WEBVTT NOTE This file was generated by Descript 00:00:02.046 --> 00:00:03.306 Zachary Scott: My name is Zachary Scott. 00:00:03.556 --> 00:00:08.226 Welcome to the Harm Reduction in Community Mental Health Settings webinar. 00:00:08.776 --> 00:00:11.956 I'm the manager of outpatient substance use services at Jefferson Center. 00:00:13.271 --> 00:00:17.261 I have my LPC, which is Licensed Practicing Counselor, LAC, which is 00:00:17.261 --> 00:00:21.071 Licensed Addiction Counselor and NCC, which is Nationally Certified Counselor. 00:00:21.621 --> 00:00:25.281 This webinar and this training has been created in conjunction with 00:00:25.701 --> 00:00:29.545 the substance use and mental health services administration, also known as 00:00:29.575 --> 00:00:33.164 SAMHSA, their harm reduction framework that recently came out this past year. 00:00:33.839 --> 00:00:38.439 I will be providing the links, to the full framework so that folks can take 00:00:38.439 --> 00:00:43.839 a look later and hopefully follow up on questions or ideas that they might have. 00:00:44.386 --> 00:00:46.596 First a question to those viewing this. 00:00:46.596 --> 00:00:47.556 So what brings you here? 00:00:47.866 --> 00:00:50.799 As we're going through the training today and talking about harm reduction. 00:00:50.889 --> 00:00:53.791 I want people to keep in the back of their minds what brings you here? 00:00:53.791 --> 00:00:55.441 Why are you interested in harm reduction? 00:00:55.871 --> 00:00:58.171 What do you hope to gain from this training? 00:00:58.531 --> 00:01:00.841 What information are you looking for? 00:01:00.901 --> 00:01:05.887 And what further exploration can you do after we wrap up today. 00:01:06.737 --> 00:01:10.143 I also want folks to think how these principles, these 00:01:10.143 --> 00:01:14.223 interventions, this framework, this philosophy of harm reduction, 00:01:14.223 --> 00:01:16.683 can help you in your role in life. 00:01:16.683 --> 00:01:21.303 And it really doesn't matter whether you are in a clinical role, whether you're 00:01:21.413 --> 00:01:24.786 talking with someone from your family or even when you're just interacting 00:01:24.786 --> 00:01:27.470 with other people at work or socially. 00:01:28.240 --> 00:01:32.759 These ideas, as we'll see, are pretty universal in the way that they help 00:01:32.759 --> 00:01:39.981 folks to interact and connect and provide care and insight in a compassionate way. 00:01:40.861 --> 00:01:43.135 Keep those thoughts through your head as we move forward. 00:01:43.505 --> 00:01:46.885 These are gonna be some of the ideas that we're gonna be looking to build 00:01:46.885 --> 00:01:49.045 upon with what we're talking about today. 00:01:50.099 --> 00:01:53.249 Some of the overall goals for what I'm trying to bring to 00:01:53.279 --> 00:01:54.809 this webinar and this training. 00:01:55.289 --> 00:01:58.822 We're trying to establish a community for harm reduction at Jefferson Center 00:01:58.822 --> 00:02:00.468 and in the Jefferson Center communities. 00:02:00.808 --> 00:02:03.928 We're trying to create synergy for this movement. 00:02:03.928 --> 00:02:08.098 We're trying to increase the amount of people who have education 00:02:08.098 --> 00:02:13.045 and who are armed with correct information to try to help implement 00:02:13.045 --> 00:02:14.605 harm reduction interventions. 00:02:14.885 --> 00:02:17.705 Not only here at Jefferson Center, but elsewhere in the community. 00:02:18.495 --> 00:02:20.445 We're trying to create a network, right? 00:02:20.445 --> 00:02:23.995 So this is important within Jefferson Center, but like I said, it's also 00:02:23.995 --> 00:02:28.278 really important for individuals and healthcare providers throughout the 00:02:28.278 --> 00:02:29.749 county and elsewhere in the Denver Metro. 00:02:30.254 --> 00:02:35.144 What we're trying to do is change our approach on substance use 00:02:35.144 --> 00:02:39.314 disorder, and one of the ways that we're doing that is through these 00:02:39.314 --> 00:02:40.874 harm reduction interventions. 00:02:41.234 --> 00:02:44.864 Creating a network of advocates, including professionals and 00:02:44.864 --> 00:02:48.244 non-professionals is gonna be a really important way to do that. 00:02:49.744 --> 00:02:54.414 We're also gonna talk and really establish a basic understanding of the harm 00:02:54.414 --> 00:02:56.484 reduction core pillars and core practice. 00:02:57.144 --> 00:03:01.374 Now when I say core pillars and core practice, as we'll see later, these 00:03:01.374 --> 00:03:06.088 are defined through SAMSHA through their recent framework introduction. 00:03:07.076 --> 00:03:09.026 We're gonna talk about what does harm reduction mean? 00:03:09.396 --> 00:03:13.626 We know that in today's climate we see the phrase harm reduction thrown 00:03:13.626 --> 00:03:17.976 around a lot, in a lot of different contexts, in a lot of different areas. 00:03:18.696 --> 00:03:23.196 We wanna establish a definition today that applies to harm reduction 00:03:23.196 --> 00:03:24.276 in community mental health. 00:03:25.206 --> 00:03:29.166 That can help not only clinicians, but also people who support 00:03:29.166 --> 00:03:30.310 these ideas in our community. 00:03:30.470 --> 00:03:33.691 I want there to be some insight and some reflection on what skills 00:03:33.691 --> 00:03:37.861 and ideas and questions can I leave here today for my role, be it a 00:03:37.861 --> 00:03:40.351 professional role or a role in society. 00:03:40.981 --> 00:03:45.751 What can I take from today's information to further help the people that 00:03:45.751 --> 00:03:46.981 we're trying to connect with, right? 00:03:46.981 --> 00:03:50.271 The most vulnerable in our society that are struggling with addiction. 00:03:51.516 --> 00:03:55.746 There's a lot of different thoughts on harm reduction that we'll touch on today. 00:03:56.616 --> 00:04:01.206 We're gonna try to dial down a definition, but also remember too, that in a broad 00:04:01.206 --> 00:04:05.033 idea like this, that involves a lot of interventions and a lot of different 00:04:05.033 --> 00:04:10.593 healthcare platforms, there's gonna be a difference in opinion, and that's okay. 00:04:10.723 --> 00:04:11.188 We welcome that. 00:04:12.168 --> 00:04:15.588 Having this conversation and having this insight and information is gonna be the 00:04:15.588 --> 00:04:17.168 first step to helping our community. 00:04:18.134 --> 00:04:20.624 All right, so let's establish a definition. 00:04:20.724 --> 00:04:23.844 What does harm reduction in community mental health mean? 00:04:24.704 --> 00:04:29.504 A practical and transformative approach that incorporates community-driven 00:04:29.504 --> 00:04:34.244 public health strategies, including prevention, risk reduction in health 00:04:34.244 --> 00:04:40.634 promotion to empower PWUD, that stands for people who use drugs and their 00:04:40.634 --> 00:04:45.544 families with the choice to live healthy self-directed and purpose-filled lives. 00:04:46.444 --> 00:04:51.544 Harm reduction centers, the lived and living experience of people who use 00:04:51.544 --> 00:04:55.971 drugs, especially those in underserved communities, in these strategies and 00:04:55.971 --> 00:04:57.621 the practices that flow from them. 00:04:58.281 --> 00:05:03.231 Now, that's the definition from SAMSHA, and it's a definition 00:05:03.281 --> 00:05:06.851 that works really well into what we're doing here at the center. 00:05:07.221 --> 00:05:12.911 I wanna highlight a couple key elements in this definition that I think are 00:05:12.911 --> 00:05:15.281 really gonna lead in our discussion today. 