2019: Harm Reduction in the House: Conversations on the Edge


Harm Reduction in the House 2019: Conversations on the Edge

UIC Student Center East, 750 S. Halsted, Chicago
8:00 a.m.- 5:00 p.m. – Friday, October 4, 2018
The 9th annual Harm Reduction in the House conference will take place on the 4th of October 2019

Last year our focus was to expand our awareness and practice of self-care to embrace the inclusive dimension of collective care. We explored innovative programs and ways to better our communities, with a focus on how we think about and show our care for each other.

This annual conference focuses on the process, challenges, and advantages of creating and working in housing programs which embrace harm reduction—that is, housing which does not require abstinence from risky behaviors. Over the years we’ve expanded our harm reduction conversations to include additional supportive services and providers who help empower people toward stability in their housing.

This year our theme is CONVERSATIONS ON THE EDGE. Conference presenters will share pioneering, groundbreaking, or trail-blazing ideas.  We’ll celebrate the opportunity to learn unconventional practices we can apply to challenges we face, people we serve, and to ourselves, while exploring possibilities to evolve even further new methods and insights.

Discussion topics will include innovative strategies on timely issues which move beyond the status quo. We’ll look to the wisdom of innovators in our field to inspire change from within.

Harm reduction evolves around creativity. As we work to implement harm reduction within longstanding organizations and environments, we must constantly innovate and push against barriers imposed by funding and standard practices, by complacencies and formulas of convenience and expedition, and the harm of our own stagnancy.

Philosopher-theologian-educator and civil rights leader Howard Thurman wrote about the “growing edge” of life. Of ALL our lives.  “The roots are silently at work in the darkness of the earth against a time when there shall be new leaves, fresh blossoms, green fruit.”

Please join us for an exciting uplifting day exploring revolutionary ideas as we share CONVERSATIONS ON THE EDGE! 

8:00am – 9:00am Registration            

9:00am – 10:20am Welcome & Opening Session–  The Alliance for Collaborative Drug Checking—Real Time (ACDC-RT) (Illinois Room)

Lydia Karch, MPH

The overarching aim of the ACDC-RT, led by The Chicago Recovery Alliance, is to establish a rigorous, street-based “drug checking service” that provides real time information on drug composition to people who consume illicit substances. At the heart of the initiative is a triangulated methodology for evaluating illicit substances to determine their actual chemical composition and providing that information directly to consumers for the purpose of reducing potential harms associated with drug use. Our primary concern is twofold: (1) developing a methodology for identifying the presence and quantity of fentanyl and its analogues in samples submitted for evaluation and (2) implementing harm reduction strategies for reducing the risk of overdose associated with the consumption of fentanyl-positive street drugs.

At a more macro level, the drug checking project collects and disseminates data on changing trends in Chicagoland’s street drug landscape. Through the use of four technologies – infrared spectroscopy, high pressure mass spectrometry, fluorescence microscopy, and lateral flow chromatographic immunoassay test strips the ACDC project has evaluated approximately 500 residue samples submitted by people who use drugs in Chicago. 

Powerpoint: ACDC-RT

10:30am – 12:00pm Psychedelics: Harm Reduction and Healing (Illinois Room)

Vilmarie Narloch, PsyD, Geoff Bathje, PhD, and Valery Shuman LCPC, ATR-BC  

Like most substance, psychedelics can be therapeutic and can have risks. However, psychedelics, to a greater degree than most substances, have healing potential and risks that are tremendously influenced by set and setting of the person using them. Our presentation will explore this dialectic of healing and harm. In particular, we will contrast personal use and medicinal use of psychedelics, how they overlap, and the potential risks and benefits of each.

We will also anchor our assessment of psychedelics within the sociopolitical context in which they are used, from indigenous community settings, to festivals, to retreats, to research trials and ketamine clinics. We will cover the range of use, including microdosing, personal use, and therapeutic use. We will evaluate the sociopolitical/cultural barriers to harm reduction and healing, and discuss the legal pathways to becoming a psychedelic-assisted therapist.  

