While working on the mobile health van and doing outreach in the community I have been talking to many individuals in residential hotels that are using and individuals that are partners of people that use. By educating them about the importance of sterile syringes and not sharing, by handing out naloxone and fentanyl test strips the feedback I have received from residents and staff at the hotel is about feeling cared for and supported. Residents have saved lives there at least 7 times if not more. There are 3 individuals I know that were tested for HepC and referred to primary care from my interactions alone. We pick up used syringes from sharps containers that we give out and thereby eliminate those syringes from being thrown out in the parking lots and/or garbage unsafely

A navigator has recounted his experience at supporting one of his participants by providing transport to the SSP program where he continues to get drug user health education, sterile supplies and had an abscess cared for by one of our collaborating primary care providers. He also assists a participant that is experiencing homelessness by taking him to his storage site and helping him access his medications that he needs to take daily to maintain his mental health and his opioid addiction.

“We support anything that helps/allows people to be in a place of greater relative health in accordance with THEIR goals. I recently did an intake with someone who returned to use because they got off their suboxone because their girlfriend wanted them to no longer be on it. We support people being on MBT and never tapering down or stopping MBT unless that is THEIR goal, and we believe there should be no stigma attached to taking MBT.

I completed an intake with a client who told me she had used a single syringe 40+ times before coming to access services with us. I provided her supplies, education, and tools, and when I saw her the following week, she now only uses a needle ONE time and disposes of it.

I have a client who regularly accesses SSP who has open sores and many abscesses. He has always said he was not interested in accessing any medical care or going to the emergency room. I continued to listen to him and offer wound care kits, antibiotic ointment and listen to his concerns about seeking medical attention. I did tell him about the medical provider we work with from CHC that is here every Friday and who approaches her work in a harm reduction based manner and does not judge, Eventually, after about 6 months this individual made and kept an appointment with this provider and is starting to feel better and has seen improvements with the skin issues. He thanked me and said that I never looked down on him or got angry with me and I thank you. He is now engaged in ongoing primary care with the provider.”

We design and re-design services based on the needs of the most vulnerable. We have cleared a shelf for providing clean, nice clothing for participants. People who receive services have GREATLY appreciated this resource.

We also expanded food access resources as an agency, allowing people to access food once per week rather than once per month, which clients have greatly appreciated. In addition to this, I strive to make food specifically accessible to the particular needs of our clients who travel only on foot or by bike, or who are houseless or without a stove, by asking if folks have a can opener, asking if they have a stove, ensuring that food resources are appropriate and will work for all people, rather than one size fits all. Last week I also got a milk crate for a client and helped her attach it to her bike with tourniquets so that she could get her meal, ELP, and new clothes home, rather than having to leave them behind because she does not have a car.

“In my time working in the SSP program I have worked with many women who have been incarcerated repeatedly and faced structural violence in the carceral setting as well as with their partners. As a peer with history of incarceration and the shame and stigma that exists within relationships and institutions over time that I have shared, I’ve had women open up and discuss ways they are now being more mindful of their reproductive health, their risks of STIs and following up with service providers that are supportive of them and not judgmental.

One of my participants has a mental health diagnosis and due to this can be argumentative and unaware of social cues. He has been turned away from some agencies because he is, in their words, difficult to work with. I realize he has a condition that makes it difficult to comprehend and respond appropriately at times and I continue to support and assist him with his interactions with other agencies and I advocate for his basic needs. He trusts me and I can deescalate situations that others may not have the ability to do thereby getting his needs met, like medications, housing, dr. appts and transportation.”

We regularly hold Community Advisory Board meetings where we partner and exchange information with people who access our services, and we have implemented feedback from CAB meetings by sending Navigators to particular locations for outreach and Naloxone distribution as the direct result of information from clients in CAB. We also pay people for their wisdom and expertise.

We implemented the white board in SSP where we have ongoing participant involvement in sharing information that aids in community access to information about the drug supply.

“I include my participants in all manners of communication with providers and I listen to their needs and follow up on their goals. For example, one of my participants had a skin infection and needed to be seen for medical care and did not want to go to an area emergency room due to the way he had previously been treated. I asked where he would feel comfortable and was able to arrange transportation outside of the immediate area and he received good care and was extremely grateful and treated well. This ensures he will continue to discuss his needs with me.”

