FILM DISCUSSION CARD 3
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Transcript of FILM DISCUSSION CARD 3
Drop-In Centre
FILM DISCUSSION CARD 3
DROP-IN CENTREUNMET NEEDS OF IDUSWhat are the needs of IDUs which cannot be provided for in outreach alone?
Additional Services: Abscess management, counselling, general health services and so on
Rest: IDUs need a place where they can be away from harassment
Interaction: IDUs need a place where they can interact with each other & staff freelyNEED FOR DICAll the services for IDUs cannot be provided in the outreach alone
IDUs often need a place where they can rest peacefully without being harassed / discriminated
Service providers need a place to address their clients (IDUs & partners) as a group
IDUs need a place where they can come together and find a common voiceAll these needs can be fulfilled by a DICLOCATION OF A DICA DIC should be located where:IDUs reside
IDUs congregate
IDUs find it easy to access
IDUs do not face discrimination and/ or stigmatisation
IDUs can enter freely without any fear of the surroundingsESTABLISHING A DICThe following steps should be followed before choosing a location for DIC
Mapping of IDUs & hotspots
Mapping of Services and Referrals
Consideration of feasibility and budgetary issues
Opinion of the IDUs through group discussions
Opinion of the general community residing nearbyCONTD.The final choice will depend upon:Proximity of proposed site to: the hotspots, Services and Referrals
Acceptability of the site to the IDU and general community
Once a location is chosen on the basis of the above steps, the TI (NGO) should hold advocacy meetings with the general community residing around proposed siteCONTD.Common concerns of general community are normally:Increase of drug use in the community
Thefts in the area owing to IDUs frequenting the area
Initiation of drug use by their children through direct/ indirect influence of IDUs
All the above concerns should be addressed by the TI staffREFERRAL PATHWAYS DICIDUs may reach DIC:DirectlyVia outreach contactVia Referrals Forcibly by family membersOUTREACH CONTACTIDUREFERRALSERVICEINFRASTRUCTURE AND STOCKSA DIC should have adequate space for:Recreation / Rest CounsellingTreatment / DressingIn addition A room for examination of client / sexual partnersBasic amenities i.e. toilet & kitchen
Timings for the DIC should be decided in consultation with the IDUsCONTD.Following should be stocked:Needles/syringesDisposal binsCondomsAbscess prevention & treatment materialsIEC materialsNotice on rules and regulations prominently displayedConfidentiality policy followed in the DIC displayedEssential furnitureSocial mapping should be displayed
The IDUs may be actively involved in the day-to-day maintenance of DICRECREATION / REST ROOMThis will be the Entry room with the largest space
Purpose:For IDUs to spend timeFor IDUs to restFor conducting group activities & discussions
To attract IDUs, recreation materials such as carom board, chess, playing cards, television, video, etc. may be provided
For Documentation:A daily attendance register should be placed at the entranceRecord of consumables bought & usedRecord of other activitiesCOUNSELLING ROOMPurposeTo provide one to one counselling to IDUs & family membersReferrals
Privacy should be maintained (both audio and video)
Counselling should include the following issuesHIV /STI preventionRisk / Harm reductionPre-post test counsellingPsychosocial counsellingOther issues of the clientEXAMINATION/TREATMENT/DRESSING ROOMPurposefor doctor to examine, elicit history, treat general medical conditions, etc.
for nurse/doctor to treat abscesses and manage STI
If space is available, there can be a separate room for the doctor and nurse
CONTD.Materials required in the room:Table and chair for nurse and doctorStool for patient to sitStool for abscess managementPatient examination tableSterilizerNeedle crusherGlovesCupboard for PEP, OST & STI drugs and other materialWaste disposal container
WHO CAN ACCESS THE DIC?IDUs
Spouses/Sexual Partners of IDUs
Family members of IDUs
General community may come to seek information
PROCESSES IN DICUpon arrival at DIC, the IDU may meet any of the staff members including ORW, PE, PM, Counsellor, etc
Usually if the client is referred from outreach, the concerned PE or ORW accompanies the client to the DIC
The first contact:Staff at DIC discuss needs of IDU
Services are provided as per identified needs in active consultation with IDUCONTD.The IDU is encouraged to visit DIC regularly
The dos and don'ts at the DIC are clearly explained to the IDU
Follow-up action is identified, e.g. referral to hospitals, ICTC, social support, etc.
Follow-upIDU should be made to feel a part of DIC
Efforts should be made to refer maximum number of IDUs to ICTC (HIV testing) with proper pre-test counsellingCONTD.IDUs should be counselled on harm reduction concept and principles, safe injection, safe sex, importance of regular access to NSEP, safe disposal, abscess prevention, what is HIV, Hepatitis B & C & ways to prevent /acquiring them
IDUs should be involved in group discussions, where above mentioned topics can be discussed in a groupCONTD.A basic medical history should be elicited by the counsellor/doctor/nurse
Enquire about type of drug and mode and patterns of use, abstinence attempts in the past, help/treatment sought earlier
Take history of exposure to contaminated blood and other risk behaviours
Glean knowledge and attitude towards diseases like TB, STIs, HIV/AIDS and Hepatitis B and CCONTD.Social well-being should be elicited by the counsellor including but not limited to:Mental health problems
Family history of drug use and family support
Legal problems encountered
Sexual behaviour and practices
In addition, efforts should be made to involve general community in DIC through: Advocacy at regular intervalsCONTD.Observance of important drug/HIV related daysSocial activities involving IDU
The PM should ensure that:A directory of services is available for referralsLiaison with hospital and emergency services to deal with any untoward medical incidents is establishedLiaison with local police station officers for enabling environment is establishedSERVICE PROVISIONServices at the DICNSEPCondom distributionAbscess management (treatment/dressing etc)STI management (syndromic)CounsellingReferralsGroup discussionsRecreation/ Rest facilitiesHUMAN RESOURCESStaff in DICFull time Project Manager, Nurse, ANM, Counsellor and ORW
Part time Doctor (min. 3 days per week)
ORWs will take turns to carry out DIC related work
One staff member (PM, Counsellor, or Nurse) must be designated as DIC In-Charge. (He/she will be responsible for the day-to-day functioning of DIC)ROLE OF OUTREACH WORKER & PEER EDUCATORSORW and PEs play an important role in bridging the gap between IDU & TI staff
Role/Responsibilities:Making the IDU comfortable in the DIC
Ensuring involvement of IDUs in DIC activities
Maintaining rules & regulations at DIC
Conducting group discussions
Encouraging the IDUs to visit DIC and access servicesCONTD.Facilitating formation of committees and self support groups in DIC
Ensuring concerns and the voice of the IDUs reach TI staff (project)
Ensuring a respectable environment for IDUs
Participating actively in the advocacy meetings with general communityBASIC RULES AT DICSome basic rules of DIC includeNo drug use on the premisesNo drug dealing on the premisesNo violence or threats
Every effort should be made to help the IDU and partner feel valued and comfortable
Informed consent must be taken before testing and medication
Confidentiality must be emphasised Listen to the whole storyCONCLUSION DIC helps in meeting some of the needs of IDUs and their partners
Establishing & maintaining a DIC requires a number of steps to be followed
DIC service is complementary to outreach
A number of other services including NSEP can be offered in DIC, which require multi-disciplinary staff
DIC can also serve as a place for community mobilization