incorporating broader syringe access into health department programs next steps

Incorporating Broader Syringe Access into Health Department Programs

Next Steps

• Conduct process monitoring• Develop and collect core (low threshold) data elements

(process objectives)—number clients, transactions, syringes and demographics (Could PEMS variables be used??)– National standard: aggregate collection and reporting– Be cautious about client-level data– Avoid using “returned syringes” for program evaluation

• Use a unique identifier (if there’s a purpose)• Ensure confidential data collection• Include local use fields in data collection

Data Collection / Monitoring & Evaluation Priorities

• Conduct surveys as needed in local setting, e.g., for evaluation, other data elements (demographics, planning, etc.)

• Identify funding for data collection • Minimize development of parallel data collection systems• More intensive data collection should be research based and participants

compensated• Ensure confidentiality of data• Consider new technologies for data collection• Keep it simple• No further need for program outcome evaluation (M&E should be tied to a

specific objective)• Consider new methods of data collection/new data sets (e.g., arrests,

harassment)

Data Collection / Monitoring & Evaluation Priorities

• RFPs (including CDC FOAs) should use a harm reduction framework– One syringe, one shot is good public health…– Could CDC/SAMHSA write a DCL re HR framework?

• Flexibility in program design and operation• Develop criteria (geographic coverage, program experience)• Funds to support N/SAP should not supplant existing funding• Data collection

Contract / RFP Priorities

• Fundable services– Infrastructure– Staff– Community readiness/relations (police)– Data– Equipment– Evaluation– Appropriate technical assistance (implementation and CBA

including infrastructure/sustainability)• Allow for various models/settings• RFPs should be brief, low threshold


• Reviewers must understand harm reduction (consider cross-state teams)• Avoid “crash and burn” funding (i.e., get it now)• Learn from restrictive legislation (one-for-one, evaluation burden)• Alleviate RFP criteria (e.g., agencies that have been around for along while?)• Keep rules flexibility and support local determination (adjust RFP

appropriately)• Include “how to” guidelines/recommendations for steps that will be taken

post-award• Create a repository for RFPs, models, data collection tools, etc. • Support blending of funding (sources outside HIV prevention) and combine

services / support service synergy• Establish MOA with key stakeholders (e.g., agencies, LHDs), as appropriate—

SAP specific???


• Include requirements re program hours of operation, disposal, client feedback, etc.

• Include grantee AND funder roles/responsibilities• CDC FOA: No additional/separate reporting requirements• DON’T assume that drug TX should be an expected outcome• Promote overdose prevention as a standard of practice• Include sexual harm/risk reduction in program deliverables (e.g.,

male and female condoms, education)• Comprehensive blood-borne pathogen prevention• Include language/requirements that addresses TG populations• Be clear about models (including partners)


• Garnering high-level buy in and leadership• Securing high-level endorsement that syringe/works access

and disposal is good public health• Considering cost-effectiveness of SA analysis in the planning

process • Ensuring the right folks are at the planning table (including

active users)• Proactively defining the process, purpose, goals and intended

outcomes of planning

Planning Priorities

• Cultivating national/federal leadership to end the war on drugs (including DOJ, ONDCP) and promote harm reduction

• Securing high-level endorsement that syringe/works access and disposal is good public health

• Developing a peer-to-peer approach to reaching stakeholders (e.g., law enforcement supporters talk to peers)

• Advancing supportive policies to compliment stakeholder education/training

Community / Law Enforcement Engagement Priorities

• Providing education/training that promotes bi-directional value and existing successes (win/win)

• Capitalizing on opportunities for new dialogue and partnerships (e.g., Overdose, HCV/HIV)

• Focusing on “behavior change” of stakeholders in addition to advancing supportive policies

• Conducting systematic review of laws restrictive syringe access and possession and plans to fix them

Community / Law Enforcement Engagement Priorities

• SA is good public health• Potentially leveraging N/SEP and pharmacy as gateways to other

services [possible access point (outreach) to other services] (how does SA link to existing programs?)

• Promoting bi-directional value of partnerships• Securing high-level endorsement that syringe/works access and

disposal is good public health• Developing proactive recommendations in preparation for lifting the

ban• Integrating low/high threshold services into venues/programs where

folks are already accessing services (bi-directional)• Ensuring resources (funding) are in place to support services

Connecting to Other Services / Systems Priorities

• Garnering high-level buy in and leadership• Changing restrictive (paraphernalia laws) to ensure

possession of syringes/works is exempted• Ensuring minority populations are reached• Framing work in the context of public health safety when

working with law enforcement• Recruiting program staff from population that is being

serviced; Proving incentives for peer recruitment• Removing age requirements• Monitoring of process and outcomes

Panel Recommendations / Priorities

• Ensuring program requirements (e.g., ID cards) are not punitive

• Developing a centralized database• Providing a range of services (e.g., case management, health

care)• Addressing disposal

Panel Recommendations / Priorities

• National AIDS Strategy• Assessment• Paraphernalia and other syringe-related laws• Law enforcement• Data collection• Program regulation• Disposal• Outdated legislation

Open Discussion—Additional Considerations

• How do we advance our priorities and recommendations?– On the state and local level?– On the federal level?

• Which priorities and recommendations are most feasible?• Which priorities and recommendations will have the greatest

impact on expanding syringe access?

Action Steps—Guiding Questions

• Individually, identify one priority/recommendation that is feasible and that you believe will have the greatest impact on the expansion of syringe access.– Determine 1 action step that YOU will take in the next 2

months to advance the priority/recommendation you identified.

• At your tables, share the selected priorities/ recommendations and action steps with your colleagues.

• As a group, select 2 priorities/recommendations that your group believes are most feasible and that will have the greatest impact on the expansion of syringe access.

Action Steps—Individual and Small Group Discussion

• What are 1-2 key action steps that will be taken in the next six months to advance each priority/recommendation?

• Who will be responsible?• How will we re-connect to share out progress on the identified

action steps?• What technical assistance and capacity building do health

departments need to support the identified priorities/recommendations?

Action Steps—Full Group Discussion

incorporating broader syringe access into health department programs next steps

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