We recognize that policing, criminalization, and the War on Drugs disproportionally harm marginalized communities, and we work with people to come up with creative approaches in the face of these structures. We speak with the police department and have come to an agreement that police will not patrol certain areas while we are doing outreach, we pick up returns via van if people do not feel safe or comfortable traveling with sharps to return, we have SSP client cards for people, and we provide info on CT Good Samaritan Law.

We also recognize that people who engage in sex work are at the intersections of several harmful systems and policies. I purposely sought-out and created sex worker-specific harm reduction information and resources, which are available in SSP.

We assist an individual that is transgender with the resources she needs to discuss her concerns regarding her use, her trauma and the fear she feels in the community on a regular basis. In being trauma informed and aware of the impact of trauma on the lives of the trans community we engender trust and show we support her needs and fears.

We use the approach that we can provide information, provide resources, and offer/encourage, but we NEVER tell people what to do, or what they "have" to do. An example of this is with a client of ours whose skin was visibly eroding, and who was also off all medication for diabetes management. I engaged with him casually and supportively over time and built trust, was able to talk with him about how his legs are feeling and if he has a Primary Care doctor he likes and trusts. In the course of these conversations he identified that his barrier to re-engaging in care was actually shame. I was able to discuss this with him, and ask open-ended questions about what's going on for him and what would feel helpful. The client trusted me and us enough to discuss this, and we approached it by providing conversation and resources but leaving it in his hands, that our role is not to tell him what to do but to remove barriers and assist him in any way that would feel helpful. As a result of our conversation, the client decided to reach back out to his Primary Care doctor and is now back in care, receiving care for his wounds, and is back on life-saving medication for his diabetes.

We aim to provide services in a non-coercive manner with a focus on the health, dignity, and autonomy of people who use drugs. We outline best practices for safer use, OD prevention, and OD response, but we know that people we serve will make their own choices. Rather than tell people what they must do, we have conversations with them about what resources may plug into their choices, barriers, and needs. We know that it is a best practice to not use alone. But if people are going to use alone, we provide and discuss the Never Use Alone hotline and overdose prevention strategies to make it as safe as possible. If clients discuss hesitancy in calling 911 in the event of an overdose, we discuss what is coming up for them and provide information and/or discuss a relative safety plan with them such as: providing info on CT Good Samaritan law, overdose prevention strategies, overdose response and Narcan training, the ability to drop someone off at the hospital if would not call 911, and whatever other strategies may serve to keep that person and others that they use with safer.

“One of the participants I work with uses alone and his mother and girlfriend do not know about his use. I discussed the overdose risks involved in using alone and I gave him the Never Use Alone hotline information. He stated he did not realize the dangers of using alone and would use the hotline. He has started using the hotline regularly and is sharing the information with other people that use.”

We understand that drug use exists in the world and provide supplies for folks who use to be as safe as possible. We discuss what acid(s) people use to break down their product and provide pharmacy-grade vitamin C powder to replace the lemon juice or vinegar that some clients use. Using pharmacy-grade vitamin C powder can reduce bacterial infections potentially caused by lemon juice or vinegar and is better for the health of people's veins. Rather than take an approach that people should not be using substances, we aim to reduce any potential harm associated with use. We want people to be safe, healthy, and alive.

“A client has acquired endocarditis. The person was hospitalized for several months, may require open heart surgery, and could die if more bacteria gets in to the client's system while using. The client is not currently interested in reducing or stopping use. I worked with this client to outline every strategy for safer injection to avoid bacterial infections and review strategies to prevent or reduce any harm that could come to the client while using. As an agency we also provide support and navigation services to remove all barriers to accessing MBT and reducing or stopping use, if or when a client is ready. The client is aware of these services and may access in the future, and for now has been provided information and necessary supplies to be as safe as possible and prevent bacteria from entering client's system.

I have had conversations with participants that are HePC positive and continue to use drugs about treatment for HePC and that they do not have to stop using to start HePC treatment. An individual that accesses our SSP and does not share paraphernalia was referred for treatment and is now on treatment for HePC and still using but understands the importance of using sterile syringes and is aware of the reinfection concerns with HePC.”