00:05:16.371 --> 00:05:17.181 Transformative. 00:05:17.751 --> 00:05:20.751 The big picture that I'd like people to think about when looking at harm reduction 00:05:20.751 --> 00:05:26.066 is we have a big history of failure in this country at many different levels 00:05:26.096 --> 00:05:27.866 in treating substance use disorder. 00:05:28.416 --> 00:05:32.526 This goes back to the drug wars the current drug war and the drug 00:05:32.526 --> 00:05:36.486 war, the 60 seventies, eighties, along with underserved communities, 00:05:36.786 --> 00:05:41.080 minorities, individuals who are vulnerable and get treated differently. 00:05:41.080 --> 00:05:44.263 Transformative means we are really looking to transform and change the 00:05:44.263 --> 00:05:49.143 way that addiction and substance use is treated, especially at the 00:05:49.143 --> 00:05:50.373 community mental health level. 00:05:52.513 --> 00:05:54.333 Another important element here. 00:05:55.143 --> 00:05:57.573 Prevention, risk reduction, health promotion. 00:05:57.573 --> 00:06:00.813 So we'll talk a little bit more about these three as we get into the pillars. 00:06:01.123 --> 00:06:02.583 Really the prevention. 00:06:02.583 --> 00:06:05.943 So we're trying to prevent people from getting into a situation where 00:06:06.393 --> 00:06:07.743 they're using in the first place. 00:06:07.923 --> 00:06:11.568 We're trying to reduce the risk of those who are actively using and 00:06:11.568 --> 00:06:15.223 we're trying to promote the general health of people who use drugs whether 00:06:15.223 --> 00:06:17.603 or not they're currently sober. 00:06:18.668 --> 00:06:22.008 You'll see that phrase, PWUD, people who use drugs. 00:06:22.248 --> 00:06:24.528 This is an effort to destigmatize. 00:06:24.588 --> 00:06:24.828 Right? 00:06:24.828 --> 00:06:28.168 We'll talk a little bit about stigma later too and the negative effect it's 00:06:28.168 --> 00:06:33.198 had on the drug using community and individuals who use drugs in this country. 00:06:33.408 --> 00:06:37.608 We wanna get away from phrases like addict, active addict, junkie, 00:06:37.608 --> 00:06:38.718 obviously, things like that. 00:06:38.938 --> 00:06:42.748 We're moving away from that into language that's respectful and 00:06:42.748 --> 00:06:48.198 language that allows some autonomy and some self-directedness from the 00:06:48.198 --> 00:06:49.428 people that we're trying to serve. 00:06:50.548 --> 00:06:53.008 That phrase, self-directed also super important. 00:06:53.408 --> 00:06:58.798 This is a journey that we are not necessarily acting as the primary guide. 00:06:58.798 --> 00:07:00.178 We're acting as a companion. 00:07:00.538 --> 00:07:04.438 We are trying to help individuals make choices that 00:07:04.498 --> 00:07:06.568 positively affect their lives. 00:07:07.028 --> 00:07:11.318 Whether or not that includes full abstinence is gonna be something 00:07:11.318 --> 00:07:13.418 that they're gonna take control of. 00:07:14.798 --> 00:07:18.278 Harm reduction is a peer led program. 00:07:18.648 --> 00:07:20.058 We'll see that in the definition here. 00:07:20.058 --> 00:07:22.638 Centers, the lived and living experience, people who use drugs. 00:07:22.638 --> 00:07:26.748 So how do we take that experience of not only people who are in 00:07:26.748 --> 00:07:31.363 recovery, but this is the kind of more radical way of looking at this. 00:07:31.413 --> 00:07:33.573 We're trying to connect with people who are currently using. 00:07:33.963 --> 00:07:34.263 Right? 00:07:34.263 --> 00:07:39.598 People who are out on the streets and really experiencing the scourge 00:07:39.618 --> 00:07:43.728 of addiction firsthand and getting insight from them on how we can 00:07:43.728 --> 00:07:47.808 help direct them towards recovery with harm reduction interventions. 00:07:49.008 --> 00:07:56.958 I'll also touch certainly on the concept of underserved communities and equity. 00:07:57.218 --> 00:08:00.843 The drug war and the pipeline to prison. 00:08:01.563 --> 00:08:05.643 For a lot of drug users has disproportionately affected minorities. 00:08:05.673 --> 00:08:10.133 We know this not only from firsthand accounts, but from the numbers. 00:08:10.443 --> 00:08:14.043 We acknowledge that in our harm reduction approach and strategy, 00:08:14.793 --> 00:08:20.943 while at the same time trying to, if we can't fix the past, at least 00:08:21.033 --> 00:08:25.133 offer a way forward for underserved communities and people who might have 00:08:25.133 --> 00:08:27.573 previously been discriminated against. 00:08:28.383 --> 00:08:31.533 That's an important part of the harm reduction approach is acknowledging 00:08:31.533 --> 00:08:36.303 that and using that experience as a guide to move forward. 00:08:37.293 --> 00:08:41.137 A couple quick milestones in terms of harm reduction history so that we can 00:08:41.137 --> 00:08:44.707 get an idea of where this movement and where this idea is coming from. 00:08:45.457 --> 00:08:47.557 Obviously this is not an exhaustive list. 00:08:47.647 --> 00:08:51.917 These are just some big events that have happened in the history of harm 00:08:51.917 --> 00:08:55.162 reduction, the history of substance use treatment disorder in this country. 00:08:55.742 --> 00:08:58.462 As far as the official date of the start of the drug war, this can 00:08:58.462 --> 00:08:59.542 really depend on a lot of things. 00:08:59.542 --> 00:09:04.262 You can look back to Reconstruction South to see the initial, parades of trying 00:09:04.262 --> 00:09:09.972 to use drugs and those who use drugs as a way to pull people down in society. 00:09:10.302 --> 00:09:13.562 For the purposes of what we're doing today we're gonna look at 1971. 00:09:14.147 --> 00:09:17.957 When President Nixon established the onset of the war on drugs near the conclusion 00:09:17.957 --> 00:09:22.907 of the Vietnam War and became a very punitive policy to punish drug users. 00:09:23.267 --> 00:09:25.361 When I say punitive, it is based on punishment. 00:09:25.391 --> 00:09:29.711 It's based on, Hey, if you do this, we are going to punish you either 00:09:29.711 --> 00:09:31.751 through jail, financial means. 00:09:31.781 --> 00:09:34.951 A strictly punitive approach doesn't focus on recovery. 00:09:34.951 --> 00:09:36.361 It doesn't focus on resources. 00:09:36.361 --> 00:09:38.671 It doesn't focus on keeping that person safe. 00:09:38.671 --> 00:09:42.436 It basically takes a moralistic look at the disease of addiction. 00:09:42.436 --> 00:09:42.736 Right? 00:09:43.036 --> 00:09:47.896 We're gonna punish you, we're gonna send you away so that we can try to change 00:09:47.896 --> 00:09:50.146 this behavior through a punitive approach. 00:09:51.751 --> 00:09:56.861 Another really important and vital piece of this conversation is 00:09:56.861 --> 00:09:59.321 the HIV crisis of the eighties. 00:09:59.941 --> 00:10:05.606 When we look to the communities and the onset of harm reduction programs 00:10:05.606 --> 00:10:07.186 that have come up in the country. 00:10:07.486 --> 00:10:11.826 A Lot of these first started being developed during the HIV crisis, where 00:10:11.826 --> 00:10:13.776 the federal response was not there. 00:10:14.416 --> 00:10:16.666 We weren't getting clean needle distribution, we weren't 00:10:16.666 --> 00:10:19.126 getting education, we weren't getting informed providers. 00:10:19.366 --> 00:10:22.866 None of this stuff was happening in the early to mid eighties as 00:10:22.866 --> 00:10:24.336 the AIDS crisis was happening. 