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Best Practices in Harm Reduction -

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Best Practices in Harm Reduction
Evan Mills - Directorof Development & HousingProgramsAdvantage Behavioral Health Systems
February 5, 2019
What is Housing First?
Evidencebased practice - Proven method of ending all types ofhomelessnessMost effective approach to ending chronichomelessnessOffersindividuals and families experiencing homelessness immediate access topermanentaffordable or supportive housing.United States Interagency Council on Homelessness,The Housing First Checklist
Why Housing First?
Withoutclinicalprerequisites - like treatmentorsobriety – andwith a low-threshold for entry, Housing Firstyields:higherhousing retentionrateslowerreturns tohomelessnesssignificantreductions in the use of crisis service and institutions.United States Interagency Council on Homelessness,The Housing First Checklist
Thoughts on HousingFirst
Housing First Partners Conference 2018Housing First ≠ Housing OnlyHarm Reduction philosophy is necessary for Housing First successResearch shows that regardless of criminal history, people are equally successful in housing.“Not a program – it’s an apartment with services”Goal is not to enforce rules but to keep someone housed“Constantly question the rules”Atlanta 2020
What is Harm Reduction?
“… a set of practical strategies that reduce negative consequences of druguse,incorporating a spectrum of strategies from safer use, to managed use, to abstinence. Harm reduction strategies meet [people]‘where they're at,’addressing conditions of use along with the use itself.”HarmReduction Coalition (
Harm Reduction - Philosophy
Botha philosophy and a set ofstrategiesPhilosophySeeks to minimize or eliminate adverse health, social and economic consequences of substance use.Respects complexity of factors that bear on drug-related harm and individual’s rights and responsibilities in making choices and managing change.Multitude of appropriate responses with a range of beneficial outcomes.Jonathan Cox, Center for Social Intervention
Harm Reduction - Strategies
It’s a pragmatic, multidisciplinary, non-judgmental approach that meets people where they are at rightnow. Outcomesinclude:imparting skills in self-care (and care for others)lowering personal riskencouraging access totreatmentsupporting reintegrationlimiting the spread of diseaseimproving environmentscutting down on public expenses, saving lives.Jonathan Cox, Center for Social Intervention
Harm Reduction - Principles
Offers a menu of services and resources that increase safety and support incremental progress of the clientCase management is compassionate and pragmaticA recognition that drug/alcohol use is complexAcknowledges that some ways of using alcohol or drugs are safer thanothersPeople have the right to make decisions about their lives and actions. Harm Reduction is about educating them to make the best decisions for themselves.Harm reduction programs neither condone nor condemn risky behaviors.The user takes responsibility for his/her choices and behavior.Jonathan Cox, Center for Social Intervention
Harm Reduction - Principles
Theuser takes responsibility for his/her choices and behavior.The individual sets his/her own goals in collaboration with the service provider.There are no punitive sanctions for what someone chooses to put/not put in his/her body.When we create punitive sanctions, people will lie.Incremental change is normal.Quality of life and well-being measure success. An individual is still held to expectations regarding paying the rent, not destroying property, and refraining from behavior that would harm other tenants or staff.Jonathan Cox, Center for Social Intervention
Harm Reduction – What It Is NOT
Promotion of substance useBased on “loose” evidence and/or absent scientific dataCounter philosophy to abstinence“enablingservices”Is not an attempt to minimize or ignore the harm and danger associated with drug useAn excuse to ignore suffering of clientsDetached from deep meaningful relationshipsBarrier to implementing Housing FirstJonathan Cox, Center for Social Intervention
Discussion -- Philosophy into Practice
Managing Landlord RelationshipsClient Behavior ConcernsCriminal Background ChecksDamage to ApartmentsPolice Involvement
Discussion -- Philosophy into Practice
Managing Client BehaviorDefining ExpectationsOccupancy AgreementsAccountability SystemClient Refusing TreatmentLease Term ViolationsCriminal BehaviorDrug / Alcohol / Cigarette Use
Housing First IS Harm Reduction
“Contrary to the fears of many providers andpolicymakers,housing consumers withoutrequiring sobriety as apreconditiondidnot increase the use of alcohol ordrugsamongthe experimental group compared with the controlgroup.Providinghousingfirstmay motivate consumers toaddresstheir addictions tokeep theirhousing,sothat providing housing beforetreatment,maybetter initiate and sustain the recovery process.”TsemberisS,GulcurL, andNakaeM: Housing First, Consumer Choice, and Harm Reduction for Homeless Individuals With a Dual Diagnosis: Am J Public Health. 2004
Housing First Resources
Housing First Assessment Tool





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Best Practices in Harm Reduction -