Product Details

Author Information

Corresponding Author
Andrea LaMarre
University of Guelph
50 Stone Road East
Guelph, ON N1G2W1
Canada
p: 5198366435
alamarre@uoguelph.ca

Authors (listed in order of authorship):
Andrea LaMarre
University of Guelph

Anne Bergen
University of Guelph

Raechelle Devereaux
Wellington-Guelph Drug Strategy

Product Description and Application Narrative Submitted by Corresponding Author

What general topics does your product address?

Public Health, Youth

What specific topics does your product address?

Access to health care, Health policy, Homeless health, Substance use, Harm reduction

Does your product focus on a specific population(s)?

Homeless, Youth

What methodological approaches were used in the development of your product, or are discussed in your product?

Community-academic partnership, Qualitative research, Quantitative research

What resource type(s) best describe(s) your product?

Community snapshot

Application Narrative

1. Please provide a 1600 character abstract describing your product, its intended use and the audiences for which it would be appropriate.*

This research was conducted for the Wellington Guelph Drug Strategy (WGDS; Ontario, Canada) addressing questions about the harm reduction approaches in general and needle exchange programs (NEPs) in particular used by shelters/programs providing services to marginalized youth. This combined report contains an initial report on youth harm reduction in Ontario, exploring tensions and barriers to providing harm reduction services and an expansion report detailing information particular to smaller cities. The initial report addressed how shelters/programs manage harm reduction and/or NEPs. The report informed a presentation at the Youth Harm Reduction Forum in Guelph (Spring 2012). Building on interest generated by the first report, the expansion report addresses the ways in which programs/shelters in cities closer in size to Guelph manage harm reduction and/or NEPs. The expansion report also addresses health and safety for youth engaged in these programs. Detailing the results of informational interviews with 11 shelters and programs across Ontario and a literature scan, the report provides a “community snapshot” of harm reduction practices for youth in Ontario. Services offered by the various programs and shelters for youth are explored in the context of potential best practices for harm reduction in particular and youth services in general. This project will help to guide the WGDS in making evidence-informed decisions and reflects products of an ongoing community-university relationship. It is appropriate for members of the general public with an interest in drug policy.

2. What are the goals of the product?

This combined report on youth harm reduction in Ontario initially sought to respond to the following questions generated by the Wellington Guelph Drug Strategy: Can the particular character of youth programs have an impact on the success of harm reduction strategies??How do youth shelters in Ontario manage harm reduction programs? Over time, these questions shifted and changed to reflect the dynamic, rapidly-changing community context around drug policy, resulting in a report that provides information about the tensions that exist with respect to youth harm reduction, and a “community snapshot” of the types of services and programs offered by shelters and programs serving “at risk” youth.

Following the presentation of the first report, several community organizations serving youth with a harm-reduction orientation requested that the research be expanded. This expansion encompassed a broader focus for target programs, including programs in cities closer in size to Guelph. Additionally, questions were raised about a largely unsupported concern raised in the initial report’s findings about the potential use of needles as weapons in programs or shelters. Harm reduction continues to be recognized as an integral pillar within drug strategy groups across Ontario, including the Wellington Guelph Drug Strategy (http://wgdrugstrategy.ca/). This report responds to questions raised by community stakeholders relating to the use of harm reduction to respond to youth needs in the context of their current service provision models. Given the community interest in service improvement for this population, current models of harm-reduction service provision organizations for marginalized youth were examined with the goal of revealing successful practices and gaps remaining in this field. The overall aim of this project was to determine what youth shelters and programs are currently doing to implement harm reduction approaches, and/or whether they perceive harm reduction to be an effective method of providing services to youth. Of particular interest to the primary community partner, the Wellington Guelph Drug Strategy, was how needle exchange programs and harm reduction models for youth manage the tensions identified in the initial report.