Powerpoint: Psychedelics Harm Reduction and Healing

10:30am – 12:00pm Takin’ It to the Streets (Cardinal Room)

Erica Ernst, LCSW, RDDP, EMT-P, CADC and Loren Phillips, LCSW 

Have you ever wondered how your clients who are now receiving your cutting-edge services in housing got to you? Often the answer is street outreach. Join us for a discussion of best practices in mental health, physical health and Harm Reduction where people need it most. We meet our folx literally and figuratively ‘where they’re at’–under viaducts, in encampments, on the trains–outreach workers bring services to the people. For multitudes of reasons, our clients are often not looking for us. Trust can take years to build. Outreach teams use best practices in mental health care to build trust and walk with participants–at their pace. We start where and when the client wants to start, often with meeting basic needs such as food, water, a tent, a sleeping bag, and safer use supplies including fentanyl test strips. After multiple meetings, folx may be open to their blood pressure being checked, glucometer readings, and STI testing.

They may be open to being linked through these relationships directly with mobile agencies such as the Night Ministry (for more in depth health services) and the Chicago Recovery Alliance (for safer use supplies and drug content checking). Later, they may be open to linkage with homeless-centered clinics such as Heartland Alliance (for general health and Suboxone if applicable). Outreach teams must build relationships with service providers as well to ensure that our folx are treated with dignity and respect–sharing our privilege–to expand opportunities for individuals living on the streets.

What’s happening to expand street outreach in Chicago:

-partnering with street medics and nurses

-mental health services and interventions where folx are most comfortable (‘street therapy’) 

-medical services in encampments, or anywhere folx are

-distribution of safer use supplies, Naloxone, Fentanyl test kits and wound care supplies

-assistance with improved vein care, safer use techniques, and wound care assessment

-‘warm hand offs’ to housing, medical treatment, MAT and any other desired services

-entry into the CES, observational assessment, and other housing options and resources

-finding and forging relationships with folx who have been rejected and disenfranchised by society 

-shifting the approach: How does the system need to change to work for the participant? vs. How does the participant need to change to be ‘ready’ for housing?

-being involved in advocacy and encouraging clients to have a voice (prison industrial complex, lack of affordable housing, lack of low barrier housing (Safe Havens, SROs, etc.)

-searching for sustainable funding streams to initiate and maintain paid Outreach Workers

-hiring those with lived experience

-how to initiate or bolster these services 

Powerpoint: Takin it to the Streets

10:30am – 12:00pm Risk Reduction with Domestic Violence Survivors (Fort Dearborn Room)

Danielle Boachie, MA, ICDVP

A common question domestic violence survivors are asked is: “Why didn’t you leave?” This interactive workshop will unpack victims’ barriers to leaving an abusive relationship, and cover risk management / harm reductive frameworks to adopt when working with victims. We will also take a trauma informed approach to conceptualizing abusers / perpetrators as people who harmed (non-static terminology) in order to affirm past trauma and victimization, and build towards a future of restorative and transformative justice. 

Powerpoint: Harm Reduction with DV Survivors

12:05pm – 1:05pm Lunch provided (Networking)

1:15pm – 2:45pm Creating Living Space for Sexuality: Harm Reduction Through Sex Ed (Illinois Room)

Worner Leland MS, BCBA 

For adults with learning/intellectual disabilities or divergence, there is heightened vulnerability to both sexual assault and sexual human rights restrictions. This talk will examine harm reduction through tailored, comprehensive sex education and environmental arrangement to accommodate and honor sexual behavior rights. 

For adults with learning/intellectual disabilities or divergence, there is heightened vulnerability to both sexual assault and to sexual human rights restrictions. Because LD/ID adults often live with family, or in group homes or institutions, there is often restricted ability to engage in preferred sexual activity, and restricted capacity to avoid abusive individuals. Unpublished Justice Department data suggests that LD/ID individuals are at least seven times as likely to experience sexual assault as their neurotypical peers, and that 86% of these assaults are committed by a non-stranger (Shapiro, Anderson, Benincasa, & Van Woerkom, 2018). Additional 2016 case study data from the state of Pennsylvania on sexual assault in group homes suggest that 42% of suspected offenders were other LD/ID adults; 14% were staff, 12% were relatives, and 11% were friends, (Shapiro et al., 2018).

