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Outreach & Engagement Strategies
TRAINER INSTRUCTIONS Welcome! This is a half-day overview on Outreach & Engagement with a focus on People Who Use Drugs (PWUD) and people who engage in sex work The workshop is 3 hours with one scheduled 15 min break. NOTES Include Introductions if this workshop does not follow another HRW training that already had an Introductions section. Introductions are when each workshop participant can share their name and program or agency they work with. Tanagra M. Melgarejo Chris Abert Julie Rwan
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Harm Reduction Coalition
Founded in 1993 by needle exchange providers, advocates, and drug users Challenge the persistent stigma faced by people who use drugs Advocate for policy and public health reform Policy & Advocacy Training & Capacity Building Overdose Prevention & Advocacy National & Regional Conferences Resources & Publications Harm Reduction Coalition creates spaces for dialogue and action that help heal the harms caused by racialized drug policies.
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to empower Community Based Organizations and Health Departments
NYC CBA NYC DOHMH’s Capacity Building Assistance project (NYC CBA) provides free and customized training, technical assistance and culturally and linguistically appropriate information to empower Community Based Organizations and Health Departments to increase health equity. HIV Testing Policy Prevention with HIV-Negative Persons Condom Distribution Prevention with HIV-Positive Persons Harm Reduction PrEP and PEP HDs CBOs Navigation & Care Coordination Outreach & Recruitment Community Mapping Follow up on today’s session: Julie Rwan Connect with us to learn more: Name-request NYC CBA by visiting
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INTRODUCTIONS Name Pronoun Role Expectation for the training
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Group Agreements Step up, Step Back Non-Judgment Use “I” Statements
Agree to disagree Confidentiality WAIT/PUSH/ELMO TRAINERS INSTRUCTIONS We are talking about outreach today, so this workshop might bring up sensitive topics for some workshop participants. Use the training to ask questions and discuss concerns. It will be important to be respectful of each other during this time. Are there other group agreements to add? (ex: cell phone or technical device use, one mic, etc.) KEY MESSAGES Step Up/Step Back: Agree to Disagree: We all have own opinions. WAIT: Why Am I Talking PUSH or ELMO: Say PUSH, to “push” on training or Everybody Lets Move On
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Training Objectives Discuss the benefits of outreach.
By the end of this session you will be able to: Discuss the benefits of outreach. Recognize participant needs, more effectively. Examine the role of self-disclosure during outreach interaction. Identify ‘best practices’ to ensure safety for both outreach providers and participants. Provide more appropriate referrals. TRAINER INSTRUCTIONS This is a half-day workshop with one scheduled break. Workshop includes discussion and activities. By the end of this session you will be able to: Discuss the benefits of outreach. Recognize participant needs, more effectively. Examine the role of self-disclosure during outreach interaction. Identify ‘best practices’ to ensure safety for both outreach providers and participants. Provide more appropriate referrals.
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BRAINSTORM: What is the Purpose of Outreach?
ASK What is the purpose of Outreach? When you hear it, what first comes to mind in terms of services? How is this term used by others [in the office, by peers, etc.]? TRAINER INSTRUCTIONS Use this brainstorm as a way to open the training, getting a sense of what harm reduction means to participants, including their experiences with harm reduction. This may be from a personal perspective (how harm reduction was -or was not- incorporated at their agency, or through their experience working as a peer/service provider). If any responses in particular seem “off-base”, use the following slide to clarify. Optional Write down responses on Newsprint w. Thick Pen Markers Or, ask if a volunteer would write down answers while you facilitate discussion Or, have this discussion only
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Outreach “A process designed to contact individuals in non-traditional settings who might otherwise be ignored or underserved.” The Open Health Services and Policy Journal; 2010. Olivet J, Bass. UK E, Elstad E, Kenney R, Jassil L.; Outreach and Engagement in Homeless Services: A Review of the Literature
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What is the Purpose of Outreach?
Make connections with people in the community. Provide harm reduction supplies and education. Offer support. Provide a non-judgmental bridge between services. ASK What is the Purpose of Outreach? KEY MESSAGES Main role: provide outreach and make connections with people in the community (engagement). Provide harm reduction supplies, education, and support. Engage individuals in the community about your organization in a neutral setting. Provide a friendly bridge between low threshold street-based services and higher threshold office-based ones.
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What is the Purpose of Outreach? You are not expected to do everything
Provide active listening Provide key referrals: medical care, syringe exchange, overdose prevention, testing for HIV and Hep C, Hep A + B vaccinations Remember You are not expected to do everything or know all of the answers.