00:10:25.156 --> 00:10:30.211 Because of that birth of involvement from federal sources and state 00:10:30.211 --> 00:10:31.476 sources and things like that. 00:10:31.716 --> 00:10:37.286 There became a kind of grassroots effort to start doing some of this stuff. 00:10:37.676 --> 00:10:39.806 Distributing needles, giving that education. 00:10:40.046 --> 00:10:41.336 Starting social groups. 00:10:41.366 --> 00:10:46.776 Peer groups, and again that idea of a peer run program, people who have 00:10:46.776 --> 00:10:50.196 gone through this, people who are going through this being the essential 00:10:50.196 --> 00:10:52.626 part of the recipe for success. 00:10:52.976 --> 00:10:57.386 As the CDC discovered that IV drug use linked to HIV in the eighties, we see 00:10:57.386 --> 00:11:01.946 this intertwining nature of the two topics that gets pulled into the political 00:11:02.246 --> 00:11:07.206 life, the social life, the prejudices of that time, especially when we look in 00:11:07.206 --> 00:11:08.526 the response of the federal government. 00:11:09.426 --> 00:11:14.456 As the aids crisis deepened and gotten worse we saw that willful neglect 00:11:14.456 --> 00:11:19.691 from federal powers to really address it in a way that was substantive. 00:11:20.211 --> 00:11:23.181 We really saw the development of community resources for harm 00:11:23.181 --> 00:11:26.685 reduction, especially out of the west coast, outta San Francisco. 00:11:27.565 --> 00:11:31.794 We saw in 1992, the first official, and I say official because they 00:11:31.794 --> 00:11:35.664 were non-official elements before this, but the first official harm 00:11:35.664 --> 00:11:41.004 reduction working group that started in 1992 in San Francisco to create a 00:11:41.004 --> 00:11:42.834 united definition of harm reduction. 00:11:43.569 --> 00:11:46.339 And to start connecting providers throughout the country. 00:11:46.969 --> 00:11:48.109 Also super important. 00:11:48.899 --> 00:11:52.743 We also saw in the mid nineties the advent of naloxone distribution. 00:11:53.593 --> 00:11:57.373 This is a drug when used appropriately for a person that's experiencing 00:11:57.373 --> 00:11:59.483 overdose can be lifesaving. 00:11:59.973 --> 00:12:05.553 We saw distribution of that drug to people throughout society who could jump in, 00:12:05.553 --> 00:12:09.553 even if they're not a trained professional to provide Narcan, as it's also known 00:12:09.553 --> 00:12:12.527 as, to people who are experiencing an overdose and save their lives. 00:12:12.707 --> 00:12:17.734 In 2019 we saw more than 700,000 doses of Naloxone or Narcan were distributed. 00:12:17.924 --> 00:12:20.754 Finally and I say finally because you'll see the huge gap here from 00:12:20.754 --> 00:12:24.742 the onset of the war on drugs in the early seventies, to finally getting 00:12:24.772 --> 00:12:27.472 an official policy on harm reduction. 00:12:27.472 --> 00:12:32.402 Finally having SAMSHA take harm reduction and establish these pillars and take all 00:12:32.402 --> 00:12:36.392 of this knowledge work that's been done at a more grassroots level in the last 50 00:12:36.392 --> 00:12:41.982 years and bring it into official federal policy, which is what we saw in 2021. 00:12:42.222 --> 00:12:47.672 First ever harm reduction framework from a federal agency and a official 00:12:47.672 --> 00:12:51.542 stance from the federal government on what harm reduction is, why it's 00:12:51.542 --> 00:12:55.352 important, and why it can help lead to recovery, which we'll talk about as well. 00:12:56.052 --> 00:12:59.685 So again, just a initial sign post here of important dates. 00:13:00.200 --> 00:13:04.850 It's important to get an idea in our heads as we look at where we wanna 00:13:04.850 --> 00:13:06.110 move forward with harm reduction. 00:13:06.110 --> 00:13:09.525 Like where it's been and the various challenges that we've had throughout the 00:13:09.525 --> 00:13:13.105 years to get some of these lifesaving interventions and policies into the 00:13:13.105 --> 00:13:14.725 hands of people that can really do good. 00:13:17.765 --> 00:13:21.562 An important element as we've discussed, especially in the last five to 10 years, 00:13:21.592 --> 00:13:27.236 is that there is a big difference in the reality of what harm reduction is and a 00:13:27.345 --> 00:13:29.899 outward policy perception of what it is. 00:13:30.669 --> 00:13:36.159 Oftentimes for professionals, we run into a difference in opinion 00:13:36.159 --> 00:13:40.084 on what harm reduction means in the context of community and mental 00:13:40.084 --> 00:13:45.484 health, and is there a connection between harm reduction and recovery? 00:13:45.514 --> 00:13:46.679 Is there even a bridge there? 00:13:47.039 --> 00:13:49.019 The answer is yes, a hundred percent, yes. 00:13:49.489 --> 00:13:53.889 We've seen harm reduction become a political issue as the scourge 00:13:53.889 --> 00:13:55.269 of addiction has gotten worse. 00:13:55.729 --> 00:14:00.509 We've seen harm reduction interventions in some ways take the fall for 00:14:00.509 --> 00:14:02.819 some of the overdose numbers that are happening in this country. 00:14:03.249 --> 00:14:08.856 We see an ideological way of thinking about drug abuse that's generally more 00:14:08.856 --> 00:14:13.756 of a moralist approach that says, no, we should be doing anything that could 00:14:13.756 --> 00:14:18.976 in any way or any interpretation, be seen as encouraging use or 00:14:18.976 --> 00:14:20.806 keeping people safe who need to use. 00:14:20.856 --> 00:14:23.286 We should only be looking at discouraging use. 00:14:23.796 --> 00:14:26.886 A good thing to remember for anybody, and this is for professionals, we get 00:14:26.936 --> 00:14:29.606 this training all the time, but also people in the community that are trying 00:14:29.606 --> 00:14:33.456 to help with the scourge of addiction is this is not about us, right? 00:14:33.681 --> 00:14:37.051 This is not about our feelings on addiction. 00:14:37.051 --> 00:14:41.346 This is not about our well-meaning intentions to try to help people. 00:14:41.346 --> 00:14:43.056 This is about them. 00:14:43.146 --> 00:14:46.776 This is about the people that are going through this process themselves and trying 00:14:46.776 --> 00:14:51.126 to meet them where they're at, to provide resources to allow them to get to the 00:14:51.126 --> 00:14:53.106 point where they can engage in recovery. 00:14:54.136 --> 00:14:59.656 This is certainly an emotional topic because addiction is so intertwined 00:14:59.656 --> 00:15:03.566 into our society and we see through our family, through our friends, the 00:15:03.566 --> 00:15:05.486 negative effects that addiction can have. 00:15:06.566 --> 00:15:09.646 Our professional duty for the professionals viewing this is to 00:15:09.646 --> 00:15:14.096 absolutely provide resources without judgment and to allow individuals 00:15:14.096 --> 00:15:18.626 to have the autonomy to move forward in their idea of recovery. 00:15:18.676 --> 00:15:22.166 To the right here of this slide, you'll see a really cool metaphor, right of an 00:15:22.166 --> 00:15:25.076 iceberg that we see above the water line. 00:15:25.076 --> 00:15:30.506 We see the things like needle exchange, safe smoking supplies, safe use sites, the 00:15:30.506 --> 00:15:34.886 things that most oftentimes we're gonna think of when we hear harm reduction. 00:15:35.166 --> 00:15:38.116 We think of safe use sites and legislation, often at the state 00:15:38.116 --> 00:15:41.686 level and until it's a federal level over the legality of safe use sites. 00:15:42.106 --> 00:15:43.936 The legality of needle exchanges. 00:15:44.226 --> 00:15:47.256 What does it do to hand out free smoking supplies to people? 