• Explore some of the barriers to youth workers and young people in engaging with and around harm reduction services
• Analyse the influence of drug related stigma and discrimination
• Explore different scenarios involving young people around injecting drug issues
• Discuss the Do’s and Don’ts of engaging young people around injecting drug use.
• Wrap up the day.
What we will be doing
Quick question:
“On a scale of 1-10 how confident are you right now having a conversation with a client about injecting drug use?”
How confident are you?
1. Break into smaller groups/discuss as a group
2. Identify some barriers a youth worker may have in engaging
with a young person around injecting drug use
• personally
• within job role
• within service
3. Identify some barriers and challenges a young person may have to ask about injecting drug use, inject safely or to
access support services
4. You have 10 minutes
5. Allocate someone to report back to the group
Exercise - Barriers to engaging with young people at risk of injecting
Understanding the influence of drug related stigma on young
person’s decision to access harm reduction services.
• is considered to be an opinion or judgement, often unfair, held by individuals or society about something.
• is the concept of people being 'marked' as different, specifically in a negative manner.
Leads to stereotyping
Results in status loss
What is stigma?
• when someone is treated less favourably than other people in the same circumstance because of a particular characteristic
• has many forms but always leads to exclusion or rejection
Stigma the belief - discrimination the action
When stigma is acted onit leads to Discrimination
• Stigma from individuals
• Institutional Stigma
• Self stigma (internalised)
• Stigma by association
Types of Stigma
Blame and moral judgement • that drug use is always a ‘choice’
• ‘just say No’
• any conditions from drug use eg hep C are brought ‘upon themselves’
Key Elements of Injecting Drug Related Stigma
Criminalising • that problematic drug use is treated as a criminal activity as opposed to a public health issue• the ‘war on drugs’ is often a ‘war on drug users’
Key Elements of Injecting Drug Related Stigma
Pathologising• implying drug users are sick
• important that when talking about for example addiction as a disease that we don’t further
stigmatise ie ‘disease’ equating to ‘diseased’
• diseases themselves are not immune to stigmatisation
• different from public health approach to drug use
Key Elements of Injecting Drug Related Stigma
Patronise• in language or
• in sense that others know better what is best
Key Elementsof Injecting Drug Related Stigma
Fear and Isolation• fear of drug use
• fear of drug users
• fear of drugs
Key Elementsof Injecting Drug Related Stigma
Developing Skills - Case Studies
Aim is to:• develop strategies to engage young people
and provide information about preventing hepatitis C
• be able to frame harm reduction work within your organisation’s broader role
Issues:
Media and public involvement, unsafe disposal, threat to service, child protection (near school), lack of knowledge around hepatitis C/HIV risks in this area
Risks:Needle stick injury, bad publicity, political ‘storm’, threat to youth service and other harm reduction services (i.e. NSP), impact on other services offered, threat to reputation
Case study 1Dealing with the public and media
Issues:Age of Steve, power dynamic (older/younger), at risk of injecting, parental concern/relationship, knowledge of hepatitis C and safe injecting, sharing of sensitive information
Risks:Child protection issues, unsafe injecting, hepatitis C transmission, overdose, becoming dependent on heroin, peer influence on behaviour, break down in Steve’s relationship with parents, arrest
Case study 2John and Steve
Issues:
Child protection, tenancy risk, unsafe injecting, power dynamic in relationship, conflicting tenancy regulations, obligations to share information
Risks:
Custody of child, tenancy at risk , BBI transmission, unsafe injecting, overdose, longer term potentially problematic injecting drug use
Case study 3Tim and Alice
Issues: Uninformed on safe injecting practices and BBI risks, infected injection site, supplying drugs to friends, youth workers knowledge of injecting PIEDs
Risks: BBI infection from sharing needles, unsafe injecting behaviour, infection left untreated could get worse, other health risks associated with PIED use, ignorance of risk taking behaviour
Case study 4Jeremy and Sue
Issues:Early exposure to injecting drug use, 3 year using history, high chance of hepatitis C infection, child protection, parental influence on drug use, limited social support, Aboriginality (specialised services available?), future work prospectsRisks:High risk BBIs transmission, overdose, losing contact with children, re-offending, homelessness, unemployment due to offending history
Case study 5Thomas
Issues:Lack of harm reduction services, confidentiality, power dynamic in the relationship, sharing injecting equipment, age (access to injecting equipment)
Risks:BBI infection, overdose, becoming dependent on heroin, losing family support, not completing education, drug use becoming public knowledge
Case study 6Amy and Greg
Issues:Possible drug induced psychosis requiring immediate attention, potential threat to all at drop-in Centre, age (access to injecting equipment), Mandatory reporting requirements, peer influence, organisations policy on drug use
Risks:Longer term mental health issues, BBI transmission, overdose, access to injecting equipment, uncontrolled methamphetamine use, police involvement, access to support services
Case study 7Caroline
Issues:Purity of the drug, using alone, his peer influence on others, enjoying drug use – lack of motivation to quit (stage of change)
Risks:Overdose, unsafe injecting, BBI transmission, heroin dependency, potential risk to employment of drug use becomes known, contact with youth service. arrest
Case study 8Chris
Issues:Relationship power dynamic, peer influence, exposure to injecting to drug use through living arrangement, knowledge of hepatitis C risk, knowledge of NSP services
Risks: BBI transmission, sharing equipment, overdose, escalation methamphetamine use, riskier drug using behaviour
Case study 9Robyn
REMEMBERYou already have a relationship with the personYour relationship with the young person is key• respect their autonomy and independence• Don’t be afraid to ask• Don’t be afraid to say ‘I don’t know’• Avoid stigmatising or stereotyping• Create a safe space for discussion
When talking to young people around injecting drug use and harm reduction services
• Be informed about injecting drug use and risks associated with injecting but you don’t need to be the expert
• Know where harm reduction services are and where to refer clients – bring in specialists if required
• Take note of ‘duty of care’ and your legal responsibilities
• Have appropriate resources eg BBI info, safe injecting information at disposal or know where to get them
When talking to young people around injecting drug use and harm reduction services
• Don’t assume that your perception of the situation is matched by the person you are working with
• Be aware of your organisation’s policy on injecting drug use, if any
• Be clear with young person what you can and cannot do as a worker and organisationeg confidentiality, mandatory reporting requirements
• Remember some of the barriers identified earlier
When talking to young people around injecting drug use and harm reduction services
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