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Summary of Outreach Skills
Philosophy of unconditional caring & respect Ability to establish trust & communicate effectively Equipped with appropriate information: knowledge of local resources relevant to target population, ability to make referrals Organizational skills, record keeping Ability to network with at-risk groups Maintaining appropriate personal boundaries Ability to work in target population’s community; actively participate in community events Refer to Characteristics Handout KEY MESSAGES Philosophy of unconditional caring & respect Ability to establish trust & communicate effectively Equipped with appropriate information: knowledge of local resources relevant to target population, ability to make referrals Organizational skills, record keeping Ability to network with at-risk groups Maintaining appropriate personal boundaries Ability to work in target population’s community; actively participate in community events Adapted from NIDA, Community-Based Outreach Model: A manual to reduce the risk of HIV & Other Blood-Bourne Infections in Drug Users; 2000
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ACTIVITY: Skills & Characteristics
TRAINERS PREP Prepared newsprint with “Skills & Characteristics” & “What gets in the way of good outreach” on 2 different sheets Thick Pen Markers ACTIVITY INSTRUCTIONS Separate the room into two groups. Distribute newsprint and markers for both groups. Review questions one and two. Keep slide up for duration of exercise so participants can refer to questions throughout activity. Allow each group to activity for five minutes on question 1 or 2 (designate one question per group to begin). Then ask groups to switch, adding thoughts/brainstorming for the next question. After five minutes, ask one representative from each group to read five of the most pertinent or interesting examples that stood out during the brainstorming session. Allow for five minutes of large group discussion.
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Skills & Characteristics
Activity: Skills & Characteristics Group 1: What skills & characteristics do you think an outreach worker needs? Group 2: What gets in the way of effective engagement and communication- actions/behaviors/attitudes? Two groups – groups switch after 5 minutes, review and add to brainstorming lists. Report back to larger group for discussion. Keep slide up during Activity ACTIVITY INSTRUCTIONS continued Allow each group to brainstorm for five minutes on question 1 or 2 (designate one question per group to begin). Then ask groups to switch, adding thoughts/brainstorming for the next question. After five minutes, ask one representative from each group to read five of the most pertinent or interesting examples that stood out during the brainstorming session. Allow for five minutes of large group discussion. NOTES: This brainstorming activity frames this section of the training around communication and engagement skills, and characteristics needed to strengthen alliances with both clients and the broader community.
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Effective Communication
& Engagement Skills
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Effective Communication DOES NOT…
X Act as “expert” or do most of the talking X Diagnose, label, judge X Argue the person has a problem and needs to change X Prescribes solutions X Pressure, threaten consequences, act punitively
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Transtheoretical Model of Behavior Change
Stages of Change Transtheoretical Model of Behavior Change Pre-Contemplation “Not considering it” Contemplation “Thinking about it” Preparation “Planning to do it” Action “Doing it” Maintenance “Staying with it” Return/Relapse “Stop doing it” KEY MESSAGES Stages of Change is also called the transtheoretical model of behavior change There are six stages that make up the process of change We all go through the process of change shown in the stages of change model. The stages of change model is not a purely linear model. People move from one stage to the next at their own pace, can go backwards to a previous step in the process, and can relapse at any time. An individual may be at different stages for different behaviors (example: someone might be at pre-contemplation around their crack use, but at maintenance around their heroin use). Relapse or return is a normal part of the process of change that is to be expected. Relapses help us learn how to make enduring change. Planning for barriers in the preparation stage and beyond can help prevent the likelihood of relapsing/slipping in the future. Social support is an important part of the process of change. MI helps an individual move through the process of change. It does so using different techniques at different stages.
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PRE-CONTEMPLATION “Not Considering It”
CONTEMPLATION “Thinking About It” PREPARATION “Planning To Do It” ACTION “Doing It” MAINTENANCE “Staying With It” RETURN/RELAPSE “Stop Doing It” TRAINERS INSTRUCTIONS Use same thread for the 6 stages: smoking cigarettes, for example: PRE-CONTEMPLATION “Not Considering It” – I buy a pack of smokes in the morning and have a few with my coffee CONTEMPLATION “Thinking About It”-- I hear smoking kills, I know this, I’m just starting to think to slow down maybe PREPARATION “Planning To Do It” -- I got a plan: I chew that gum for 2 weeks, I stop smoking before 12 noon, I have an end-date ACTION “Doing It” – I’m not smoking, one day at a time! MAINTENANCE “Staying With It” – Some say you need 6 months of doing something for real before you hit ‘maintenance’ RETURN/RELAPSE “Stop Doing It”-- – Lapse is doing that one thing maybe once, ReLapse is when you resume the behavior; I bum a smoke from a gal at a party after having not smoked for 6 months (Lapse), I start buying a pack in the morning to go with my coffee (ReLapse). Re/Lapse can come in handy to re-calibrate Preparation: maybe I can’t handle coffee without cigarettes so my next run at this includes drinking tea in the morning (Action) til I feel confident I can have the coffee without cigarettes for two seasons (welcome back to Maintenance) 18
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Motivational Interviewing (MI) Basics
Motivational Interviewing is a directive, client-centered counseling style for eliciting behavior change by helping clients to explore and resolve ambivalence. Miller and Rollnick
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Directive and Participant-Centered
Focused and goal-directed Elicits exploration of ambivalence Guides client toward acceptable resolution that stimulates behavioral change Change comes from the participant, its not imposed Provider and Participant relationship is collaborative. KEY MESSAGES Beware of pushing your goals and ideals instead of eliciting the participants.
