WEBVTT

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A slide appears titled “Harm Reduction in Community Mental Health Settings.” The on-screen text reads: “Zachary Scott, M.Ed., LPC, LAC, NCC, Manager of Outpatient SUD Services, Jefferson Center,” followed by the date “1/25/2024.” Additional text states: “Created in conjunction with Substance Abuse and Mental Health Services Administration (SAMHSA) Harm Reduction Framework, 2022.”

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A slide appears titled “What brings you here?” The on-screen text lists three bullet points: “Why are you interested in harm reduction?” “What do you hope to gain from this training?” and “How can this help you in your daily life?”

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A slide appears titled “Goals for Today.” The on-screen text is divided into two sections. The first section, “Establish community for harm reduction at JCMH,” includes two bullet points: “Create synergy for this movement” and “Network of advocacy is integral to harm reduction.” The second section, “Basic understanding of Harm Reduction core pillars and core practice,” includes four bullet points: “SAMSHA harm reduction framework intro,” “What does harm reduction mean?” “What skills and ideas can I leave with here today for my role?” and “Space for all ideas/thoughts.”

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A slide appears titled “What does it mean?” The on-screen text reads: “A practical and transformative approach that incorporates community-driven public health strategies – including prevention, risk reduction, and health promotion – to empower PWUD and their families with the choice to live healthy, self-directed, and purpose filled lives. Harm reduction centers the lived and living experience of PWUD, especially those in underserved communities, in these strategies and the practices that flow from them. (SAMHSA Harm Reduction Framework, 2022).”

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A slide appears titled “Harm Reduction Milestones.” The on-screen text presents a timeline with six sections: “Onset of War on Drugs – 1971,” with text stating that President Nixon established the onset of the “War on Drugs” near the end of the Vietnam War and began punitive policy toward drug users; “CDC Discovers IV Drug Use Link to HIV – 1982,” noting CDC findings that HIV is transmissible through IV drug use and that PWUD and social groups began distributing clean needles and providing education; “AIDS Epidemic – 1982–1992,” describing how incompetence and willful neglect for LGBTQIA+ individuals led to the development of community resources for harm reduction; “First Harm Reduction Work Group – 1992,” noting that the group met in San Francisco to create a unified definition of harm reduction and establish the Harm Reduction Coalition; “Advent of Naloxone Distribution – 1996,” stating that naloxone distribution began and that more than 700,000 doses were distributed in 2019; and “Official Federal Policy (finally!) – 2021,” stating that SAMHSA convened the first ever Harm Reduction Over 100 experts representing prevention, treatment, recovery and peer work.

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A slide appears titled “Reality vs. Perception.” The on-screen text lists: “Harm reduction as a ‘political issue’,” “Ideology reduces service effectiveness and damages access to care,” “This is not about ‘you’; it is about helping people,” “Emotional topic,” and “Our professional duty is to provide resources/services without judgement.”

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A slide appears titled “Why Harm Reduction?” The on-screen text is divided into three sections. Under “Innovative strategy responding to decades of failure,” the bullet points read: “106,000 deaths in 2021 in United States,” “National public policy has not worked,” “Health inequity,” and “Prison pipeline / drug war fallout.” Under “Public Health Approach,” the bullet points read: “MAT treatments,” “Disease model,” and “Public health crisis.” Under “Peer led,” the bullet points read: “Guided by people who use drugs (PWUD) and with lived experience,” “Non-punitive approach,” and “Autonomous blueprint to recovery.”

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A slide appears titled “Harm Reduction and Recovery – Can they co-exist?” The on-screen text lists the following points: “This is not a clash of ideas – harm reduction connects seamlessly with our JCMH values and the vast majority of therapeutic interventions.” “Harm reduction is not ‘replacing’ abstinence and traditional recovery for those who want to take that path.” “Harm reduction practices are a piece of the repair work going on in the mental health field for decades of unfair treatment.” “Majority of negative opinions of harm reduction in recovery community comes from misunderstanding.” “It takes a village to provide a roadmap to recovery – this is just another set of positive interventions.” “12-step models continue to provide support and positive communities – peer led support comes from this model.” “Harm reduction interventions are proven to result in higher likelihood to engage in recovery services.” “Autonomy and recovery go hand-in-hand!”

