For Magdalena. For Tommy. For Daniel. For Cathal. For all those we have lost along the way and who continue to guide our work.
As Global Health Corps Fellows we believe that every person has the right to live a healthy, dignified life. This ‘every’ does not contain a hidden caveat; an asterisk that refers the reader to the bottom of the page, to a line that says ‘except those who choose to live a life that society does not condone’.
It is this understanding of ‘every’ that fuels my passion to work in low barrier, harm reduction services; with those individuals that often fall through the cracks in society. To date, it has guided my work with rough sleepers and substance users in Northern Ireland. And it is what brought me to HIPS – working to reduce the harm experienced by sex-workers, drug users and their communities in Washington, DC.
The importance of low barrier, harm reduction services for me is defined by the worth of the individual. Such services aim to reduce the harm associated with certain human behaviors dictated by choice, coercion or circumstance, whilst placing as few barriers as possible in the way of engagement with services. These behaviors include drug use, sexual exchange, mental health and homelessness and often lead to a life on the margins of society. Low barrier, harm reduction services focus on the individual rather than the criteria or goal of the service. They do so by recognizing the worth of the individual: by meeting people where they’re at and working with them to promote their health, rights and dignity whilst emphasizing individual power and agency.
Many people are born significantly disadvantaged, but no individual is born on the margins of society. We, as participants in society, gradually push them out. Stigma, discrimination, criminalization, inflexibility, repeat trauma, social determinants, institutional oppression and a failure to see the individual behind the presenting issue are just some of the factors which contribute to this – and which ultimately prevent individuals from accessing services. This, combined with a complexity of needs, can lead to a population that is highly transient, isolated, chaotic and suffers from long term disengagement from services. It is this population for whom low barrier harm reduction services exist.
One of the challenges faced by such services lies in establishing and maintaining consistent contact with clients. This challenge results from the client’s transience, chaotic lifestyle, repeat exclusions and lack of confidence in service providers, combined with practical barriers such as lack of phone access or permanent contact address. In light of this, outreach work can prove to be some of the most effective and rewarding in terms of seeking out and engaging marginalized individuals and acting as a bridge to the appropriate services. In many cases, outreach work is the catalyst for reconnecting marginalized individuals with mainstream health and social services. Despite this however, outreach work is often undervalued, as is the role of the outreach worker itself.
An effective outreach worker is highly skilled – they are flexible, adaptable, empathetic, compassionate and determined. Above all however, they are client-centered. The most significant aspect of an outreach worker’s role is the ability to connect with the client and to develop a relationship and bond of mutual trust. Whilst there is no one way or ‘right’ way to approach this work, there are certain factors that can dictate how effective this work is. I have had the privilege to work with and to learn from some unique and special people in this field – from clients and outreach workers alike. Reflecting on these experiences has taught me the following principles of effective outreach:
• Be conscious of ‘baggage’ – clients that engage with outreach services are often highly transient, marginalized individuals who may have had long periods of disengagement from service or who have had previously poor experiences with mainstream service providers. Be conscious of this and adjust your behavior accordingly. Ask yourself how this might affect your interaction and how you can work to make this interaction meaningful, or better than the client’s last.
• Go slow, be patient – building relationships and trust with the client populations that outreach services aim to reach can be painstaking work. In some cases, it can take months or years to build a relationship that bears fruit. Never lose sight of the fact that your client is an individual with his or her own unique narrative. Be aware that you may appear invasive with your questioning, particularly for a client who has become socially isolated or disengaged from services long-term.
• Identify the window of opportunity – and grasp it! It could make all the difference to the client and to your relationship with them. Do not be overly quick to think ‘who can I refer this client on to?’ as oftentimes this translates to the client as ‘who can I pass this person on to so that I no longer have to deal with them?’ Think instead ‘what action steps can I take to assist this person in this moment?’ And if concrete assistance is not possible, ‘how can I ensure that we are best able to link with them again (if that is what the client wants), or how can I ensure that they will want to approach the outreach team again?’
• Be realistic – be clear about what your limitations/the organization’s limitations are in terms of what you or the organization can accomplish for the client. Failure to inform the client of the limitations of the service can undermine the relationship that you are trying to build, or have built, with the client.
• Never make promises – you can very rarely promise anything so don’t do it. Making promises sets you, the organization and the client up for failure. Making promises also has the potential to undermine the relationship that you are trying to build, or have built, with the client. Honesty, integrity and candor are valued over promising a lot and delivering little.
• Be respectful and keep the client informed at all times – value the client as an individual. Be clear about why you are asking for certain information, how this information will be used and who has access to it. Be clear about what action steps you are going to take and what those steps involve. Always gain consent for any action you take – no matter how small or insignificant it may seem. Keeping the client informed gives the client control of their situation as far as is possible. This is particularly important among highly transient populations or with clients who lead chaotic lifestyles, where they may already feel that they lack control.
• Be sensitive to the client’s time – advise the client at all stages of the process about what you are doing, how long you expect the task to take and how long you need them to wait. This gives the client control of the situation as far as is possible and demonstrates respect for the client as an individual with needs, priorities and responsibilities.
The most effective outreach workers possess all of the attributes listed above but more so than this, they have a unique ability to combine all of these skills whilst knowing how to adapt their approach to the individual client, based on that client’s needs and desires. By investing time, energy and resources in employing effective outreach in our work, and by recognizing and valuing the contribution that effective outreach makes to the success of our service, we can begin to connect with those individuals most marginalized in our societies.
It is through effective, client-centered outreach that we can begin to reach out.