00:15:47.256 --> 00:15:47.916 Does that help? 00:15:47.916 --> 00:15:48.516 Does that hurt? 00:15:48.826 --> 00:15:52.366 That's often the discussion that's happening regarding harm reduction. 00:15:52.416 --> 00:15:58.206 Now below the waterline, we're gonna see 95% of what harm reduction 00:15:58.206 --> 00:16:01.266 interventions are, especially at the community mental health level. 00:16:01.656 --> 00:16:02.766 Things like test strips. 00:16:03.556 --> 00:16:08.676 Things like drug checking kits to make sure that the drugs that individuals 00:16:08.676 --> 00:16:10.146 are using what they think they are. 00:16:10.206 --> 00:16:15.156 Overdose education, STD screening, equitable access to safe housing, 00:16:15.816 --> 00:16:20.816 reproductive health, educational supplies, public health programs, day 00:16:20.816 --> 00:16:26.051 centers, social spaces, non-punitive care and diversion programs. 00:16:26.441 --> 00:16:27.731 Very key, very important. 00:16:28.061 --> 00:16:29.861 Informed healthcare providers, right? 00:16:29.861 --> 00:16:33.581 So having people who are providing this healthcare, be it a primary 00:16:33.581 --> 00:16:38.681 care physician, a dentist, a therapist, having them informed on 00:16:38.681 --> 00:16:42.176 what harm reduction is, and how some of these interventions can help. 00:16:42.716 --> 00:16:44.966 Mobile medication assisted treatment. 00:16:45.016 --> 00:16:47.476 Being able to offer these services in rural areas. 00:16:47.476 --> 00:16:48.676 Also super important. 00:16:49.246 --> 00:16:52.876 Having providers with lived experience, perhaps the most important element. 00:16:53.286 --> 00:16:55.986 Expanded telehealth, lower barrier services. 00:16:56.236 --> 00:16:57.826 Trying to meet people where they're at. 00:16:58.126 --> 00:17:02.191 Not have these, Hey you gotta be here at 1:00 PM, and if a client doesn't 00:17:02.191 --> 00:17:03.781 show up, they get cut off from services. 00:17:03.781 --> 00:17:04.081 No. 00:17:04.561 --> 00:17:08.896 Let's try to make services as easy to access as possible so that we connect 00:17:08.896 --> 00:17:13.411 with that person who might be struggling even to make that first appointment. 00:17:13.931 --> 00:17:17.801 By offering the lowest barrier to doing so, we're really giving 00:17:17.801 --> 00:17:20.951 them the best chance to get their foot in the door towards recovery. 00:17:21.621 --> 00:17:24.171 Also living wages for harm reduction providers. 00:17:24.171 --> 00:17:24.501 Right? 00:17:24.771 --> 00:17:27.836 So how do we make this field a place where. 00:17:29.096 --> 00:17:33.116 People can work in and also live their lives and be able to afford the things 00:17:33.116 --> 00:17:35.036 that they need to do to live successfully. 00:17:35.096 --> 00:17:37.616 So that they can come in every day and provide these services to the 00:17:37.616 --> 00:17:39.836 most vulnerable people in our society. 00:17:40.206 --> 00:17:44.676 All super important questions that we will continue to discuss. 00:17:47.256 --> 00:17:48.306 So why harm reduction? 00:17:48.306 --> 00:17:48.846 Why now? 00:17:49.176 --> 00:17:51.606 Why are we making this a focal point of recovery? 00:17:52.566 --> 00:17:56.166 So this is an innovative strategy, responding to decades of failure. 00:17:56.626 --> 00:18:01.626 In 2021, there were 106,000 deaths due to overdose in the United States. 00:18:02.026 --> 00:18:05.536 That's a vast increase even in the last five years, especially 00:18:05.536 --> 00:18:07.876 so in the last 20 years. 00:18:08.186 --> 00:18:12.611 The reasons for that are many, but the most obvious reason is 00:18:12.611 --> 00:18:14.141 the proliferation of fentanyl. 00:18:14.301 --> 00:18:18.921 Fentanyl is an extremely easy drug to overdose and die on. 00:18:19.441 --> 00:18:22.941 We like to think of if you aren't alive you can't recover, right? 00:18:22.941 --> 00:18:26.741 Keeping an individual alive is essentially the most key component 00:18:26.741 --> 00:18:28.151 to helping them towards recovery. 00:18:28.371 --> 00:18:30.231 Because if they use fentanyl and they pass away. 00:18:31.251 --> 00:18:32.751 That's another person that we've lost. 00:18:32.751 --> 00:18:37.271 That's another opportunity for recovery down the road that has been extinguished. 00:18:37.811 --> 00:18:39.791 The national public policy has not worked. 00:18:40.151 --> 00:18:41.321 A hundred percent has not worked. 00:18:41.691 --> 00:18:44.601 How do we take that knowledge that we've been doing something that maybe 00:18:44.631 --> 00:18:47.631 hasn't been effective, a punitive approach that hasn't been effective, 00:18:47.931 --> 00:18:51.846 and how do we craft that into policies that can help people right now? 00:18:52.951 --> 00:18:58.281 Health inequity, prison pipeline, drug war, fallout, all super important, bigger 00:18:58.281 --> 00:19:06.021 picture elements of the addiction crisis in this country and elements that harm 00:19:06.021 --> 00:19:08.456 reduction can address and try to improve. 00:19:10.041 --> 00:19:11.421 This is a public health approach. 00:19:11.871 --> 00:19:16.371 So not only does it require engagement on a community mental health level, but 00:19:16.371 --> 00:19:20.421 as you saw from the previous slide, a lot of these harm reduction interventions 00:19:20.421 --> 00:19:22.041 are focused on public health. 00:19:22.671 --> 00:19:25.341 How do we get buy-in from public health sector? 00:19:25.341 --> 00:19:28.191 How do we get buy-in from private hospital systems? 00:19:28.246 --> 00:19:30.046 These are all super important questions. 00:19:30.871 --> 00:19:35.161 This is a disease model, and we look at this as a disease, which we are trying 00:19:35.161 --> 00:19:40.561 to treat with every single tool that we have, every single tool at our disposal. 00:19:40.711 --> 00:19:46.481 And it's a public health crisis that needs not only addressing from the community 00:19:46.481 --> 00:19:49.061 mental health and psychological side. 00:19:49.646 --> 00:19:53.466 The public health side, the housing side, the social side, the family side. 00:19:53.556 --> 00:19:58.746 Every single element of society needs to be motivated to make this change. 00:19:59.996 --> 00:20:05.026 Peer led, you've heard me mention this a couple times because the peer led nature 00:20:05.026 --> 00:20:08.716 of harm reduction interventions are the most important element of harm reduction. 00:20:09.196 --> 00:20:12.166 Guided by people who use drugs and people with lived experience, 00:20:12.346 --> 00:20:13.666 a non-punitive approach. 00:20:14.191 --> 00:20:16.411 An autonomous blueprint to recovery. 00:20:16.441 --> 00:20:19.491 I love that phrase and I love that theory and that philosophy. 00:20:19.541 --> 00:20:23.561 We are using these interventions to provide individuals with this blueprint. 00:20:24.131 --> 00:20:25.481 It's not a blueprint that we're making. 00:20:25.581 --> 00:20:26.331 That doesn't work. 00:20:27.036 --> 00:20:27.696 It doesn't work. 00:20:27.796 --> 00:20:32.476 What does work is giving people tools to create their own blueprint 00:20:32.506 --> 00:20:34.186 towards their definition of recovery. 00:20:34.746 --> 00:20:38.406 If I didn't believe as a professional that harm reduction interventions 00:20:38.616 --> 00:20:40.546 led to recovery, I wouldn't do it. 00:20:40.916 --> 00:20:43.846 The reason that we're adopting these strategies, the reason that we're 00:20:43.846 --> 00:20:46.756 pushing for these interventions to be used in a public health sphere. 00:20:47.506 --> 00:20:50.566 Is that we believe as professionals that they lead to recovery. 