Parallel Session A – Harm Reduction Proposed List of Minimum Quality Standards

Parallel Session A Proposed List of Minimum Quality Standards Are the proposed lists of minimum quality standards (high consensus in surveys) acceptable? For which types of services / interventions are they accepted? Which standards from the presented additional lists of quality standards (medium consensus in surveys) should be included in the definite lists of minimum standards ? For which types of services / interventions?

General remarks on methodological challenges: Whole issue of definitions, how deep What level of detail is needed in terms of definitions, e.g.‘ sheltered housing’ Standards would benefit from better definitions Examples need rephrasing Limitations in response > France Differences in the range of interventions List of interventions > drug dependence treatment, methadone To have it in both places: treatment and HR the way the questions were proposed (e.g. informed consent in pill testing) some services are not relevant for some standards, e.g.remove ‘ no answer’ for pill testing solution: separate questions to separate services, but that was not possible, budget

Structural standards of Interventions: 1.accessibility: location (service can easily be reached by public transport) Remarks: Accessibility is not only question of location or public transport or distance: Services have to match the needs of clients

Staff qualification: Agreed that people should be qualified Qualification standards should be transparent Missing: peer involvement/support has to get a place here “Minimum qualification” needs to be defined > different in all countries - some countries have no qualification for social work not only paper qualification: specify knowledge, skills, attitude, not one size fits it all What is staff training? timing, funding Language problem for guidelines etc Minimum requirements

Outcome standards at the system level 3. Goal: Reduce risk behavior goal should be clearly specified in the outline of the service 4. Goal: referrals ( hr services must be prepared to refer patients to other hr or treatment services if needed and agreed) also : legal services, education ?? - linkages and integration of services > structural networking

6. internal evaluation (services must regularly perform an internal evaluation of their activities and outcomes) on the base of what? Short report, quantitative? Minimum requirements, specify the goals, timelines Structured, comparable > discussion in the afternoon Definition and more content as example 7. external evaluation (independent) what is evaluation in that context? minimal definition, consensus cost effective HR services: no consensus of written record keeping Limitations: costs, time burden

Process standards of Interventions 8. Assessment procedures ( risk behaviour assessement of clients) 9. Informed consent (patients must receive on available service options and agree with a proposed plan) People are informed what is offered rather than to sign a ‘ treatment plan’ Watch about hidden agenda Transparency 10. Confidentiality of client data ( records are exclusively accessible to staff involved in a patient intervention) Switzerland is mandatory to collect data > anonym In NL client data of cr’s are provided to police Data should not be accessible without agreement of the client Different standards for the different interventions Needs of the clients comes first

Process standards of Interventions 11. Routine cooperation with other agencies > Distinction to referral procedures 12. Continued staff training

Quality standards with moderate consensus: Structural standards of hr interventions Difficult to judge responses : can be related to costs etc 1. Accessibility: opening hours All services need to match needs of clients Opening hours as criteria for accessibility Extended definition 2. Accessibility: costs to be paid Costs should not be a barrier rather than to recommend free at all services Is it acceptable that there is a financial barrier? High consensus 3. Indication criteria: diagnosis (treatment indication is always What is the distinction between indication and risk assessment ? Term diagnosis is medical sounded

4. Indication criteria: age limits for admittance No minimum age required On which services we are referring to? Sexual counselling, hr services Related to national legislation Are there advantages to limit access to services > young people Access should not be restricted WHO recommendation: Criteria risk assessment, well trained staff Interventions have to be age appropriate > move this to high consensus Was not complete consensus, age appropriate, no age restrictions

Outcome standards at System Level – moderate consensus 6. Goal: reduced substance use Reduce the risks not the substance use, promote well-being Services have to interact, goal substance use is not the aim here Is not the goal of hr Stick to the quality of hr services Otherwise we have ideological clash > low consensus to put it in as a standard

5. Staff composition: trans disciplinarity (e.g. at least 3 professions) People need appropriate skills, experience and training > Issue of peer involvement, peer support should have more attention and a devoted question Other remarks: > legal services, prison services are not covered There was no referral in any document to legal services, that’ s why it was not included