder in 2015, 2 million had a substance use disorder involving prescription pain relievers and 591,000 had a substance use disorder involving heroin.
It
is estimated that 23% of individuals who use heroin develop opioid addiction
.
The
National Institute on Drug Abuse (NIDA) reports that the relapse rate for drug addiction is 40 to 60 percent. In 2012, 259 million prescriptions were written for opioids, which is more than enough to give every American adult their own bottle of pills4 out of 5 new Heroin users began with prescription opiates.It’s the leading cause of accidental death in the US.Slide24
Overdose Facts in CT
From 2009-2015 there have been over 2,500 accidental/undetermined opiate overdose deaths.152 of 169 CT towns and cities experienced at least one opioid related death during this time period.Benzodiazepines were identified in 42%, and alcohol in 28%.
70% male, 84% white, mean age of 40 years, 70% pharmaceutical opioid involved, 82% occurred in a residence, increase in heroin between 2012- 14.
44% had some history with the Department of Corrections.Slide25Slide26
Overdose Risk Assessment
Previous overdoseUsing aloneRecent release from prison or treatment or other period of abstinence.Mixing: opioids, especially in combination with benzodiazepines and alcohol.
Quality
of drugs can be
unpredictable.
Administration
– injection, increased use.Other health issues (asthma, liver and heart disease, HIV/AIDS, malnourishment, age).Slide27
Signs/Symptoms of an OD
UnresponsiveConstricted pupils
Breathing is very slow, irregular, or stopped
Pulse (heartbeat) is slow, erratic, or not there
Blue skin tinge- usually lips and fingertips
Body very limp
Face very pale, clammy
VomitingPassing out
Choking sounds or a gurgling/snoring noiseSlide28
OD Response Myths
Salt Water
Ice on Body
Cold Shower
Cocaine
Milk
Burning SkinPunching
SlappingSlide29
Narcan and Opiate OD PreventionSlide30
Forms of Narcan/NarcanSlide31
Narcan/Naloxone
Opioid Antagonist.Store @ 77 degrees (no extreme highs/lows)
Medication that
only reverses an OPIOID overdose
.
Cannot get high on it.
Little to no adverse effects.Stays active for 20-90 minutes depending on metabolism, amount of drug used, quality of drug used.Slide32
Overdose Response
Rub your knuckles on the bony part of the chest (sternum) to try to get them to wake up and breathe.
Call
911.
All you need to say is:
The address and where to find the personA person is not breathing
When medics come, tell them what drugs the person took if you knowTell them if you gave NarcanSlide33
Overdose Response
The AHA now recommends hands-only resuscitation for those untrained in standard CPR.A number of studies have shown that hands-only resuscitation is as effective or more effective in sudden cardiac arrest than standard methods (chest compressions with mouth-to-mouth ventilation).How to Give Hands-Only CPR. If you see a teen or adult suddenly collapse, call 911 and push hard and fast in the center of the chest to the beat of any tune that is 100 to 120 beats per minute. Immediate CPR can double or even triple a person's chance of survival
.
http
://cpr.heart.org/AHAECC/CPRAndECC/Programs/HandsOnlyCPR/UCM_473196_Hands-Only-CPR.jspSlide34
Overdose Response
Intranasal1. Remove small purple and yellow caps from Narcan vial and injector2. Attached vial to injector using three half turns or until stopper is pierced by needle **Do not push vial into injector**
3. Remove large yellow cover from injector
4. Make sure there are no air bubbles in injector
5. Twist plastic side of nasal atomizer onto injector
6. Insert side with white foam tip into person’s nostril
7. Push half of Narcan out of injector into person’s nostril, then push remaining half into the other nostril8. Administer a second dose of Narcan if person is not responsive after 3-5 minutes.Slide35
Overdose ResponseSlide36
Liability
“Any person, other than a licensed health professional acting in the ordinary course of such person’s employment, who administers an opioid antagonist in accordance with this subsection shall not be liable for damages in a civil action or subject to criminal prosecution with resect to the administration of such opioid antagonist.”Slide37
Overdose Response
W
hat if police show up?
