3.6 Harm Reduction Housing Models (Respress)
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Harm reduction strategies can be very effective for housing people with substance use disorders. This workshop will explore practices that help ensure successful implementation of harm reduction housing models.
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3.6 Harm Reduction Housing Models (Respress)
- 1. Harm Reduction Housing ModelsNational Alliance to End HomelessnessJuly 12-14, 2010Washington, DC Christy Respress, MSW Pathways to Housing DC 1
- 3. Experiencing chronic/long term homelessness
- 4. Co-occurring substance use disorders- at least 80%
- 6. Histories of trauma and violence
- 7. Lack of hope
- 8. Various stages of readiness to make change, with the majority entering with ambivalence2
- 10. PSH program serving 105 people w/ intensive case management and scattered site apartments
- 11. Outreach Team
- 12. Community Support- 40 served
- 14. Housing First Program Practice Immediate access to permanent, independent housing No requirement for sobriety or treatment Harm reduction approach to services Program participant sets service priorities (e.g., job, family connection, addictions Tx, psychiatric Tx, etc.) Follow standard lease obligations Need to visit in home at least 1x per month 4
- 16. Recovery is a process and looks different for each person
- 17. People still need support while they’re using!
- 18. Need a framework for delivering services while person engaging in harmful activities/behaviors, actively using drugs/alcohol, or disengaged from psychiatric/medical treatment- harm reduction5
- 19. Definitions of Harm Reduction Harm reduction is a set of practical strategies that reduce negative consequences of drug use, incorporating a spectrum of strategies from safer use, to managed use to abstinence. Harm reduction strategies meet drug users "where they're at," addressing conditions of use along with the use itself. (Harm Reduction Coalition) Harm Reduction is a set of non-judgmental strategies and approaches which aim to provide and/or enhance skills, knowledge, resources and support that people need to live safer, healthier lives. (Streetworks, 1997). 6
- 21. Principles of harm reduction support Stages of Change- Prochaska & DiClemente
- 22. Most needed in early stages of precontemplation and contemplation
- 23. Harm reduction doesn’t mean we encourage people in their use- still want folks to stop using!7
- 24. What Does Harm Reduction look like at PTHDC? Addictions Psychiatric Medical 8
- 25. Practicing harm reduction allows us to continue to provide high quality, compassionate services to people still engaged in harmful behaviors. This model doesn’t discriminate against persons with disease of addiction. Who needs to change? We do. Requires most staff members to approach the work in a new way. 9
- 27. HUD looking for outcomes such as retention for these “hardest to serve” populations- requires a paradigm shift in how we provide services.
- 28. Reeducate staff so that they can keep their jobs in this new way of doing things.
- 29. Ex: DC’s shift 10
- 30. Contact Info Christy Respress, MSW (202) 529-2972crespress@pathwaysdc.orgwww.pathwaystohousing.org 11
Notas do Editor
- t/a choice being at the center of program design and decision making.
- My conversion to HF. Original fear was that we would throw people into housing w/ no services. If we are going to engage/treat this group of individuals, we need to structure our services to make them attractive/inviting
- Common examples of harm reduction: seat belt laws, condom distribution (in our office everywhere), needle exchange, methadone
- Some people think that by practicing harm reduction we’re encouraging more use. Ex. Of HUD folks and reduced $ on ETOH once inside.James- nobody wanted to put him in their housing program. Mumbling, feces, drinking heavily. Would have died on street. First apt. a mess in two days. Tried it again. Different services in place. Still drinking- not much! Smiling, well dressed, engaged in groups, looking for a girlfriend, etc.Edward: nobody wanted him in housing, and he didn’t want to go! If we required insight- still on street. Apt. signs on door, food cans, suspicions, now health issues. Wouldn’t have been able to treat any of this if didn’t allow to come into program in first place.
- Addiction- Keith- budgeting for drinking, smoking, letting people in. make sure eating, in group, monitor $, involve family, intense medical servicesPsychiatric- Anthony- young, Dx w/ schizophrenia. Hates how meds make him feel. Negotiate w/ doctor. Taking apart apt. Walking in traffic.Medical- Agnes. 70 y.o Drinking, open wounds on legs, heart problems, daily wound care. Buying ETOH while shoppingStaff struggles w/ these decisions daily. Teamwork is essential- decisions not made independently
- Need to understand in the hiring process. Ex. Of Liz as the Addictions Specialist. Open to new idea, but uncomfortable at first. Now she loves it b/c it allows her to do what was instinctual all along, and to continue to work w/ those most in need of her services.
- Ex. Of how PTHDC started. Nobody else doing HF. Took partnership w/ community members, but original champion was DMH. Hard to get referrals b/c new way of doing housing. Now the whole community has taken it on.