Safer Inhalation Services Program Evaluation Proposal, 2017
28
January

By Adem Lewis / in , , , , , , , , , , , , , /


Hello everyone can you hear me okay? Okay so
I am Ashley Sagan indeed not Chase. And I was fortunate enough to complete my
practicum at the Interior Health Authority in the Office of the Medical Health
Officers and Population Health. My project consisted of a proposal for a
program evaluation for Interior Health’s safer inhalation services which was
actually accepted and is currently being implemented which is exciting.
So to begin Interior Health is the regional health authority for BC’s
Southern Interior and includes regions such as the Okanagan, Kootenay-Boundary,
East Kootenay and Thompson Cariboo Shuswap region. The public health function
of Interior Health is unified under the Vice President of Population Health and
the project I worked on was a collaborative project between the
departments of Clinical Operations and Epidemiology and Surveillance in which I
worked closely with a harm reduction coordinator and epidemiologist. So what
exactly are safer inhalation services? While safer inhalation services are
one of the many harm reduction services offered by Interior Health
the main component of these services is the distribution of safer smoking
supplies which consists of the four commonly distributed items which we have
a glass stem or a Pyrex glass stem or pipe, a vinyl mouthpiece, wooden push sticks,
and screens. Another part of these services there is also information on
safer smoking practices and then referrals to care such as addiction or
referrals to health care. So on first hearing this you might just see these
things listed and think that it is really just another form of drug
paraphernalia so I’ll first explain why the Interior Health Authority
distributes these items and why a program evaluation was necessary. So as
many of you know disease prevention is one is British Columbia’s
core functions of public health and include responsibilities such as disease
prevention and surveillance of various communicable diseases. And although the
transfer of communicable disease can transfer through various vectors such
drug use practices and behaviours associated with smoking crack cocaine
these practices increase the risk of transmission and so some of these things
associated of smoking crack cocaine are the materials used to
smoke crack cocaine commonly. So hot pipes and different makeshift items such
as light bulbs and what other is available to that population are used
and it can actually increase cuts and burns and blisters in the mouth and oral
cavity and so when these open wounds are then paired with different
sharing behaviours such as sharing of used equipment or unsafe sexual
practices such as unprotected oral sex there is an increased risk for communical
disease transmission. So to help mitigate these risks associated with smoking
crack cocaine harm reduction programming such as safer inhalation
services are implemented and these services have been documented in the
literature to increase access to safer and unused equipment which then
increases or decreases sorry sharing patterns and can also decrease the use
of these makeshift equipment and items that increase wounds and the mouth
and oral cavity. The literature also does explain that access to these services
can also reduce injection drug use which does have very important implications as
we do know that there is increased risks of HIV as well as overdose with
injection drug use so that was another important finding with these services. I
do want to note however though that these drug use behaviours and decisions
about whether you’re sharing a pipe or whether you’re choosing to smoke versus
inject a drug are very complex decisions and so I do just want to
note that it is not directly related to just mere access to these safer
inhalation services. So these services you may have
also heard them call the safer crack use distributions or safer crack use kits
they’re starting to become a more widely implemented harm reduction program
across Canada and although there have been program evaluations on programs in Victoria,
Vancouver, Winnipeg and Ottawa there has been no evaluation on Interior Health
services before which is the biggest piece of rationale for this evaluation.
Because there are national and provincial best practice recommendations for how
these services are recommended it was important to assess Interior Health’s
services and check their alignment with these recommendations. The literature is
also very clear and identifies different barriers associated with these services
such as location, hours of service, police interference so that was another huge
piece of the rationale was looking at Interior Health Services, identifying
those barriers and then maybe seeing what other barriers do exist. And another
interesting additional piece of rationale that was identified by
community stakeholders and was also supported by the literature is that
pipes that are distributed through safer inhalation services can also be blown
like glass blown into methamphetamine pipes and used to smoke that way because
methamphetamine pipes is not a harm reduction service commonly offered in
Interior Health so that was something that community stakeholders brought up
that they’re interested about because there are obviously risks associated with
that practice and not a huge opportunity to engage with that segment of the
drug-using population so that was definitely another important part of
this evaluation. So with this rationale the purpose of
the program evaluation is to assess the current state and scope of safer
inhalation services in Interior Health and determine if these services are
meeting the needs of people who smoke drugs. The objectives were to assess like
I said if the services assess the current state of services,
assess if the services are accessible to the population both logistically and
socially, determine if the services and the supplies are suitable for the
administration needs of those who smoke drugs and to assess if the services are gauging
the population and safer smoking education and referrals to care. These