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Expresses Empathy Understanding of individual’s perspective and frame of reference. Explores fears or hesitations regarding change; comfort with current habits, rituals, environment, etc. Counselor conveys understanding and builds an alliance through reflective listening.
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“I don’t know why everyone is so upset I’m still getting high now and again…it’s not like I’m doing it everyday anymore!” “So others have expressed concerns about your drug use, but you don't feel the same concern because you are not using as much as you once did.” Express Empathy
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Encourages Self-Efficacy & Motivation
Does the participant perceive change as being important? Look for recognition around issues (change talk): “I guess it doesn’t really make sense. I don’t even enjoy getting high anymore. It’s just making my problems worse.” Is the participant confident they’re able to make the change? Look for optimistic expressions around change.
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Encourages Self-Efficacy & Motivation
Reinforces the perceived importance of making a change. “That’s great you feel ready to make a change, and moderating your use sounds like a really positive step!” Highlight strengths, resources, abilities, history, and belief that change is possible. Expect success! KEY MESSAGES “Last year you cut down your use to weekends only. I remember you describing how hard that was for you, but you made a strong support network that you still have today. I’m so glad you did, because you can reach to them for support now when you need it. That’s great!”
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Self-Disclosure The role of personal information during outreach:
Disclosure can be a powerful tool. Keep boundaries in mind. Always consider the reasons why you are sharing this information – how will this information benefit the participant? ASK When is it good to disclose and share your lived experience? When is it NOT? KEY MESSAGES Disclosure can be a powerful tool, minimizing status differences and strengthening relationships. As with any personal information shared, it’s good to keep boundaries in mind. Always consider the reasons why you are sharing this information – how will this information benefit the participant?
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Engagement Toolbox Ask open-ended questions Use affirming statements
Reflective listening & summaries Decision balance Change plan KEY MESSAGES Ask open-ended questions In the past, how have you overcome an important obstacle in your life? Use affirming statements You've accomplished a lot around moderating your use. Reflective listening & summaries Just to make sure I’m understanding you correctly… Decision balance (ambivalence, contemplation) Good things about using x/not-so-good-things Change plan (determination/preparation) Participant choice based on need and readiness Menu of options Make long-term goals into “doable” units
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ACTIVITY: Flip That Question!
Refer to Flip That Question Handout ACTIVITY INSTRUCTIONS The purpose of this activity is to turn Closed questions into Open questions, not to answer the questions Have the room pair up Together, they will write questions on the handout that began as a Closed question Circulate Activity Handout Afterwards, ask from each pair to share a response to one of the Closed questions 27
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Safety and De-escalation
Safety First: Always let your supervisor know where you are. Go out in pairs, watch each other’s backs. Don’t approach people who are signaling they don’t want to be approached. Don’t interrupt sales of drugs or sex. Don’t work sick. KEY MESSAGES Safety First! Be aware of your agencies policy/procedures of how you should interact with law enforcement and other community members.
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Safety and Outreach Introduce yourself and let people know what you’re doing. And why. Wear an agency ID or carry documentation identifying you as a peer just in case. Trust your instincts! If you are uncomfortable in a situation, walk away from it. Make contingency plans for worst case scenarios agreed upon by the whole team. ASK Anything else? KEY MESSAGES Introduce/Identify yourself and inform people what you’re doing and why. Ex: “My name is Sandy and I work with the health department. I have bandaids, condoms, and gear, do you want anything tonight?” Wear an agency ID or carry documentation identifying you as a peer in case you are stopped by police. Trust your instincts! If you are uncomfortable in a situation, walk away from it. Make contingency plans for worst case scenarios agreed upon by the whole team.
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What is your agency’s protocol in the event you are stopped by police?
Or had an accidental needlestick? Make this plan and identify a point-person to call at any hour when workers are conducting outreach. Check the weather. Keep supervisors informed of your location & activities.