The CT
Good Samaritan Drug Overdose Law lets bystanders give Narcan if they suspect an overdose.
The law protects the victim and the helpers from prosecution for drug possession. The police can confiscate drugs and prosecute persons who have outstanding warrants.Slide38
Who Should Have Narcan?
It should be in every medicine chest, first aid kit, school nurse’s office, and alongside AEDs in malls, airports and other public places.Anyone completing released from incarceration,
opioid detoxification
, treatment or who has been abstinent for a period of time.
People with
prescription opiates for medical conditions.Any programs working with staff or clients, or family members who fit these descriptions.Slide39
Where can I get Narcan?
Prescription from your medical providerCertified pharmacistsOrder from manufacturers http://prescribetoprevent.org/wp2015/wp-content/uploads/Naloxone-ordering-information-only.16_01_21.pdf Slide40
Applying Harm Reduction to shelter services: Opening doors and breaking down barriersSlide41
Harm Reduction applies to any behavior that is resulting in a negative consequence
(Not just substance use)In applying this to a shelter model the potential harm is that individuals would not be able to access shelter or be “kicked out” due to certain behaviorsSome behaviors that could result in this harm are related to substance use but others stem from things such as:
Domestic violence
Physical health (this can include malnutrition and exhaustion)
Behavioral health
Trauma
Education levelAnd many othersSlide42
Implementing HR at the Hartford No Freeze Shelter: 2017-2018 season
Policy and Procedure reflected Harm Reduction practice regarding shelter access, code of conduct, and suspension.Staff orientation included Harm Reduction philosophyEncouraged to work as a team, “switch out” with another staff if they could not successfully de-escalate a situationThe use of “time outs” for clients to “cool down”
Only asking a client to exit the facility if there was an immediate danger to staff, other clients or the facility with a referral to another shelter if possible
Staff were supported with 24/7 on-call
If client was an immediate danger escort them outside and call emergency personnel if necessary then call Program Manager
If client was not an immediate danger work to de-escalate and reintegrate into shelter and if needed call Program Manager as added supportSlide43
Types of behavior categorized by incidents recorded
Medical issue Intoxication where there is concern for safety of clientIntoxication/overdose where Narcan was administeredIntoxication/overdose where CPR was administration
Disruptive behavior (verbal altercations, threatening verbally, other outburst that were disruptive)
Contraband (possession of weapons, drug paraphernalia, drugs or alcohol)
Drug/alcohol use in building or on property
Indecent exposure or inappropriate physical contact
Physical altercation between clientsVerbal altercation or threatening staff verballyPhysical assault on staffThreatening to tamper w/fire alarmSlide44
Did it work?
551 unduplicated men were served and there were only 40 recorded incidences from December 1, 2016 – March 31, 2017The most common recorded incidents were for medical issues not directly related to substance use and clients returned from the hospital the next dayIn most cases clients were allowed back to the shelter the following day or within 1 weekIn four months we did not suspend/ban any individual for longer than one month (for physically assaulting a staff member)Slide45Slide46
How to have a successful team
Provide the right training:De-escalation and Conflict resolutionMotivational interviewing/stages of changeSafety trainingHarm reduction
Trauma sensitivity
Cultural sensitivity
Narcan training
CPR/First Aid
Watch for signs of vicarious trauma, compassion fatigue, and general staff burnoutProvide support and appreciation to staffSupervision and all staff meetings Highlight successes and strengths Retreats, trainings, speakers on self careSlide47
Questions?
Contact: Mary Ann Haleymhaley@cceh.orgSarah Chessschess3@gmail.com
Shawn M
Lang
slang@aids-ct.org
Yolanda Potter
ypotter@mercyhousingct.org
Christie Corrigan
ChristieCorrigan@hotmail.com