00:20:50.596 --> 00:20:54.646 People in recovery, peers, people who use drugs, believe that these 00:20:54.646 --> 00:20:56.086 interventions lead to recovery. 00:20:56.636 --> 00:21:01.326 That's a really important distinction, especially with the conversation 00:21:01.326 --> 00:21:04.986 happening at the national level about whether or not these interventions work. 00:21:05.316 --> 00:21:09.836 We believe they do, the data says they do and we're here to help implement 00:21:09.836 --> 00:21:12.356 these interventions into everyday life. 00:21:14.876 --> 00:21:16.976 Harm reduction and recovery, can they coexist? 00:21:18.056 --> 00:21:19.706 So a very important point. 00:21:19.736 --> 00:21:21.386 This is not a clash of ideas. 00:21:21.386 --> 00:21:25.076 This is not a, we have recovery on one side and harm reduction where 00:21:25.076 --> 00:21:26.966 we're encouraging use on the other. 00:21:27.761 --> 00:21:31.301 Harm reduction connects seamlessly with the values of Jefferson Center 00:21:31.661 --> 00:21:34.631 and the vast majority of therapeutic interventions that we're doing. 00:21:35.351 --> 00:21:39.131 Harm reduction is not replacing abstinence, and it's not replacing 00:21:39.131 --> 00:21:42.281 that traditional recovery path for those who want to take that path 00:21:42.281 --> 00:21:44.141 and for those who that works for. 00:21:44.471 --> 00:21:49.291 Individuals who can have additional support to go into AA and who could 00:21:49.291 --> 00:21:54.571 use 12 step meetings and who can go through a traditional abstinence focused 00:21:54.571 --> 00:21:56.581 plan of recovery a hundred percent. 00:21:56.861 --> 00:21:57.566 If that works for you. 00:21:58.556 --> 00:21:59.246 A hundred percent. 00:21:59.306 --> 00:22:02.156 We wanna be able to offer that support and offer those resources. 00:22:02.696 --> 00:22:07.121 What harm reduction is about is about the other percentage of people that doesn't 00:22:07.121 --> 00:22:11.881 work for and making sure that we're having all of these tools available to everyone. 00:22:12.091 --> 00:22:15.331 Not just one way of doing things to those who are really seeking 00:22:15.331 --> 00:22:16.831 that abstinence only path. 00:22:18.481 --> 00:22:20.971 Harm reduction practices, again, are a piece of the repair work 00:22:20.971 --> 00:22:24.496 going on in the mental health field for decades of unfair treatment. 00:22:25.546 --> 00:22:30.426 A lot of the negative opinions that you'll see in the community as you talk with 00:22:30.426 --> 00:22:34.176 folks come from misunderstanding it, it comes from people being like, I don't 00:22:34.176 --> 00:22:36.241 want a safe use site in my backyard. 00:22:36.781 --> 00:22:37.681 Okay, that's fine. 00:22:37.871 --> 00:22:41.861 Let's have the conversation then about what harm reduction principles you do like 00:22:42.101 --> 00:22:44.021 and what things you do think make sense. 00:22:44.121 --> 00:22:49.941 We're looking for areas to connect and things that we can agree on rather 00:22:49.941 --> 00:22:53.211 than focusing on the small sliver of things that we don't agree on. 00:22:53.211 --> 00:22:57.351 Let's talk about the vast majority of things we do agree on, which is reducing 00:22:57.351 --> 00:23:01.716 suffering, increasing compassion, and increasing access to resources. 00:23:02.466 --> 00:23:06.336 Harm reduction interventions are proven to result in higher likelihood 00:23:06.336 --> 00:23:08.046 to engage in recovery services. 00:23:08.516 --> 00:23:11.366 Again, keeping people alive, keeping them healthy. 00:23:11.416 --> 00:23:16.576 Reducing the impact on emergency rooms, on the public health sector are all 00:23:16.576 --> 00:23:21.616 things that harm reduction can do to help guide that person to the eventual area 00:23:21.616 --> 00:23:23.296 of recovery that we want them to be at. 00:23:24.366 --> 00:23:26.106 Autonomy and recovery go hand in hand. 00:23:26.841 --> 00:23:29.836 We know for our family members or our friends who are struggling with 00:23:29.836 --> 00:23:33.976 addiction, very difficult to force someone to make a change that they 00:23:33.976 --> 00:23:38.306 don't want to unless you are willing to have them be in a lockdown situation. 00:23:38.516 --> 00:23:40.826 Which is not gonna work for the vast majority of people. 00:23:40.826 --> 00:23:44.696 It's very hard to get people to take that first step if they're not bought in. 00:23:48.746 --> 00:23:51.866 We've talked about this a little bit, but again, harm reduction's, 00:23:51.866 --> 00:23:55.676 really a core element of it is addressing these health inequities. 00:23:56.146 --> 00:24:00.556 Harm reduction acknowledges the intended and unintended impacts of past 00:24:00.556 --> 00:24:03.406 health policies, programs, procedures. 00:24:04.141 --> 00:24:07.531 That have adversely impacted people of color, indigenous peoples, members 00:24:07.531 --> 00:24:13.201 of religious minorities, LGBTQI plus individuals, persons with disabilities, 00:24:13.531 --> 00:24:17.251 persons who live in rural areas and persons otherwise impacted by 00:24:17.251 --> 00:24:19.291 persistent poverty or inequality. 00:24:19.651 --> 00:24:23.191 This is a huge part of harm reduction and it's a huge part of why we think 00:24:23.191 --> 00:24:25.081 these interventions make sense. 00:24:25.081 --> 00:24:28.811 They're gonna help individuals who have oftentimes been overlooked. 00:24:30.251 --> 00:24:33.831 One thing I think is really important is this bottom point. 00:24:33.831 --> 00:24:37.071 So community trust and buy-in has to be earned, right? 00:24:37.071 --> 00:24:39.831 And that has to begin with truth and reconciliation of community 00:24:39.831 --> 00:24:43.611 shared traumatic history and the structural racism that perpetuates 00:24:43.671 --> 00:24:48.181 inequities that we've seen highlighted so often in substance use. 00:24:48.721 --> 00:24:49.951 We need that community buy-in. 00:24:50.191 --> 00:24:55.891 This can't just be one section of the community or one agency 00:24:55.891 --> 00:24:58.281 or one federal arm of government. 00:24:58.701 --> 00:25:01.011 You need to have the churches involved. 00:25:01.041 --> 00:25:02.601 You need to have community centers. 00:25:02.601 --> 00:25:05.511 You need to have work groups involved. 00:25:05.541 --> 00:25:08.001 You need to have 12 step groups involved. 00:25:08.001 --> 00:25:09.411 You can have hospital systems. 00:25:09.996 --> 00:25:13.916 Every single element needs to engage these interventions to really have 00:25:13.966 --> 00:25:17.576 the structural effect that we're looking to have through harm reduction. 00:25:20.396 --> 00:25:21.866 So a little bit about the framework. 00:25:21.866 --> 00:25:25.966 Again, I let y'all know that in 2021 was the first time that this language 00:25:25.966 --> 00:25:31.331 harm reduction has been adopted in a federal document with SAMSHA. 00:25:31.641 --> 00:25:34.581 The Biden Harris administration identified harm reduction as a 00:25:34.581 --> 00:25:36.291 federal drug policy priority. 00:25:36.981 --> 00:25:40.911 And in 2022, national drug control strategy meeting harm reduction is 00:25:40.911 --> 00:25:44.811 described as a public health approach designed to advance policies and 00:25:44.811 --> 00:25:49.371 programs for people who use drugs and is supported by decades of evidence. 00:25:50.191 --> 00:25:51.301 What does that evidence show? 00:25:51.421 --> 00:25:54.661 It shows that we can reduce HIV and Hep C infection. 00:25:55.051 --> 00:25:57.271 We can reduce overdose risk and death. 