3. Who are the intended audiences or expected users of the product?

The original intended audience for the report was the Wellington-Guelph Drug Strategy, comprised of community stakeholders influencing and implementing drug policy in Guelph. The WGDS is made up of a number of community agencies, including the AIDS Committee of Guelph and Wellington, the Guelph Police Service, CAMH, Wellington Dufferin Guelph Public Health and others interested in developing and implementing a drug strategy that serves the needs of Guelph and Wellington. The first report was shared with various community stakeholders at the Youth Harm Reduction Forum to an audience of service providers and youth, as well as interested community members. The reports are intended for the Drug Strategy, service providers, youth with lived experience, and the general public alike.

4. Please provide any special instructions for successful use of the product, if necessary. If your product has been previously published, please provide the appropriate citation below.

There are no particular special instructions for the use of this product. The product has not been previously published through a peer-review process. However, the reports have been uploaded to two websites in their original form (The Research Shop and the Wellington-Guelph Drug Strategy) to ensure community accessibility.

5. Please describe how your product or the project that resulted in the product builds on a relevant field, discipline or prior work. You may cite the literature and provide a bibliography in the next question if appropriate.

Harm reduction can be defined as strategy for drug policy advocating “meeting the client where they are,” where seeking treatment is one option among many. Harm reduction has been identified as a key strategy in drug policy in Canada, and is one of the “4 pillars” of substance use management (1). The needle exchange program (NEP) falls under the harm reduction umbrella, recognizing abstinence from drugs as but one option among many for drug users (2). NEPs provide intravenous drug users with materials to support safer drug use. Although harm reduction-oriented programming in general and needle exchange programs in particular have become more common practice for adult intravenous drug using population, harm reduction based programs for youth remain somewhat contentious (3). Following best practices from the Ontario Needle Exchange Programs established in 2006 by the Ontario Needle Exchange Coordinating Committee (ONECC)’s (2006), some programs and services for marginalized youth allow needles on site, providing an environment that supports safer drug use. Although some programs in Ontario provide needle exchange programs specifically for youth, expanding youth-oriented programming to include a focus on needle exchange and safe injection is not universal (4). Acknowledging that programs and shelters using a more traditional, non-harm reduction focused orientation may not reduce the incidence of drug use or associated health issues including HIV/AIDS and Hepatitis C (5), this report details some alternative approaches being taken by programs, shelters and services for marginalized youth in Ontario. The literature indicates that providing programming for this population may be most effective when youth are able to choose services that they feel best meet their needs (6), when services are individualized and client-centered (7), when peer outreach and peer led models are utilized (8), and when services are provided through the use of satellite sites (9). Given these potential guidelines for best practices, this report explores the ways in which youth programs and shelters provide youth with services, and whether their service models adhere to a harm-reduction orientation.

6. Please provide a bibliography for work cited above or in other parts of this application. Provide full references, in the order sited in the text (i.e. according to number order). .

(1) Wellington Guelph Drug Strategy. (2012). “4 Pillar Drug Strategies: Harm Reduction.” http://wgdrugstrategy.ca/get-informed/4-pillar-drug-strategies/harm-reduction/

(2) Poulin, C. Harm reduction policies and programs for youth. Harm Reduction for Special Populations in Canada: Canadian Centre on Substance Abuse 2006; 1-16.

(3) Ibid

(4) Ibid

(5) Bonomo, Ya & Bowles, G. Putting harm reduction into an adolescent context. Journal of Paediatric Child Health 2001;37:5-8.

Greene, J.M., Ennett, S.T. & Ringwalt, C.L. Substance use among runaway and homeless youth in three national samples. American Journal of Public Health 1997;87(2):229-235.

Mayfield Arnold, E. & Rotheram-Borus, M.J. Comparisons of prevention programs for homeless youth. Prevention Science 2009;10:76-86.

(6) Walsh, C.A., Shier, M.L. & Graham, J.R. Local community engagement: implications for youth shelter and support services. Canadian Journal of Urban Research 2010;19(2):46-61.

(7) Bonomo, Y. & Bowles, G. Putting harm reduction into an adolescent context. Journal of Paediatric Child Health 2001;37:5-8.

(8) Strike, C., Leonard, L., Millson, M., Anstice, S., Berkeley, N. & Medd, E. Ontario needle exchange programs: best practice recommendations, Health Canada 2006:1-260.

(9) Ibid.