Infantilization of LD/ID adults and cultural discomfort discussing sex both lend to creating a climate in which sexual health and sexual behavior are ignored, as is the potential for LD/ID adults to engage in sexual assault of peers. Two important strategies for reducing these harms are tailored, comprehensive sex education and environmental arrangement to accommodate sexual behavior. This talk will examine current best practice for assessing sex education needs, providing tailored support, and measuring outcomes. This talk will also examine different models of arranging living space to accommodate and honor the sexual behavior rights of LD/ID adult residents.

After attending this intermediate-level workshop, participants will be able to:

a) Explain how a perspective of neurodiversity differs from a more traditional view of mental illness, and the impact of this framework on sex education. 

b) Explain sex and consent education for LD/ID adults.

c) Describe concrete strategies for arranging living space to meet sexual behavior needs of LD/ID adults. 

Powerpoint: Sex Ed as Harm Reduction

1:15pm – 2:45pm Being a Good Neighbor: Engage Your Community (Fort Dearborn Room)

Chris Schaffner, CADC 

Being a good neighbor and having the support of your community can impact the influence you have on those your organization serves. In this workshop you will learn how to effectively network and partner with organizations such as; social service organizations, shelters, housing programs, anti-violence programs, and the individuals living in your community. You will also learn how to promote your services in a way that shapes the narrative about how you are impacting your community in a way that increases effectiveness and volunteers.

Working with the community can be a difficult task. NIMBYs, politicians, and local organizations likely do not understand harm reduction. Developing partnerships is important but takes time and intentionality. This workshop will explore best practices for engaging your community and overcoming unnecessary barriers. 

Powerpoint: Being A Good Neighbor

1:15pm – 2:45pm Outreach and Clinical Models to Identify and Address Barriers to Hepatitis C Treatment (Cardinal Room)

Thomas Ambelang, Sam Forsythe, Alaa Wasfi, RN, and Sarah Kwasigroch, PharmD

In Chicago access to Hepatitis C treatment is limited by proximity to health care centers, sobriety requirements, insurance restrictions, income, and community stigma. This can results in patients suffering from preventable disease progression towards cirrhosis. Howard Brown Health, a network of FQHCs throughout Chicago, implemented an HCV treatment program to address the above-described barriers in order to treat those who are mono and co-infected with HCV and HIV. We bring services to clients by utilizing an outreach model based on community feedback and executed within community spaces; once clients are engaged in services treatment is achieved in clinic with a multidisciplinary team.

Issue: Globally, an estimated 71 million people have been infected with Hepatitis C virus (HCV), yet roughly 1% (950,000) have been cured. Though medication has shown to be highly effective, patients are often denied treatment due to substance use restrictions implemented by providers and insurance, cost, and availability of services. We frequently hear of patients facing 2 month waits for HCV treatment consultations, or if they’ve been prescribed treatment and approved they are required to pay unrealistic copays. Many don’t even get tested or pursue treatment due to preconceived notions about risk factors or fear of blame, rejection, and
judgement.

Learning Objectives:

a) Analyze stigma and illustrate the ways in which it affects patient’s access to and engagement in care.

b) Review an outreach model formulated around feedback from community institutions, leadership, and groups.

c) Describe the implementation of a multidisciplinary treatment model that is adaptable to each patient’s set of barriers and verbalized needs.

d) Model conversations with patients that normalize and validate the personal and systemic barriers patients encounter, so language may be used as a tool against the stigma associated with HCV.

Strategies: Outreach efforts increase awareness and accessibility through education, testing, and case management services within trusted community centers, and afford the opportunity to hear what resources are needed directly from leadership. Once clients are engaged in services, treatment is pursued through the multidisciplinary care team to ensure clients receive consistent, individualized support. The team utilizes a harm reduction framework and is composed of social, medical, and pharmaceutical assistance while working with patients from initial referral through post-treatment labs, explaining and arranging next steps as well as advocating for patient needs with providers and insurance companies. 

In order to effectively educate, test and treat HCV, it is necessary to acknowledge existing barriers to care and their unique and varying effects on both communities and individuals. This tailored approach allows our multidisciplinary team to more effectively reach communities on their terms and open conversations about HCV through education, testing and linkage to care. Since implementing this program in March of 2017, we’ve assisted 128 patients in achieving sustained virologic response despite ongoing barriers of substance use, unstable housing, repeated insurance denials and histories of clinical or social shaming. 