00:25:58.096 --> 00:26:03.016 We can enhance general public health and safety and increase by five 00:26:03.016 --> 00:26:07.696 times the likelihood of a person who injects drugs to initiate treatment. 00:26:08.836 --> 00:26:09.886 Super, super important. 00:26:10.786 --> 00:26:15.496 Harm reduction has been identified as one of the four strategic priorities by the 00:26:15.496 --> 00:26:18.416 HHS overdose prevention strategy pillars. 00:26:19.206 --> 00:26:23.526 Those go along with prevention, evidence, space treatment, recovery 00:26:23.526 --> 00:26:25.501 support, along with harm reduction. 00:26:26.721 --> 00:26:29.281 First ever federal document to outline harm reduction. 00:26:29.281 --> 00:26:30.301 So let's celebrate that. 00:26:30.331 --> 00:26:32.991 I think when we look at this, oftentimes there's a lot, there's 00:26:32.991 --> 00:26:36.131 a ton of negative, as we look at the history of harm reduction and 00:26:36.131 --> 00:26:38.441 trying to get these interventions to the people that need them. 00:26:39.161 --> 00:26:41.201 Let's take a moment to celebrate and acknowledge that 00:26:41.201 --> 00:26:42.431 this is a huge step forward. 00:26:42.701 --> 00:26:45.821 That we're gonna see increased funding, we're gonna see increased 00:26:45.821 --> 00:26:49.161 resources for these programs, and that's something to celebrate. 00:26:51.256 --> 00:26:56.896 Okay, so I'm gonna talk briefly about the six pillars of harm reduction. 00:26:57.456 --> 00:27:00.906 These pillars have been created to drive conversation and establish 00:27:00.906 --> 00:27:04.026 initial points of reference for harm production providers. 00:27:04.806 --> 00:27:09.426 They connect with the 12 principles and six core practice areas. 00:27:09.876 --> 00:27:13.416 Mainly for our discussion today, I'm gonna be talking about these pillars 00:27:13.596 --> 00:27:14.826 'cause these are the main ideas. 00:27:15.811 --> 00:27:20.281 This reframes harm reduction as a wide breadth of services with roots 00:27:20.281 --> 00:27:23.941 and motivational interviewing, unconditional positive regard 00:27:24.271 --> 00:27:27.601 and interventions applicable in a wide variety of clinical settings. 00:27:28.531 --> 00:27:31.951 I'm using some clinical terms here, so I'll just give a brief explanation. 00:27:31.951 --> 00:27:35.041 When we think of motivational interviewing, the best way to think of 00:27:35.041 --> 00:27:41.851 that is a therapeutic engagement that is client led and autonomous for the client 00:27:42.761 --> 00:27:44.136 and meets the client where they're at. 00:27:44.496 --> 00:27:46.716 Helps the client establish their own goals. 00:27:47.286 --> 00:27:50.316 It's a good way of thinking big picture, what does motivational interviewing mean? 00:27:51.396 --> 00:27:52.956 Unconditional positive regard. 00:27:53.226 --> 00:27:54.516 Another clinical term. 00:27:54.646 --> 00:28:01.206 Basically the short of it is this means treating each person as a human, 00:28:01.386 --> 00:28:04.536 giving them the respect that they deserve as a human being, just as 00:28:04.536 --> 00:28:06.516 you would every other single person. 00:28:06.991 --> 00:28:13.381 Allowing them to experience mistakes, failures, and not having that alter your 00:28:13.381 --> 00:28:15.241 perception of them as a human being. 00:28:16.321 --> 00:28:20.101 These pillars can be practiced within organizations that do not primarily 00:28:20.101 --> 00:28:21.601 provide harm reduction services. 00:28:21.651 --> 00:28:25.321 For example this could be a case manager at Jefferson Center, at 00:28:25.321 --> 00:28:26.481 a community mental health center. 00:28:26.721 --> 00:28:30.171 This could be someone with a Denver Health Harm Reduction team who's applying 00:28:30.321 --> 00:28:32.241 specific harm reduction interventions. 00:28:32.451 --> 00:28:36.181 This could also be someone, as I said, even in a place like a dentist's office. 00:28:36.666 --> 00:28:39.546 Being trained in some of these interventions so that they can 00:28:39.546 --> 00:28:44.146 help identify and point people to resources who might come in with IV 00:28:44.146 --> 00:28:45.736 drug use or another piece of drug use. 00:28:45.946 --> 00:28:49.816 They could be interventions that are used in the court system, in the criminal 00:28:49.816 --> 00:28:52.106 justice system, in the hospital system. 00:28:52.496 --> 00:28:55.316 Any single area of life that were interacting with people who 00:28:55.316 --> 00:28:58.226 use drugs, which as we know is probably every single area of life. 00:28:58.476 --> 00:29:00.366 We're gonna be able to provide these interventions. 00:29:00.706 --> 00:29:03.361 So it's a wide breadth of services and a wide breadth of ideas. 00:29:04.466 --> 00:29:08.576 These pillars cannot only help engage with the individual, but they can help 00:29:08.576 --> 00:29:10.376 engage with that individual's family. 00:29:10.836 --> 00:29:14.286 So how do we help connect the family to services and help them feel 00:29:14.286 --> 00:29:15.816 supported in this journey also? 00:29:16.786 --> 00:29:18.436 The first pillar as we discussed. 00:29:18.536 --> 00:29:22.886 Lived experience, the guided process, all aspects of harm reduction interventions 00:29:22.886 --> 00:29:26.456 are guided from this core principle of lived experience and peer work. 00:29:27.006 --> 00:29:31.206 Should include a formal mechanism or role to meaningfully include 00:29:31.206 --> 00:29:32.976 voices of people who use drugs. 00:29:32.976 --> 00:29:36.936 So this is important distinction, not only people who use recovery, but we 00:29:36.936 --> 00:29:40.266 are really going to people who are currently involved in this crisis. 00:29:40.671 --> 00:29:43.641 Getting input from them, getting ideas from them, allowing them to 00:29:43.641 --> 00:29:48.751 have an active role in how we are presenting solutions to this population. 00:29:49.781 --> 00:29:52.811 This is, like I said, this is a radical way of looking at this. 00:29:53.351 --> 00:29:55.031 We want to get every voice heard. 00:29:55.061 --> 00:29:58.631 I think it is the best way to think of this and the people that are currently 00:29:58.631 --> 00:30:03.341 experiencing these problems that are having every day daily IV drug use. 00:30:03.731 --> 00:30:05.351 Of course, we want to hear from them. 00:30:05.381 --> 00:30:08.141 Of course we want to know what works for them, what doesn't work for them. 00:30:08.421 --> 00:30:10.221 Their voice is super, super important. 00:30:11.237 --> 00:30:14.622 Pillar two embraces the inherent value of people. 00:30:16.097 --> 00:30:19.457 All individuals have inherent value and are treated with dignity, 00:30:19.457 --> 00:30:20.927 respect in positive regard. 00:30:21.257 --> 00:30:25.317 I think this pillar especially connects to the stigma, right? 00:30:25.317 --> 00:30:30.177 The stigma of drug use and how drug users in our society are 00:30:30.177 --> 00:30:31.737 often looked at as lesser than. 00:30:32.497 --> 00:30:38.257 The people who are on the bottom rung of society and who don't have access to 00:30:38.257 --> 00:30:39.822 the same resources that other people do. 00:30:41.042 --> 00:30:45.962 Treating individuals with respect, embracing their value 00:30:45.962 --> 00:30:50.292 of every single person is key to these interventions working. 00:30:50.342 --> 00:30:51.572 One doesn't go without the other. 