Module 3 Engaging with young people around injecting drug use and harm reduction services

Explore some of the barriers to youth workers and young people in engaging with and around harm reduction services Analyse the influence of drug related stigma and discrimination Explore different scenarios involving young people around injecting drug issues Discuss the Do’s and Don’ts of engaging young people around injecting drug use. Wrap up the day. What we will be doing

Quick question: “On a scale of 1-10 how confident are you right now having a conversation with a client about injecting drug use?” How confident are you?

1.Break into smaller groups/discuss as a group 2.Identify some barriers a youth worker may have in engaging with a young person around injecting drug use personally within job role within service 3.Identify some barriers and challenges a young person may have to ask about injecting drug use, inject safely or to access support services 4.You have 10 minutes 5. Allocate someone to report back to the group Exercise - Barriers to engaging with young people at risk of injecting

Understanding the influence of drug related stigma on young person’s decision to access harm reduction services.

is considered to be an opinion or judgement, often unfair, held by individuals or society about something. is the concept of people being 'marked' as different, specifically in a negative manner. Leads to stereotyping Results in status loss What is stigma?

when someone is treated less favourably than other people in the same circumstance because of a particular characteristic has many forms but always leads to exclusion or rejection Stigma the belief - discrimination the action When stigma is acted on it leads to Discrimination

Stigma from individuals Institutional Stigma Self stigma (internalised) Stigma by association Types of Stigma

5 elements of drug related stigma can be identified Drug- Related Stigma

Blame and moral judgement that drug use is always a ‘choice’ ‘just say No’ any conditions from drug use eg hep C are brought ‘upon themselves’ Key Elements of Injecting Drug Related Stigma

Criminalising that problematic drug use is treated as a criminal activity as opposed to a public health issue the ‘war on drugs’ is often a ‘war on drug users’ Key Elements of Injecting Drug Related Stigma

Pathologising implying drug users are sick important that when talking about for example addiction as a disease that we don’t further stigmatise ie ‘disease’ equating to ‘diseased’ diseases themselves are not immune to stigmatisation different from public health approach to drug use Key Elements of Injecting Drug Related Stigma

Patronise in language or in sense that others know better what is best Key Elements of Injecting Drug Related Stigma

Fear and Isolation fear of drug use fear of drug users fear of drugs Key Elements of Injecting Drug Related Stigma

Developing Skills - Case Studies Aim is to: develop strategies to engage young people and provide information about preventing hepatitis C be able to frame harm reduction work within your organisation’s broader role

Issues: Media and public involvement, unsafe disposal, threat to service, child protection (near school), lack of knowledge around hepatitis C/HIV risks in this area Risks: Needle stick injury, bad publicity, political ‘storm’, threat to youth service and other harm reduction services (i.e. NSP), impact on other services offered, threat to reputation Case study 1 Dealing with the public and media

Issues: Age of Steve, power dynamic (older/younger), at risk of injecting, parental concern/relationship, knowledge of hepatitis C and safe injecting, sharing of sensitive information Risks: Child protection issues, unsafe injecting, hepatitis C transmission, overdose, becoming dependent on heroin, peer influence on behaviour, break down in Steve’s relationship with parents, arrest Case study 2 John and Steve

Issues: Child protection, tenancy risk, unsafe injecting, power dynamic in relationship, conflicting tenancy regulations, obligations to share information Risks: Custody of child, tenancy at risk, BBI transmission, unsafe injecting, overdose, longer term potentially problematic injecting drug use Case study 3 Tim and Alice

Issues: Uninformed on safe injecting practices and BBI risks, infected injection site, supplying drugs to friends, youth workers knowledge of injecting PIEDs Risks: BBI infection from sharing needles, unsafe injecting behaviour, infection left untreated could get worse, other health risks associated with PIED use, ignorance of risk taking behaviour Case study 4 Jeremy and Sue

Issues: Early exposure to injecting drug use, 3 year using history, high chance of hepatitis C infection, child protection, parental influence on drug use, limited social support, Aboriginality (specialised services available?), future work prospects Risks: High risk BBIs transmission, overdose, losing contact with children, re-offending, homelessness, unemployment due to offending history Case study 5 Thomas

Issues: Lack of harm reduction services, confidentiality, power dynamic in the relationship, sharing injecting equipment, age (access to injecting equipment) Risks: BBI infection, overdose, becoming dependent on heroin, losing family support, not completing education, drug use becoming public knowledge Case study 6 Amy and Greg

Issues: Possible drug induced psychosis requiring immediate attention, potential threat to all at drop-in Centre, age (access to injecting equipment), Mandatory reporting requirements, peer influence, organisations policy on drug use Risks: Longer term mental health issues, BBI transmission, overdose, access to injecting equipment, uncontrolled methamphetamine use, police involvement, access to support services Case study 7 Caroline

Issues: Purity of the drug, using alone, his peer influence on others, enjoying drug use – lack of motivation to quit (stage of change) Risks: Overdose, unsafe injecting, BBI transmission, heroin dependency, potential risk to employment of drug use becomes known, contact with youth service. arrest Case study 8 Chris

Issues: Relationship power dynamic, peer influence, exposure to injecting to drug use through living arrangement, knowledge of hepatitis C risk, knowledge of NSP services Risks: BBI transmission, sharing equipment, overdose, escalation methamphetamine use, riskier drug using behaviour Case study 9 Robyn

REMEMBER You already have a relationship with the person Your relationship with the young person is key respect their autonomy and independence Don’t be afraid to ask Don’t be afraid to say ‘I don’t know’ Avoid stigmatising or stereotyping Create a safe space for discussion When talking to young people around injecting drug use and harm reduction services

Be informed about injecting drug use and risks associated with injecting but you don’t need to be the expert Know where harm reduction services are and where to refer clients – bring in specialists if required Take note of ‘duty of care’ and your legal responsibilities Have appropriate resources eg BBI info, safe injecting information at disposal or know where to get them When talking to young people around injecting drug use and harm reduction services

Don’t assume that your perception of the situation is matched by the person you are working with Be aware of your organisation’s policy on injecting drug use, if any Be clear with young person what you can and cannot do as a worker and organisation eg confidentiality, mandatory reporting requirements Remember some of the barriers identified earlier When talking to young people around injecting drug use and harm reduction services

Tell us: One new thing you learned today One practical thing you will take away Who you would go to for more help or info (service/person) regarding injecting clients Any questions? Please fill out the evaluation form Thanks for participating today Closing activity