7. Please describe the project or body of work from which the submitted product developed. Describe the ways that community and academic/institutional expertise contributed to the project. Pay particular attention to demonstrating the quality or rigor of the work:

• For research-related work, describe (if relevant) study aims, design, sample, measurement instruments, and analysis and interpretation. Discuss how you verified the accuracy of your data.
• For education-related work, describe (if relevant) any needs assessment conducted, learning objectives, educational strategies incorporated, and evaluation of learning.
• For other types of work, discuss how the project was developed and reasons for the methodological choices made.

This project emerged from a partnership between the Wellington-Guelph Drug Strategy (WGDS) and the Research Shop at the University of Guelph, which began in September 2011. The WGDS manager acted as interface between the Research Shop and the larger WGDS. The WDGS was working on several issues at the time the collaboration began; one of the suggestions raised was an investigation of the state of youth harm reduction services. Research goals were to determine if the model used impacts the effectiveness of youth harm reduction and how shelters/programs in Ontario manage harm reduction for marginalized youth. Goals were jointly determined by the community partner (Raechelle Devereaux, WGDS manager), an Institute for Community Engaged Scholarship postdoctoral fellow (Anne Bergen), and a student intern (Andrea LaMarre). As the project progressed, goals shifted toward the development of a “community snapshot” of the state of local youth programs and services, in accordance with community partner priorities. These reports followed a "rapid response" model, involving literature scans, rather than comprehensive reviews. This model meets community partner needs for quick project turn around and provide an overview of the issue. The rapid response model allows for an efficient and timely synthesis of research results. The primary tension in developing rapid response research is balancing a rigorous review of the literature and providing the information within the timeline required by the audience (1). In the case of research conducted for the WGDS, waiting for a systematic review of the literature is undesirable, as decisions based on the research are to be used prior to the period of time it would take to conduct a full review. The rapid response model provides an option for basing these decisions on at least some of the most pertinent research. As noted by Khangura et al. (2012): “a modestly robust summary of the evidence is better for informing a health services decision than no evidence at all” (p.15). This project’s literature scan involved a search of two major academic databases which index a number of journals (ProQuest and Google Scholar), as well as a scan of the “grey” literature (e.g. organizational websites). Shelters contacted in the first phase of the research were identified as shelters or programs in Ontario providing harm reduction or needle exchange services for youth clientele. The shelters and programs contacted in this phase were all based in Toronto, as these were the shelters and programs that clearly identified as harm-reduction oriented. Parameters for inclusion were broadened for the second report, after feedback from community stakeholders indicated that the report would be more relevant if it were to include a "community snapshot" of the state of youth services, programs and shelters. For the first report, 3 shelters and programs were included; 11 shelters and programs took part in the second report. This expanded focus allowed for the development of some basic statistical identification of services offered at various shelters and programs. At each phase of the research, all parties reviewed drafts and data. The combination of community expertise in the field of drug strategy and extensive academic and community work strengthened the reports' content and quality. Communication between the community partner and the Research Shop ensured that the research accurately addressed the community partner's needs within the context of Research Shop research capacity. Both finalized reports were presented to and reviewed by community partners, including those shelters and programs who had been interviewed and used as case studies, before being shared with the wider WGDS audience, uploaded to the Research Shop website and/or presented at the forum.

(1) Khangura, S., Konnyu, K., Cushman, R., Grimshaw, J. & Moher, D. Evidence summaries: the evolution of a rapid review approach. Systematic Reviews 2012;1(10):1-22.

8. Please describe the process of developing the product, including the ways that community and academic/institutional expertise were integrated in the development of this product.

The Research Shop, housed at the Institute for Community Engaged Scholarship at the University of Guelph, serves as a link between the university and community. The Research Shop connects graduate student interns to community projects. Students work on projects that address community issues and priorities for an average of 5 hours per week in unpaid (volunteer) internships. The Research Shop matches interns to projects for which they have skills that could benefit community partners, such as research expertise or writing skills, adding capacity to community-initiated projects. Research Shop staff, including project coordinators and postdoctoral fellows, facilitate and support the placement of interns on community-based research projects.