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A slide appears titled “Addressing Health Inequities.” The on-screen text lists: “Harm reduction acknowledges the intended and unintended impacts of past health policies, programs and procedures that have adversely impacted people of color, indigenous peoples, members of religious minorities, LGBTQIA+ individuals, persons with disabilities, persons who live in rural areas and persons otherwise impacted by persistent poverty or inequality.” “Substance use, substance use disorder and mental illness can find roots in structural inequity and are influenced by the social determinates of health.” “Community practitioners and behavioral health providers must be culturally responsive and attentive to healthy equity.” “Community trust and buy-in must be earned and that begins with truth and reconciliation of a community’s shared traumatic history and structural racism that perpetuates inequities.”

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A slide appears titled “SAMHSA Harm Reduction Framework.” The on-screen text lists: “Biden–Harris Administration has identified harm reduction as a federal drug policy priority.” “In the 2022 National Drug Control Strategy, harm reduction is described as ‘a public health approach designed to advance policies and programs for PWUD and is supported by decades of evidence.’” “Reduce HIV and Hep-C infection, reduce overdose risk, enhance public health and safety, increase by 5x the likelihood of a person who injects drugs to initiate SUD treatment.” “Harm reduction has been identified as one of four strategic priorities by the HHS Overdose Prevention Strategy pillars. (Prevention, Evidence Based Treatment, Harm Reduction, Recovery Support, HHS).” “First ever federal document to outline harm reduction as official policy of HHS.” “Made up of 6 Pillars, 12 Supporting Principles and 6 Core Practice Areas.”

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A slide appears titled “Six Pillars of Harm Reduction.” The on-screen text lists: “Created to drive conversation and establish initial points of reference for harm reduction providers.” “Connects to the Twelve Principles and Six Core Practice Areas.” “Reframing Harm Reduction as a wide breadth of services with roots in motivational interviewing, unconditional positive regard, and interventions applicable in a wide variety of clinical settings.” “Can be practiced within organization that does not primarily provide harm reduction services (i.e. case manager or therapist at JCMH vs. Denver Health Harm Reduction team).” “Use pillars as a blueprint to engage with PWUD and their families.”

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A slide appears titled “Pillar One: PWUD / Lived Experience Guided Process.” The on-screen text lists: “All aspects guided by those with lived experience.” “Should include formal mechanism (role) to meaningfully include voices of PWUD.” “System of shared decision making.” “Inclusion of PWUD into fold – active users,” followed by two sub-bullets: “What helps and what does not help” and “People who are actively using have unique insight into problems on the ground.”

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A slide appears titled “Pillar Two: Embraces the Inherent Value of People.” The on-screen text lists: “All individuals have inherent value and are treated with dignity, respect and positive regard.” “Trauma informed services.” “Never patronize or pathologize PWUD, nor their communities.” “Acknowledgement of realities of substance abuse and nuanced and complex reasons for use.”

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A slide appears titled “Pillar Three: Community Engagement.” The on-screen text lists: “Must engage with communities impacted by systemic harms.” “Funding agencies and programs that sustain cultural practices and value community wisdom.” “Community led initiatives with geographically specific, culturally based models.” “Each community given autonomy to improve their environment.”

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A slide appears titled “Pillar Four: Equity and Social Justice.” The on-screen text lists: “All aspects of work incorporate an awareness of race, class, language, sexual orientation and gender-based power differentials.” “Pro-health and pro-social practices aligned with the organization and mobilization of direct services.” “Acknowledgement of past harm and discrepancy in services of minority groups.”

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A slide appears titled “Pillar Five: Lowest Barrier Access and non-coercive support.” The on-screen text lists: “Lowest possible requirements for access.” “Non-punitive and non-judgmental.” “Participation in services is always voluntary, confidential, self-directed, and free from threats, force, and the concept of compliance.” “Data collection of any kind requires informed consent.”

