This project aimed to identify and minimise barriers to accessing and enhancing effective health and social care services for vulnerable and/or marginalised young drug users. Based on an in-depth and prospective analysis of injecting drug use by young people in three well-established settings, innovative harm reduction approaches will be developed, reviewed, adjusted and implemented, and the capacity of key on-site staff will be built. The specific mix of interventions at each site will be determined at the initial planning meeting, so that they meet the particular local needs. While directly benefitting participating services, lessons learned will form the basis for developing a Toolkit for providing comprehensive harm reduction interventions for young, marginalised drug users.
Access Quality International/Asian Harm Reduction Network, Chiang Mai, Thailand
Yunnan Institute for Drug Abuse, Kunming, China
Youth Vision, Kathmandu, Nepal
Thai AIDS Treatment Action Group (TTAG), Bangkok, Thailand
Research Questions to be addressed by this project are:
- What are the attributes of harm reduction interventions / programmes that produce positive outcomes (e.g. reduced risk behaviours, improved social functioning) for young people who use drugs in the target countries?
- What is required to scale up effective harm reduction interventions for young people (aged 10-25) who use drugs?
Working with implementing partners in situ, interaction with young people, staff and communities during field visits, ongoing consultation will lead to facility and service (re)design and the development of training materials and a tool kit. Data collection systems will be enhanced to allow for synthesis of monitoring and evaluation activities.
Field visits assisted shaping the local projects at the three sites (Kathmandu, Nepal, Kunming, China and Bangkok, Thailand), and to assist in the synthesis of key learnings. Focus groups were conducted at each site to identify the needs and wants of young IDUs and those at risk of IDU, and have led to more depth understanding of their substance use and the contexts within which it emerges and is maintained.
The Tool Kit was developed from the focus groups, site visits and literature and used in trainings to assist better understanding of the rationale for and practice of ‘youth friendly’ approaches to harm reduction. Data collection tools and monitoring and evaluation processes were enhanced. The purpose of the Toolkit is to provide a set of training sessions to stimulate discussion that can lead to ‘youth friendly harm reduction’ services. This may entail review of services, their renewal and, possibly, re-design.
The Toolkit is provocative at times – tempting services to reflect on their current practice and explore options for enhancing or developing a more youth friendly approach to harm reduction. A secondary aim is to utilize any training provided to assist in building essential relationships and networks with key stakeholders and service providers. If a training provided includes representatives of essential key services, they should develop a better understanding of both young people who use drugs and youth friendly approaches to harm reduction.
By early December 2010 a ‘full draft version’ of the Toolkit had been finalized. The format came from a four-day training provided during the project on youth friendly harm reduction by Youth Vision, Nepal in February 2009. It was adapted and other topics included based on suggestions from the three sites and observations and discussions during field visits. The final draft was tested in a national workshop organized by Youth Vision, Nepal in February 2010. The Toolkit is also in a format that makes it suitable for self-directed learning, or to be used by a ‘learning circle/group’ of individuals who wish to expand their knowledge.
The Toolkit comprises:
- The main text (PDF): Introduction & 16 sessions
- Worksheets
- PowerPoint Presentations to accompany sessions
- Resources (digital collection of 66 key documents/publications)
The sessions deal with the following subjects:
- Youth friendly Services Part 1
- Youth friendly Services Part 2
- Harm Reduction
- NSP, Outreach, Drop-in-Centres, Safety
- Drugs, Withdrawal, Overdose, OST
- BBIs, HIV, HCV, HBV, TB, STIs
- Health and Nutrition
- Mental Health and Wellbeing
- Basic Counselling
- Motivational Enhancement
- Group Work
- Relapse Prevention
- Building Young Leaders
- Activities
- Essential Networks and Advocacy
- The Change Process
Use of the Toolkit:
After a period of reviewing and revising, the first regional workshop was held in Bangkok, Thailand, in February 2010. NGO managers and/or field workers of NGOs from nine countries participated: Cambodia, China, Indonesia, Lao DPR, Malaysia, Myanmar, Nepal, Thailand, and Viet Nam, as well as representatives from UNICEF, UNODC, and UNESCAP. The IPs facilitated most of the sessions, assisted by the Project Team where needed. The experience of the workshop led many of the inputs being incorporated in the ‘Final’ version of the Toolkit.
To facilitate a roll out of training a TOT training in Bangkok in September 2011 with participants from Myanmar, Malaysia, Indonesia, Viet Nam, Nepal and Lebanon. All participants will facilitate training in their own countries on return. About 40% of the trainees were aged under 26 years.
After the Bangkok workshop there three national trainings on Youth Friendly Harm Reduction were held in Penang, Malaysia, Yangon, Myanmar and Denpasar, Indonesia.
Papers at conferences:
2010: 21st IHRA, Liverpool, UK; World Congress of the International association for Child and Adolescent Psychiatry and Allied Professions, Beijing, China; AIDS 2010 XVIII International AIDS Conference, Vienna, Austria; 2nd EFCAP Congress, Basel, Switzerland; ANEX 2010 Australia Drugs Conference, Melbourne; 14th Pacific Rim College of Psychiatrists Scientific Meeting, Brisbane; APSAD 2010 Conference, Sydney.
2011: 22nd International Conference on the Reduction of Drug Related Harm, Beirut; 6th International Conference on Drugs and Young People, Melbourne; Education and Social Integration of Vulnerable Groups International Conference, University of Macedonia, Thessaloniki, Greece; APSAD 2011 Conference, Hobart.
Papers:
Howard, J. (2011) ‘Opening Doors’ – Increasing access to youth friendly harm reduction. Centrelines Number 29: National Drug and Alcohol Research Centre, University of New South Wales.
Howard, J., de Kort, G., Pandey, B., Joshi, S., Kaplan, K., Sumannawong, P., Jian, L., Cunmin, Z. “Opening Doors” –increasing access to youth friendly harm reduction. Exartisis: Scientific Journal on Addiction Issues
The “Opening Doors” project has been associated with some potentially beneficial activities and outputs, particularly in identifying and responding to what the young people need/want. The ‘voice’ of young people who use drugs is ‘louder’ and youth participation in shaping and operating services is increasing. Resources have been produced, such as those related to MMT, networks and links to essential partners and education, vocational training and employment have been developed and strengthened, and youth leaders are being developed.
In addition, the toolkit has been translated into Mandarin, Thai, Indonesian, Malaysian and Arabic. National trainings have been provided in Nepal, Thailand, Mayaysia, Indonesia and Myanmar, and a regional train-the-trainer workshop in Bangkok. An extension of the project into the Middle Eastern and North African Region is planned.