00:30:51.752 --> 00:30:56.542 You can't have a hospital admin person screening for IV drug users 00:30:57.022 --> 00:30:59.122 without this way of looking at them. 00:30:59.212 --> 00:31:00.532 You can't have them looking down. 00:31:00.622 --> 00:31:01.372 It's not gonna work. 00:31:02.137 --> 00:31:05.767 Never patronize or pathologize people who use drugs nor other communities, 00:31:06.307 --> 00:31:11.047 not helpful, and not something that goes forward with the ideals of harm reduction. 00:31:12.667 --> 00:31:13.387 Acknowledgement. 00:31:13.387 --> 00:31:16.447 Just a general acknowledgement as a society of the realities of 00:31:16.447 --> 00:31:20.527 substance abuse and the nuanced and complex reasons for use. 00:31:20.527 --> 00:31:24.757 This is not a one size fits all problem and it's the solution is 00:31:24.757 --> 00:31:26.677 gonna be applying to everyone also. 00:31:26.897 --> 00:31:30.407 It's a very nuanced problem and we need to acknowledge and recognize that. 00:31:33.407 --> 00:31:35.297 Pillar three, community engagement. 00:31:35.357 --> 00:31:38.357 I alluded to this a little bit earlier, but we've gotta engage with 00:31:38.357 --> 00:31:42.017 communities, especially those that have been impacted by systemic harms. 00:31:42.447 --> 00:31:46.267 Funding agencies and programs that sustain cultural practices 00:31:46.777 --> 00:31:48.012 and value community wisdom. 00:31:49.232 --> 00:31:53.602 Getting input, getting buy-in from different community organizations, be it 00:31:53.602 --> 00:31:57.202 a community mental health organization, a church group, a community group. 00:31:57.982 --> 00:31:59.602 Very, very integral, very important. 00:32:00.302 --> 00:32:03.452 Community led initiative with geographically specific 00:32:03.752 --> 00:32:05.162 culturally based models. 00:32:05.162 --> 00:32:09.651 We know that one approach that works in Philadelphia, Pennsylvania, 00:32:10.001 --> 00:32:14.081 might not work in rural Colorado and likewise, and that's okay. 00:32:14.401 --> 00:32:16.621 We're looking at a different cultural perspective. 00:32:16.621 --> 00:32:21.276 We're looking at different demographics and acknowledging that is important and 00:32:21.276 --> 00:32:22.866 we're looking at a different drug, right? 00:32:22.866 --> 00:32:26.316 So sometimes certain drugs and certain ways of using are prevalent in certain 00:32:26.316 --> 00:32:28.416 places, not prevalent in others. 00:32:28.666 --> 00:32:32.446 Going about this process with geographically specific 00:32:32.446 --> 00:32:34.276 interventions is super important. 00:32:35.926 --> 00:32:38.776 Each community is given autonomy to improve their environment. 00:32:38.956 --> 00:32:43.026 Again, this is a macro idea, but it's also micro in that we 00:32:43.026 --> 00:32:44.526 are doing this with each client. 00:32:44.526 --> 00:32:46.146 We're also doing this with each community. 00:32:46.921 --> 00:32:49.891 Each community is given the autonomy to improve their environment. 00:32:49.891 --> 00:32:53.371 We are not coming down with a heavy hand of this is how it has to be. 00:32:53.471 --> 00:32:56.171 There's an open willingness to have a conversation about what 00:32:56.171 --> 00:32:59.801 works and what doesn't, while also respecting the community at large. 00:33:01.126 --> 00:33:03.286 Pillar four, equity and social justice. 00:33:03.286 --> 00:33:07.576 So all aspects of work incorporate an awareness of race, class, 00:33:07.576 --> 00:33:11.056 language, sexual orientation, and gender-based power differentials. 00:33:11.766 --> 00:33:17.476 Pro-health and pro-social practices align with the organization and mobilization of 00:33:17.476 --> 00:33:21.706 direct services and the acknowledgement of past harm and discrepancy 00:33:21.946 --> 00:33:24.046 in services of minority groups. 00:33:24.466 --> 00:33:26.946 Again, the element that I would emphasize here most is 00:33:26.946 --> 00:33:28.506 coming with an open ear, right? 00:33:28.586 --> 00:33:30.476 Not talking for a little bit, just listening. 00:33:30.666 --> 00:33:33.756 Can be the first step and the most important step into 00:33:33.756 --> 00:33:35.106 making this pillar a reality. 00:33:35.106 --> 00:33:37.736 Especially when we're working with communities that have 00:33:37.736 --> 00:33:39.656 experienced systemic racism. 00:33:40.356 --> 00:33:41.666 Listen, listen first. 00:33:41.836 --> 00:33:45.246 Pillar five, very important from the perspective of community 00:33:45.246 --> 00:33:48.148 mental health, which is an important part of this venture. 00:33:48.148 --> 00:33:49.988 But really any intervention. 00:33:50.048 --> 00:33:54.288 Lowest barrier access, non course of support, lowest 00:33:54.288 --> 00:33:55.818 possible requirements for access. 00:33:55.818 --> 00:33:57.408 So an example of this might be. 00:33:58.698 --> 00:34:04.438 Not requiring someone to come in person for two hours, complete paperwork and go 00:34:04.438 --> 00:34:09.088 through a very regimented administrative process to get involved in a program. 00:34:09.598 --> 00:34:11.608 What can we do to make this easier? 00:34:11.608 --> 00:34:13.258 Can we offer a telehealth appointment? 00:34:13.558 --> 00:34:16.998 Can we offer a digital signatures on legal documents? 00:34:17.338 --> 00:34:20.158 What can we do to make the process easier? 00:34:20.158 --> 00:34:23.188 For example, at Jefferson Center, our recovery clinic 00:34:23.308 --> 00:34:25.108 has a no appointment process. 00:34:25.108 --> 00:34:26.223 So you don't make an appointment. 00:34:26.223 --> 00:34:27.873 You come when you can come. 00:34:28.343 --> 00:34:31.553 You have a bus ticket, you have someone to watch your child. 00:34:31.793 --> 00:34:35.273 You're able to come at 10 o'clock on Wednesday, we're open. 00:34:35.643 --> 00:34:38.673 That's an example, but an important example of how we can lower 00:34:38.673 --> 00:34:40.293 barriers to increase access. 00:34:41.583 --> 00:34:43.203 Non-punitive and non-judgmental. 00:34:43.203 --> 00:34:46.583 We are not punishing, we are not judging, we are not demanding 00:34:46.973 --> 00:34:50.453 abstinence or sobriety to walk through that door to engage in services. 00:34:50.853 --> 00:34:55.083 We are here to create an autonomous blueprint, as we discussed for 00:34:55.083 --> 00:34:58.773 recovery with the client at the head of this process as the 00:34:58.773 --> 00:35:00.393 expert, the client is the expert. 00:35:01.653 --> 00:35:04.593 Participation and services is always voluntary, confidential, and 00:35:04.593 --> 00:35:08.973 self-directed, free from threats force and the concept of compliance. 00:35:09.423 --> 00:35:13.773 We certainly do work with individuals who are mandated 00:35:13.773 --> 00:35:15.423 through the courts and that's okay. 00:35:15.753 --> 00:35:17.853 We just don't wanna make that a requirement, right? 00:35:17.853 --> 00:35:22.473 We don't wanna make it a requirement that you are committing to a certain 00:35:22.473 --> 00:35:23.853 set of standards from day one. 00:35:24.223 --> 00:35:28.453 We want this process to be voluntary, obviously confidential and self-directed. 00:35:29.668 --> 00:35:32.538 Data collection of any kind requires informed consent. 00:35:32.628 --> 00:35:36.148 Super important for any time you're working with individuals, especially 00:35:36.148 --> 00:35:40.168 from communities that have experienced poor treatment in the past. 00:35:40.558 --> 00:35:43.738 Any data collection, there needs to be an element of informed consent. 00:35:48.148 --> 00:35:48.928 Pillar six. 00:35:49.048 --> 00:35:52.708 So positive change as defined by the person. 