Zaragoza Sofia, Silcox Joseph, Rapisarda Sabrina, Summers Charlie, Case Patricia, To Clara, Chatterjee Avik, Walley Alexander, Komaromy Miriam, Green Traci
The Heller School for Social Policy & Management at Brandeis University.
Northeastern University, Bouve College of Health Sciences.
Res Sq. 2024 Oct 15:rs.3.rs-4999367. doi: 10.21203/rs.3.rs-4999367/v1.
The City of Boston has faced unprecedented challenges with substance use amidst changes to the illicit drug supply and increased visibility of homelessness. Among its responses, Boston developed six low threshold harm reduction housing (HRH) sites geared towards supporting the housing needs of people who use drugs (PWUD) and addressing health and safety concerns around geographically concentrated tent encampments. HRH sites are transitional supportive housing that adhere to a "housing first" approach where abstinence is not required and harm reduction services and supports are co-located. Despite the importance of HRH, the specific characteristics and operations of these sites are not well understood. This study sought to address this gap by cataloging the common features of Boston's HRH sites to generate a comprehensive inventory tool for evaluating implementation of harm reduction strategies at transitional housing locations.
We collected data between June and September 2023 and included semi-structured qualitative interviews with HRH staff (n = 19), ethnographic observations and photos at six HRH sites. Candidate inventory components were derived through triangulation of the data. Two expert medical staff unaffiliated with data collection reviewed a draft inventory measuring awareness and utility of HRH inventory components. We then pilot tested the inventory with 3 HRH residents across two sites for readability and reliability. Inventory performance was further tested in a survey of 106 residents.
HRH staff identified best practices, resources, and policies in HRH sites that were further contextualized with ethnographic field notes. Common to all were overdose prevention protocols, behavioral policies, security measures, and harm reduction supplies distribution. The initial 44-item inventory of services, policies and site best practices was further refined with expert and participant feedback and application, then finalized to generate a 32-item inventory. Residents identified and valued harm reduction services; medical supports were highly valued but less utilized.
The HRH inventory comprehensively assesses harm reduction provision and residents' awareness and perceived helpfulness of HRH operational components. Characterizing the critical components of HRH through this tool will aid in standardizing the concept and practice of HRH for PWUD and may assist other cities in planning and implementing HRH.
在非法药物供应发生变化以及无家可归现象日益凸显的情况下，波士顿市在药物使用方面面临着前所未有的挑战。作为应对措施之一，波士顿设立了六个低门槛减少伤害住房（HRH）场所，旨在满足吸毒者（PWUD）的住房需求，并解决地理上集中的帐篷营地周围的健康和安全问题。HRH场所是过渡性支持住房，遵循“住房优先”原则，不要求戒毒，减少伤害服务和支持设施位于同一地点。尽管HRH很重要，但这些场所的具体特征和运营情况尚不清楚。本研究旨在通过梳理波士顿HRH场所的共同特征来填补这一空白，以生成一个全面的清单工具，用于评估过渡性住房场所减少伤害策略的实施情况。
我们在2023年6月至9月期间收集数据，包括对HRH工作人员进行的半结构化定性访谈（n = 19）、在六个HRH场所进行的人种学观察和拍照。候选清单组件通过对数据的三角测量得出。两名与数据收集无关的专家医务人员审查了一份衡量HRH清单组件的知晓度和实用性的清单草案。然后，我们在两个场所对3名HRH居民进行了清单的试点测试，以检验其可读性和可靠性。在对106名居民的调查中进一步测试了清单的性能。
HRH工作人员确定了HRH场所的最佳实践、资源和政策，人种学实地记录进一步对其进行了背景化。所有场所共有的是过量用药预防方案、行为政策、安全措施和减少伤害用品分发。最初的44项服务、政策和场所最佳实践清单在专家和参与者的反馈及应用后进一步完善，最终确定为32项清单。居民们识别并重视减少伤害服务；医疗支持受到高度重视，但利用率较低。
HRH清单全面评估了减少伤害措施的提供情况以及居民对HRH运营组件的知晓度和感知到的帮助。通过该工具描述HRH的关键组件将有助于规范针对PWUD的HRH概念和实践，并可能协助其他城市规划和实施HRH。