At the time of the Youth Harm Reduction project's initiation, the student intern assigned to this project had written two short reports for the WGDS and had established a working relationship with both the Research Shop project manager and the WGDS manager. Thus, the Youth Harm Reduction project began with the intern already possessing an idea of the types of products that they desired, based on the reception of and feedback on previous reports. This project required a longer time frame than some of the others, particularly due to an expressed interest to access the points of view of service providers through short informational interviews, which resulted in the production of two reports.

The project began with a search for shelters and programs in Ontario that employed a harm reduction approach in their youth services, using a basic Google search approach. The academic literature was also reviewed to identify the types of approaches that have been used elsewhere and to situate the work in the points of contention that have been expressed. Once the shelters and programs self-identified as harm reduction oriented, had been identified, they were contacted by phone. Questions were drafted in collaboration with the community partner, to ensure that they would be informational in nature, would reflect the goals of the project, and would generate relevant responses. In several cases, no shelter/program representatives were willing or able to answer the questions. As a result, the final number of case studies was three. Finding shelters and programs within Ontario that readily identified as harm-reduction oriented or providing needle exchange to youth proved rather difficult. Additionally, research questions and goals evolved throughout the collaboration, shifting the report’s focus toward capturing the current tensions in the literature and an overview of current state of programs and services serving marginalized youth.

Throughout the process, the WGDS manager consulted with other members of the WGDS to ensure the relevance, scope and potential uses of research products. She also provided guidance in terms of where to look for appropriate participants to interview, and indicated that in the initial report, the few case studies did indeed provide a helpful context for the tensions identified in the literature. After the report was compiled, the results were presented informally to several representatives from the WGDS in order to get their feedback prior to the report's presentation at the Youth Harm Reduction Forum. The community representatives offered insights into potential areas for improvement and indicated interest about continuing the project. The reports were used to inform a presentation about Youth Harm Reduction services and best practices at the Youth Harm Reduction Forum in May 2012. At the presentation, several attendees indicated a desire for the project to be expanded to include a deeper focus on cities closer in size to Guelph, in order to make the results more relevant to the local context.

An even greater degree of guidance from the WGDS was taken for the second phase of the research, particularly in identifying a sample of youth programs and shelters to be interviewed in order to access various models of service provision. This second report intended to provide a "community snapshot" of how harm reduction is (or is not) being incorporated into youth services and shelters, and thus had wider parameters for inclusion. Informational interviews were conducted with 11 shelters and programs in cities in Ontario of a similar size to Guelph (population of around 120 000). After the report was complete, it was distributed to all stakeholders, including those shelters and programs interviewed. Throughout the project and the editing process, guidance and support of the Research Shop and the community partner was essential to the intern’s work. Reviewing all reports with the community partner ensured that the language used was accurate, clear, and reflected the tone present in the literature about drug strategy. This helped to ensure that the reports accurately responded to the needs of the community and were presented in a clear and relevant way.

9. Please discuss the significance and impact of your product. In your response, discuss ways your product has added to existing knowledge and benefited the community; ways others may have utilized your product; and any relevant evaluation data about impact, if available. If the impact of the product is not yet known, discuss its potential significance.