objectives were supported by specific indicators which were then used to
design the program evaluation and methodology and this is just an example
here of a poster that went out to the different agencies. So the design
of this evaluation was a formative evaluation and in two parts assesses the
activities and outputs of safer inhalation services. Activities addresses
the current state of services while the second part outputs addresses the
outputs and was going to be gauged through the feedback from the target
population. So this evaluation is a snapshot of time and the methodology was
processed through Interior Health quality insurance and project ethics
screening tool called ARECCI and we did also make further consultation with the
research ethics boards due the vulnerability of population although
they had no further recommendations for us to go through. So as I
mentioned part one of the evaluation will address the current state and scope
of safer inhalation services. So within Interior Health we have 19 public health
centres and 7 contracted harm reduction agencies that distribute these supplies
but the centres and the agencies do things differently and they might
distribute only one of those four key items, they might distribute both of
those, they might distribute those via a harm reduction menu, it might come
in a kit so needless to say there’s variability that we wanted to assess and
look at. So we designed this online survey via Survey Monkey that went to
the agencies and the contracted agencies and public health centres and
they were to be filled out by either the manager or their most suitable team
member. The second part of the survey was a paper survey and it was distributed to
the contracted harm reduction agencies who are then responsible to
adminisering the survey to individuals who smoke drugs. So the service providers
using the daily encounters that they already have through the organization
would then approach these individuals and any individuals that
has accessed safer inhalation supplies in last 12 months was eligible for
participation. So individuals were to complete the surveys while at the agency
and they’re either allowed to go and complete this on their own or with the
help of a service provider. It consisted of both an open and closed questions and
there is no personal identifying information available. Those who
completed the survey also did receive a $5 remuneration for their time.
So plans for all this information while the knowledge gained from this
evaluation it will provide insight into the current state of services and
effectiveness of the services in Interior Health. Recommendations will be
made to the harm reduction coordinator so that they can support these services
and also use them for future funding opportunities and I’ll actually be
returning next week to present some of the findings to the contracted harm
reduction agencies in a face-to-face meeting and one other exciting part of
this evaluation is that we also did have interest from Vancouver Island Health
and Fraser Health on this methodology as they are also looking to do evaluations
on similar services so we’ve been able to provide this methodology and data
collection tools with them and they’re hopefully going to be revising those as
they need. So here’s hoping that this methodology and those tools will not
only be helpful in Interior Health but Island and Fraser health as well. So
lastly I’d just like to say special thanks to Interior Health and the population
health team. I had an incredible experience at my practicum. And as well
specifically to my co supervisors Gillian Frosst and Dr. Sue Pollock,
special thanks also to Nigel Livingstone my practicum supervisor and my second
reader Dr. Karen Urbanoski. Thank you and I’d be happy to answer any questions. Such cool work Ashley. There we go a
question over there. I learned lots about drugs it was fascinating. I just have a
quick question with regards to your survey so when you had some of the data
collected on Survey Monkey and then some on paper base did you have any
challenges de-identifying it as you combine the two sets of data or how did
you manage that just given the different clientele. Yeah so one this is kind of in the
like background piece so both of the surveys did have to go through privacy
impact assessments so in the creation of those data collection tools there was
similar processes but very different because one was online for a completely
different target group essentially and so those both did go through privacy
impact assessments and those are currently being implemented so I haven’t
done any data analysis on that yet. Those surveys are currently out right now but
that’s the the evaluation kind of did happen in part 1 and part 2 because part
1 was very much geared towards the agencies and the public health centres
while part 2 was very much gauged towards that target population. Any other
questions? Hi so that was great thank you and I
was just wondering what kind of questions you asked. Oh did you
have a survey in mind between the service provider or the – Both I’m just
curious. Yeah sure so for the first survey ad the one that was done by
Survey Monkey to the service providers and the agencies some of the questions
were meer what are your hours of services or please provide a description of how
you provide those services. Do you distribute a kit or do you do that
through a harm reduction menu as some places call it and then for the
survey that went out to the target population some of those questions were
how often do you use a pipe or like do you pick up a pipe from this location?
Have you ever been limited in getting a pipe? Have you have ever been denied a
pipe? Do you feel comfortable accessing these services? So we’re really trying to
identify if there were any barriers and another part to that survey was also
asking if individuals have indeed blown a crack pipe into a methamphetamine pipe
because that was some of the information that is not well documented in the
literature that we were trying to get a better understanding of. Any other
questions? Alright then thank you Ashley.


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