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Crisis Intervention Strategies
Crises occur when a person can not utilize coping skills to manage stress from a difficult situation. Providers can help the participant feel an immediate de-escalation of anxiety, fear and panic. Maintaining your personal safety is key! Refer to De-Escalation Handout KEY MESSAGES Crises occur when a person can not utilize coping skills to manage stress from a difficult situation, often leading them to feel powerless, and lacking emotional regulation and/or self-control. By intervening effectively in a crisis situation, providers can help the participant feel an immediate de-escalation of anxiety, fear and panic, preventing harm to self or others. Maintaining your personal safety is key!
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Example Strategies and Action Steps
Project calmness; acknowledge and validate feelings; encourage the person to talk; listen closely and patiently. Maintain a relaxed and attentively open posture; non- challenging or threatening. Point out choices/options, break big problems into smaller ones. Position yourself so that have easy access to an exit if you are in an office or private space.
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Maintaining Safety: What to Avoid in a Crisis
T.A.C.O.S. X Threatening X Arguing X Challenging X Ordering X Shaming KEY MESSAGES TACOS stands for: X Threatening the individual X Arguing or contradicting the individual X Challenging the individual X Ordering or commanding the individual X Shaming or disrespecting the individual
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Supportive Referrals Identifying participant needs that cannot be met by yourself or agency (beyond base of knowledge, skills or responsibility) and assist participants in accessing available support systems and community resources. ASK What does Supportive Referrals mean to you?
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Providing Supportive Referrals
Referral Forms Communication with a Contact Provide Assistance Timely Follow-Up Re-Assess Plan of Care
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Building a Strong Referral Network
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ACTIVITY: Referrals TRAINERS PREP
Post prepared newsprint on the walls around the room. Nine (9) sheets with referral categories as headings. Have thick pen markers ready. To start, have one or two examples of local referrals. NOTES The purpose of this activity is to brainstorm local referrals for various categories and pull from other’s experiences, backgrounds, and resources. This provides HRWs an opportunity to network w. other HRWs and learn about services provided at other agencies.
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Group Activity: Referrals
Break into groups Each group can start at opposite sides of the room, brainstorming local referrals for each category One person from each group report back examples of referral options to large group for discussion or expansion ACTIVITY INSTRUCTIONS Point out the prepared newsprint around the room. Break one large group into two smaller groups. Each group gets thick marker pens. Ask each group to start at opposite ends of the room Allow each group 1-2 minutes to write down as many referral ideas as they can for each category, preferably local. After each group has worked there way through each category (10-15 minutes total), ask one representative from each group to move through each category, pointing out 1-2 examples of referral options. Pull up next slide and leave up during activity. Optional If time is running short the facilitator can walk through each category and read 3-5 examples of referral options.
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Group Activity: Referrals
Hep C, HIV, STI Testing (including Hep A + B vaccinations & care) HIV, Hep C Primary Care and Treatment Dental Care Mental Health Services Support Groups Alcohol & Substance Use Treatment (Suboxone, MMTPs, in/out-patient, ) Harm Reduction/ Syringe Access Programs Overdose Prevention Case Management & Housing Keep slide up for Activity ACTIVITY INSTRUCTIONS continued Allow each group 1-2 minutes to write down as many referral ideas as they can for each category, preferably local. After each group has worked there way through each category (10-15 minutes total), ask one representative from each group to move through each category, pointing out 1-2 examples of referral options. Pull up next slide and leave up during activity.
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Reflective Practice: Outreach & Engagement
Identify What are specific engagement skills you can improve on during your interactions with participants during outreach? Think about “desirable characteristics of outreach workers.” Explain Describe important issues related to self-disclosure to a colleague or in group supervision, including an example where you were uncertain whether or not to disclose. Apply After identifying areas for improvement, begin to implement your engagement strategies. Discuss how it impacted your outreach encounters and share during supervision and/or with your peers. Refer to Worksheet TRAINER INSTRUCTIONS These are a few ideas to apply the day’s workshop into practice. Encourage participants to share in supervision, with peers, and/or with colleagues at their agency.
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Put completed surveys in the folder
Closing & Evaluations Anonymous Surveys: Put completed surveys in the folder Refer to Blank Evaluation Handout TRAINERS INSTRUCTIONS Ask participants to complete the anonymous survey. Provide a large manila envelope or folder for participants to put their completed surveys. Optional Plus/Delta is a closing exercise where every person can give one example of what worked or was effective about the day’s workshop, and one suggestion that could improve the workshop. Each person has a turn with the option to say “Pass.” The purpose of this closing exercise is to give each participant a chance to share their opinion verbally if writing is not how they express themselves best. Avoid having discussion on responses, this exercise is meant to move forward to wrap up the day.
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HRC thanks you for participating in this workshop!
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