This research responded to a community-identified question: what is the state of harm reduction policies and practices in programs and shelters that serve marginalized youth? It identifies tensions around harm reduction for youth and provides a basis for understanding what is and is not being done in terms of harm reduction for youth. As several WGDS representatives noted, programs/shelters may operate without a strong understanding of what other shelters and programs are using as harm reduction guidelines. Policies for harm reduction stem largely from independent funding bodies or government funding. However, many of the shelter/program representatives indicated an interest in discovering the ways in which various programs, each operating in a different context but serving a similar clientele, manage harm reduction. Many of the shelters and programs not currently operating as "harm reduction oriented" services were interested in moving toward a more harm reduction oriented approach. The case studies in particular provide interesting examples of shelters and programs operating under the harm reduction model, potentially providing a starting point or impetus for conversations around what a harm reduction model looks like for youth. They reinforce the useability of the reports for diverse organizations, providing concrete examples of how harm reduction is managed in youth programs. Consulting with the WGDS throughout the process and revising research goals accordingly reinforced the importance of this contextualized approach. As the Youth Harm Reduction Forum in Guelph revealed, harm reduction for youth is building momentum as youth indicate a desire to be accepted "where they are." A report such as this identifies where some of the hesitancy in implementing harm reduction approaches lies and what types of approaches are used to overcome these tensions. The initial report was met with interest and calls for expansion. The expansion report has been distributed to all who took part in the research, and may have been shared by the organizations. One of the organizations who took part in the research, the POSSE project, has used citations from the expansion report in an application for grant funding.While this report is based in academic literature, the rapid response approach taken is not yet recognized by many major peer-reviewed journals. However, feedback from community partners suggests that these reports have been useful in decision making and conversation generation. Feedback was obtained at the Youth Harm reduction forum and through the Research Shop’s ongoing relationship with the WGDS. The reports have informed several WGDS initiatives, including a Community Framework for Youth. Stakeholder organizations who participated in interviews for the expansion report, in particular the POSSE project, also used citations from these reports in an Ontario Trillium Grant application. Despite addressing a specific community context, publishing these reports in CES4Health may expand their utility through sharing and discussion with other community and academic partners. Community stakeholders suggested this research be broadly disseminated, as the topic may be of interest to audiences beyond the Ontario area. It is important to conduct this work in cities of a similar size to Guelph, as knowledge in this area comes mainly from larger municipalities such as Toronto. Little is known about the services available to youth in smaller cities. Our community partners and interviewees indicated a desire to know more about what other, similar organizations are doing with respect to harm reduction, partly out of a recognition that this approach is increasingly appealing to such organizations. However, programs in service operating in smaller cities may not be able to apply approaches used in larger cities, about which information might be more readily available, as the effectiveness of such approaches may not translate to smaller city contexts.

10. Please describe why you chose the presentation format you did.

The presentation format reflected the Research Shop formatting template. The Wellington-Guelph Drug Strategy does not at present have a formatting template that is used for reports, and thus was satisfied with the use of the Research Shop "branding" on the report. The 3 different forms of the reports were distributed: the first report, a 2 page summary of the first report, and the second report. The summary version was intended for community members to be able to quickly scan the information and have access to the most pertinent details, whereas the longer versions were intended to give more in-depth information to those interested in discovering more about how harm reduction for youth is managed in Ontario. These reports were also uploaded to the Research Shop and WGDS websites for broader community dissemination.Both reports and secondary products coming from this research are presented in clear language to increase accessibility to community members. For example, this research was adapted to be presented at the Youth Harm Reduction Forum (1) used language that could be understood by diverse stakeholders, including youth with lived experience.

(1) Bergen, A., & LaMarre, A. (2012). Youth harm reduction programs: What does the research tell us? Presentation at the Wellington Guelph Drug Strategy’s May 2012 Youth Harm Reduction Forum. Guelph, ON

11. Please reflect on the strengths and limitations of your product. In what ways did community and academic/institutional collaborators provide feedback and how was such feedback used? Include relevant evaluation data about strengths and limitations if available.

Some of the limitations of the report include the literature review portion, which, as previously mentioned, consisted of a scan rather than a comprehensive systematic review. If a more thorough review of the literature were to be conducted, it is possible that the research could be either strengthened or contradicted. Nonetheless, the literature consulted did provide some "research-informed" grounding to address community concerns. Additionally, it was quite difficult to find and contact organizations for youth who self-identified as “harm reduction oriented”. Though some shelters and programs employed a harm reduction or harm reduction-like approach, it was uncommon for this to be identified on the programs' websites. This made it more difficult to determine which shelters and programs to include in the research, and it is possible that some interesting cases were excluded.

The nature of the work of the community partners and contributors also made it difficult to find time to interview some of the organizations, as their workloads prevented them from being able to take part in the research without detracting from their service provision roles. To minimize this issue, the interviews were kept as short as possible, and were purely informational in nature (i.e., asking only about publicly available information related to service delivery and relevant policies). Future research might consider seeking ethics approval to conduct more in-depth interviews with the service providers and youth themselves. The youth perspective was not included in this research, but may provide further insight into the tensions relating to harm reduction, as well as potentially providing compelling reasons for employing such approaches in service provision.