00:35:53.098 --> 00:35:55.408 Driven by a person-centered positive change in the 00:35:55.408 --> 00:35:56.938 individual's quality of life. 00:35:57.208 --> 00:36:01.088 I'm not gonna tell an individual seeking substance use treatment and what they 00:36:01.103 --> 00:36:02.768 need to do to improve their life. 00:36:02.768 --> 00:36:05.668 I want them to trust me enough to tell me what that's gonna look like 00:36:05.668 --> 00:36:09.328 for them, and then for me and my team to come in and provide the 00:36:09.328 --> 00:36:10.858 resources to help them get there. 00:36:11.378 --> 00:36:15.248 Positive change can be defined by moving towards more connectedness to the 00:36:15.248 --> 00:36:20.308 community, family in a more healthful state as the individual defines it. 00:36:20.488 --> 00:36:21.478 Very, very important. 00:36:21.748 --> 00:36:28.438 If the individual defines success as only using their drug of choice once a week. 00:36:28.818 --> 00:36:29.388 A hundred percent. 00:36:29.658 --> 00:36:30.528 We're on board for that. 00:36:31.038 --> 00:36:31.788 We're on board for that. 00:36:31.788 --> 00:36:32.028 Why? 00:36:32.028 --> 00:36:35.628 Because it's reducing the hold that the substance has on the person. 00:36:35.838 --> 00:36:39.258 It's making it more likely that they're gonna come back and engage with us. 00:36:39.618 --> 00:36:42.528 It makes it more likely that they're gonna feel like a success, right? 00:36:42.528 --> 00:36:46.398 That they're not gonna feel like complete abstinence is a requirement 00:36:46.398 --> 00:36:48.768 a week or two weeks coming into recovery because it's not. 00:36:49.228 --> 00:36:52.588 Very important that the positive change is defined by the 00:36:52.588 --> 00:36:54.358 individual, not the organization. 00:36:55.363 --> 00:36:58.783 Many pathways to wellness, including full abstinence and non abstinence. 00:36:59.083 --> 00:37:04.213 This isn't a way of looking at recovery that says abstinence is not okay for 00:37:04.213 --> 00:37:05.863 a lot of the individuals we work with. 00:37:06.193 --> 00:37:10.423 Full abstinence from substances and alcohol is gonna be necessary 00:37:10.423 --> 00:37:12.703 for them to reach recovery and get to where they wanna be. 00:37:13.033 --> 00:37:13.843 Not for everybody. 00:37:13.903 --> 00:37:14.653 And that's okay. 00:37:14.833 --> 00:37:18.143 And that difference is okay, which is an important part of the messaging 00:37:18.143 --> 00:37:22.358 that we're trying to bring is that full abstinence works for some, it 00:37:22.358 --> 00:37:26.618 doesn't work for others, and a lot of people who come to a program without a 00:37:26.618 --> 00:37:29.108 requirement of abstinence later get there. 00:37:29.228 --> 00:37:32.798 They later see the benefits that reducing has in their lifestyle. 00:37:32.798 --> 00:37:35.688 And they say, actually, maybe I don't need to drink on the weekends. 00:37:35.848 --> 00:37:39.388 Maybe I can make further reductions and get to an  abstinent lifestyle, 00:37:39.418 --> 00:37:42.598 if that's what I want to do as they go through this process. 00:37:43.438 --> 00:37:44.003 Super important. 00:37:47.113 --> 00:37:50.198 Some of the supporting principles, I'm not gonna go through all of them, but they 00:37:50.198 --> 00:37:53.618 reinforce the pillars and provide more structure and guidance to the framework. 00:37:54.048 --> 00:37:57.618 All of these resources after the webinar will be made available. 00:37:57.748 --> 00:38:00.278 So you'll be able to access these in the future. 00:38:02.993 --> 00:38:05.543 I'm just gonna click through these quickly again. 00:38:05.593 --> 00:38:09.103 We're not gonna talk about them today, but these connect to the pillars and 00:38:09.103 --> 00:38:14.433 create a more direct intervention to what harm reduction means. 00:38:15.093 --> 00:38:16.233 Core practice areas. 00:38:16.233 --> 00:38:20.283 Again, I'm not gonna dive deeply into those today, but again, the practice 00:38:20.283 --> 00:38:22.683 areas are the real life interventions. 00:38:22.683 --> 00:38:25.923 How do we take these ideas and put them into society in a way that they work? 00:38:26.133 --> 00:38:27.903 The core practice areas are gonna be. 00:38:28.233 --> 00:38:29.013 How we do that. 00:38:29.353 --> 00:38:31.183 Awareness of resources is key. 00:38:31.453 --> 00:38:32.743 This is the meat of the framework. 00:38:32.743 --> 00:38:34.783 These are the interventions and the roles that are actually 00:38:34.783 --> 00:38:36.103 gonna be doing these things. 00:38:36.533 --> 00:38:39.493 So again, I'll provide this information after the webinar that 00:38:39.493 --> 00:38:40.843 you'll be able to get access to. 00:38:41.173 --> 00:38:44.653 I'm gonna talk about specific programs, specific resources in 00:38:44.653 --> 00:38:48.943 your community that you can access for harm reduction resources. 00:38:50.941 --> 00:38:51.131 Okay. 00:38:51.621 --> 00:38:53.541 That comes to the end of the webinar today. 00:38:53.541 --> 00:38:57.471 I know it's a lot of information and there's a lot of history here. 00:38:57.521 --> 00:39:02.586 There's a lot of work that we in community mental health and we in therapy and 00:39:02.616 --> 00:39:04.176 drug treatment we need to work on. 00:39:04.486 --> 00:39:06.676 But again, it's a multidisciplinary approach. 00:39:07.366 --> 00:39:11.046 These interventions can work in every single area of society. 00:39:11.046 --> 00:39:14.586 This way of looking at drug use, of looking at people who use drugs 00:39:14.916 --> 00:39:18.931 with a compassionate lens is the most important thing you can do if 00:39:18.931 --> 00:39:20.311 you want to help this population. 00:39:20.981 --> 00:39:22.481 Does not dissuade abstinence. 00:39:22.541 --> 00:39:23.891 Get that outta the way right now. 00:39:24.296 --> 00:39:29.246 Is not solely focused on things like safe use sites and needle exchange. 00:39:29.486 --> 00:39:31.736 Those are an element of harm reduction practice. 00:39:31.736 --> 00:39:34.646 They are not by any means to the majority of the interventions 00:39:34.946 --> 00:39:35.936 that we're talking about. 00:39:36.956 --> 00:39:40.766 Client directed definition of subriety, very important. 00:39:41.316 --> 00:39:44.376 Use this as a guidebook for implementing harm reduction interventions. 00:39:44.856 --> 00:39:49.266 Can be combined with 12 step programs and other traditional recovery strategies. 00:39:50.031 --> 00:39:53.841 This is a full tool belt of interventions and multiple approaches 00:39:53.841 --> 00:39:57.711 are always necessary to address a problem, which is really complex. 00:39:58.701 --> 00:40:02.701 Every person in addiction is different and every recovery is gonna be different. 00:40:03.421 --> 00:40:07.081 So keep that in mind as you're approaching this problem and thinking about ways 00:40:07.081 --> 00:40:08.551 that you can make a positive impact. 00:40:09.346 --> 00:40:13.481 I do have a list here of resources that were brought in for this presentation. 00:40:13.631 --> 00:40:17.436 Also, just really great articles to read and things to read up on as 00:40:17.436 --> 00:40:20.496 you're furthering your understanding of this really complex topic. 00:40:20.796 --> 00:40:24.156 I especially encourage everyone to take a look at the SAMHSA Harm Reduction 00:40:24.156 --> 00:40:27.936 framework in full, which is linked here and will be linked after the webinar. 00:40:28.936 --> 00:40:33.306 Thank you again very much for joining me today and I hope it is a journey and a 00:40:33.306 --> 00:40:38.506 continuation of understanding of these principles as we continue as a community 00:40:38.506 --> 00:40:43.336 to work together to try to improve this problem and help others in our community. 00:40:44.326 --> 00:40:45.286 Thank you so much.