9th - Harm Reduction Coalition

9th
National Harm Reduction Conference
FROM PUBLIC HEALTH TO SOCIAL JUSTICE
Clifasefi, Seema, University of Washington, Seatlle, WA
seemac@uw.edu
Where Harm Reduction Meets Housing First
Background: Housing first (HF) programs provide low-barrier, non-abstinence-based, immediate, supportive and permanent
housing to chronically homeless people who often have co-occurring substance-use and/or psychiatric disorders.
Project-based HF programs offer housing in the form of individual units within a larger housing project. Recent studies
conducted at a specific project-based HF program that serves chronically homeless individuals with alcohol problems found
housing provision was associated with reduced publicly funded service utilization, decreased alcohol use, and sizable cost
offsets. No studies to date, however, have qualitatively explored the role of alcohol use in the lives of residents in projectbased
HF.
Methods: We collected data in a project-based HF setting via naturalistic observation of verbal exchanges between staff
and residents, field notes taken during staff rounds, and audio recorded staff focus groups and resident interview sessions.
Qualitative data were managed and coded using a constant comparative process consistent with grounded theory methodology.
The goal of the analysis was to generate a conceptual/thematic description of alcohol’s role in residents’ lives. Results:
Findings suggest it is important to take into account residents’ motivations for alcohol use, which may include perceived
positive and negative consequences. Further, a harm reduction approach was reported to facilitate housing attainment and
maintenance. Residents and staff reported that traditional, abstinence-based approaches are neither desirable nor effective
for this specific population. Finally, elements of the moral model of alcohol dependence continue to pervade both residents’
views of themselves and the community’s perceptions of them. Conclusions: Findings suggest it is necessary to set aside
traditional models of alcohol use and approaches to better understand, align with, and address this population’s needs. In
doing so, we might gain further insights into how to enhance the existing project-based HF approach by applying more tailored,
alcohol-specific, harm reduction interventions.
Seema Clifasefi, PhD is an Acting Assistant Professor at the University of Washington and has been part of the academic team
working in partnership with the Downtown Emergency Service Center to evaluate its project-based Housing First (HF) approach
since 2006. Her current focus involves research, training and evaluation in the development and dissemination of substance use
interventions.
Coauthors: Elizabeth A Dana; Michele P Andrasik; Natalie Stahl; Megan Kirouac (University of Washington), Callista Welbaum;
Margaret King; Daniel K Malone (Downtown Emergency Service Center)
Coffin, Lara, People’s Harm Reduction Alliance, Oakland, CA
laracoffin@gmail.com
Vein Care Tips and Tricks.
Loss of veins can be devastating for a person who injects drugs. The risk of losing peripheral (arm or leg) veins, and having
to rely on muscling, skin popping, femoral or jugular veins, increases with certain types of drugs, qualities of drug, and
approaches to injection. This workshop will review the risks and consequences of losing veins, discuss some approaches
drug users have found to cope with worsening vein access, demonstrate a vein care session, and consider what we can do
as service providers to help drug users maintain or even improve their peripheral veins.
Lara Coffin, MPH, is a public health researcher, consultant, and provider. She has been involved in harm reduction for the past
17 years with programs and investigations in Santa Cruz, San Francisco, Ann Arbor, New York, and Seattle. Topics of particular
interest to Lara include naloxone distribution program evaluation, blood-borne pathogen prevention, HIV and hepatitis C education
and prevention and vein care. She also has a thing for steam punk.
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