In spite of these limitations, there are many strengths of the product, including the way in which it was conceptualized, leading to increased relevance of the findings. The research goals were determined in collaboration with the Wellington Guelph Drug Strategy, and then expanded upon with feedback from other key stakeholders in and around Guelph. Over the course of the research, continual communication with the WGDS was essential in order to make sure that the direction of the research was appropriate. The Research Shop also helped to guide the intern in her work to ensure that the research was taking shape in a way that would best fit the needs of the community partner. The informational interview portions of the research provided key data for the report as well as details about other organizations to contact for inclusion in the research. These interviews also increased contact between the research and community stakeholders, who often indicated a desire to learn more about the research and/or distribute the products among drug strategies/other organizations in their own communities.

The insights generated by community partners drove and shaped the research, giving it life beyond the academic literature consulted to ground the research in the already-identified tensions. As such, the research took place at the interface between research and practice. While the academic literature provided a basis for speculation, there were some surprising convergences and divergences from the literature identified in interviews with community organizations. Consultation with the community through the first report's presentation at the Youth Harm Reduction Forum also drove the follow-up research. Without this presentation and subsequent feedback, the expansion report may not have been conducted. As it stands, the follow-up report holds more relevance to communities similar in size to Guelph than the initial report, and may thus be more useful not only to the primary community partner but also to the organizations who took part in the informational interviews. These reports provide a starting point and "community snapshot" for considering the implementation of harm reduction practices for youth.

12. Please describe ways that the project resulting in the product involved collaboration that embodied principles of mutual respect, shared work and shared credit. If different, describe ways that the product itself involved collaboration that embodied principles of mutual respect, shared work and shared credit. Have all collaborators on the product been notified of and approved submission of the product to CES4Health.info? If not, why not? Please indicate whether the project resulting in the product was approved by an Institutional Review Board (IRB) and/or community-based review mechanism, if applicable, and provide the name(s) of the IRB/mechanism.

Throughout this project, the community partners were involved in decision making and reviewing of the progress and products of the partnership. All research goals were either developed in collaboration with or identified by the community partner. Further, at each stage of the research process and report writing, the community partner was consulted to ensure that the research accurately responded to their questions and goals. The Research Shop provided the WGDS with a "third party" to look into the question of how youth harm reduction is (or is not) being managed. As such, the WGDS did not conduct interviews or write the report. In this partnership, the community partner identified that having an intern prepare the report was preferable, as it would provide a perspective on the issue that may not be considered by those who work in the field. Having an intern conduct the research provided the WGDS with the opportunity to evaluate the question from arms-length. While the intern was able to provide this opportunity to the WGDS, she also benefitted from the expertise of the WGDS and other community stakeholders in conducting the research. Having community partners and the Research Shop review the products of the research enabled the student intern to become more fluent in the language of the drug strategy. Conducting informational interviews and writing up research products in a tone and language that responds to the needs of a community partner are also skills that the intern developed over the course of this partnership. All primary collaborators support the submission of the product to CES4Health.info. We also presented on this collaboration at CUExpo 2013 (1).. In this presentation we touched upon some of the information identified in this product narrative, including details of the collaboration.

This research did not seek Research Ethics Board (REB) approval , as the interviews conducted were informational in nature (i.e., asking only publicly available information about services provided and relevant policies). While obtaining REB approval and conducting a larger-scale project would have been interesting, the decision not to do so reflects the community-driven nature of this project. As the project progressed, it was determined, in collaboration with the community partner, that informational interviews and the creation of a “community snapshot” with a quick turn around time would best meet the needs of the partner. If the WGDS should decide in future to probe these issues more deeply, the Research Shop would be open to negotiating a further expansion of this project. As it stands, however, the report’s goals and research questions evolved as the project progressed, and the report reflects the dynamicism and flexibility inherent to working on community-engaged research in time-sensitive contexts.

(1) LaMarre, A., Bergen, A., & Devereaux, R. (2013). Engaging transformation: Creating and realizing a community driven research program. Presentation at the 2013 CU Expo, Corner Brook, NL.