Powerpoint: Outreach and Clinical Models to Identify and Address Barriers to Hepatitis C Treatment

3:00pm – 4:30pm Death Panel: Harm Reduction and End of Life Care (Illinois Room)

Kimber Brightheart, LCSW, Jamie Lavender, LMFT, Bobbi Nyman, RN, and Emily Segal, MAAT, LPC 

Harm reduction helps people feel empowered to survive, heal, and design the life they need most in whatever forms are possible, desirable, and meaningful. It supports individual autonomy as well as connection and companionship with others, emphasizing that no one should have to go through life alone in their experiences, especially the most challenging ones.

At the same time, survival, healing, and living aren’t the only applications of harm reduction– it’s also uniquely suited to supporting a person’s end of life goals. Harm Reduction means to live with dignity, and it also means to die with dignity.

In serving vulnerable communities experiencing serious health inequalities, we likely encounter death more regularly–it is not uncommon for clients to die within our care, in a variety of settings and circumstances. Many people in these communities encounter barriers to quality end of life care, including:

loss of autonomy

poverty/lack of available services

lack of dual diagnosis-specific services

judgment about life and health choices (including blame for harms of historical health choices that have led them to an end of life diagnosis i.e. alcohol use and liver disease)

stigma related to medicines they are utilizing for physical, emotional, and spiritual symptom management (based on whether or not those medicines are medically prescribed, plant-based, legally available or prohibited, sourced from underground markets, etc.).

It is our responsibility to reframe our thought processes to appropriately assist our clients in meeting their end of life needs and goals in ways that make sense for them. This panel will address how we can better meet individualized end of life needs and goals using harm reduction models in medical, therapeutic, and spiritual dimensions. In the process we’ll identify ways in which end of life care and harm reduction perspectives are naturally aligned, and can help foster collaboration and acceptance with people in end of life care and their loved ones. Additionally, we hope to assist people who work in treatment settings to adapt their thinking from curative to palliative care, and to improve physical and psychic comfort levels for those in the dying process. 

Powerpoint: Death Panel

3:00pm – 4:30pm Moving past systemic oppression: Creating realistic safe spaces for street-based youth (Cardinal Room)

Nikki Mckinney and members of the Street Youth Rise Up Task Force

This workshop will demonstrate how interpersonal and institutional violence affects youth who are involved in street based economies. Using an interactive approach, the presenters will guide attendees through an experience to help them understand what makes everyday spaces unsafe for street-based youth, and learn alternatives to supporting this population. 

3:00pm – 4:30pm Medical Cannabis (Fort Dearborn Room)

Kelly Ducheney, PsyD. Cori Blum, MD, AAHIVS, and Claudia Smith 

This presentation will discuss the harm reduction, primary care focused, interdisciplinary medical cannabis program developed at Howard Brown Health, an LGBTQ community health center in Chicago. Presenters will offer examples of client materials and describe challenges and decision points we have encountered in the 3 years of running the program.

This presentation will discuss the state of Illinois’ medical and opioid alternative cannabis programs and the harm reduction focused medical cannabis program developed at Howard Brown Health, an LGBTQ community health center in Chicago. Howard Brown Health launched
its program in 2015, with over 680 patients requesting medical cannabis to date. We’ll discuss our model and interdisciplinary team approach, offer examples of client materials and describe challenges and decision points we have encountered in the 3 years of running the program.
The presentation will offer attendees the opportunity to consider the creation of a similar program at their organization and/or become more informed advocates for medical cannabis access. We will discuss our attempts to integrate medical cannabis into the provision of primary care. Attendees will be able to:

a) Identify the core components of a medical cannabis certification program 

b) describe program elements to enhance the harm reduction impact of the program

c) describe 2 ways that medical cannabis access and/or legalization of recreational cannabis use could impact the provision of primary care and behavioral health services.

Powerpoint: Medical Cannabis 

Handouts: Medical Cannabis Handouts

 

For contact information, questions, comments, or concerns, please email MHRI@heartlandalliance.org