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A slide appears titled “Pillar Six: Positive Change as Defined by Person.” The on-screen text lists: “Driven by person-centered positive change in the individual’s quality of life.” “Positive change can be defined by moving towards more connectedness to the community, family, and a more healthful state, as the individual defines it.” “Many pathways to wellness including full abstinence and non-abstinence.”

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A slide appears titled “Supporting Principles.” The on-screen text reads: “The 12 core principles reinforce the pillars and provide more structure and guidance to the framework.” “Are used as supplemental elements that connect to the pillars.” “Many of these should be familiar to clinicians and mental health workers.”

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A slide appears showing a table of supporting principles. The on-screen text includes four sections:

Promote safety: “Harm reduction initiatives, programs, and services actively promote safety as defined by PWUD, families, and communities.” The bullet points listed are: “Is guided by people who use drugs (PWUD) and with lived experience of drug use,” “Commits to deep community engagement and community building,” and “Focuses on any positive change, as defined by the person.”

Engage first: “Each community has different cultural strengths, resources, challenges, and needs. Harm reduction initiatives, programs, and services are grounded in the most impacted and marginalized communities. It is important to bring to the table as many individuals and organizations as possible who understand harm reduction and who have meaningful relationships with the affected communities.” The bullet points listed are: “Is guided by people who use drugs (PWUD) and with lived experience of drug use,” “Commits to deep community engagement and community building,” “Promotes equity, rights, and reparative social justice,” and “Focuses on any positive change, as defined by the person.”

Prioritize listening: “Each community has its own unique story that can be the foundation for harm reduction work. When we listen deeply, we learn what matters. Harm reductionists engage in active listening — the act of inviting people to express themselves completely, without any preconceived notions, with the intent to fully absorb and process what they are saying.” The bullet points listed are: “Is guided by people who use drugs (PWUD) and with lived experience of drug use,” “Embraces the inherent value of people,” “Commits to deep community engagement and community building,” and “Focuses on any positive change, as defined by the person.”

Work toward systems change: “Harm reduction initiatives, programs, and services recognize that trauma, social determinants of health, inequitable policies, and inadequate healthcare, housing, employment, and social support have all had a responsibility in systemic harm.” The bullet points listed are: “Embraces the inherent value of people,” “Commits to deep community engagement and community building,” and “Promotes equity, rights, and reparative social justice.”

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A slide appears titled “Core Practice Areas.” The on-screen text reads: “Six core practice areas that make up the Harm Reduction Framework.” “Some of these may be applicable in your role, some not.” “Awareness of resources is key no matter your role or the agency you work for.” “This is the ‘meat’ of the framework, i.e. the interventions that need to be implemented.”

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A slide appears titled “Safer Practices: Education and Support on Safe Use.” The on-screen text lists: “Syringe Service Programs,” “Safe Smoking Supplies,” “Overdose education and naloxone distribution,” “Test strips,” and “Reproductive health education, services and supplies.”

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A slide appears titled “Safer Settings: Access to Safe Environment.” The on-screen text lists: “Access to Day Centers and Social Spaces,” “Access to safe housing,” “Public health programs as alternative to arrest,” and “General reduction of stigma across society.”

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A slide appears titled “Safer Access to Healthcare: Ensuring access to person-centered healthcare.” The on-screen text lists: “Low barrier opioid treatment services,” “Providers informed of harm reduction principles,” “Non-punitive healthcare,” “Mobile and take-home MAT services,” and “Access to care for specific drugs of abuse (opioids, stimulants, alcohol).”

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A slide appears titled “Conclusion.” The on-screen text lists: “Multi-disciplinary approach,” “Does not dissuade abstinence,” “Provides a client-directed definition of sobriety,” “Use this as a guidebook for implementing harm reduction interventions,” “Can be combined with 12-step and traditional recovery strategies,” “Full toolbelt of interventions and approaches is necessary,” and “Every person in addiction is different – every ‘recovery’ will be different.”

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A slide appears titled “Resources.” The on-screen text lists multiple citations under the header “SAMHSA Harm Reduction Framework,” including references to research articles, national reports, SAMHSA behavioral health resources, the National Drug Control Policy, and publications on overdose education, naloxone distribution, harm reduction history, and community engagement.