267166 Understanding harm reduction: A qualitative study of service provider knowledge and its impact on service delivery

Wednesday, October 31, 2012

Marian Katz, PhD , Division of General Internal Medicine and Health Services Research, University of California, Los Angeles, Los Angeles, CA
The California Mental Health Services Act (MHSA) created a new type of program, called a full service partnershp (FSP). Based on evidence from research and previous state-funded pilot projects, the FSPs were mandated to adopt a "recovery vision" in their approach to improving the quality of life and reducing the societal cost of care of individuals with serious mental illness (SMI) and chronic homelessness, often along with substance abuse. Harm reduction is a service philosophy that focuses attention on prevention and wellness, and it is widely considered the approach most compatible with a recovery vision. Based on interviews with over 100 FSP service providers from a federally-funded, mixed methods study of the FSPs, this presentation examines how service providers describe and explain their approaches to harm reduction. These descriptions and explanations reveal a range of understandings, including misunderstandings, of what a harm reduction approach entails. Our analysis examines this wide variation in the meaning of harm reduction and considers its impact on service provision and client outcomes. In particular, it considers how service provider misunderstandings may be a barrier to effective care for individuals experiencing chronic homelessness and SMI. This study offers insights into the local context of service delivery and how service delivery can be improved. It also reveals challenges in the dissemination of evidence-based practices and suggests some ways to address these challenges.

Learning Areas:
Chronic disease management and prevention
Diversity and culture
Other professions or practice related to public health
Social and behavioral sciences
Systems thinking models (conceptual and theoretical models), applications related to public health

Learning Objectives:
1. Explain what harm reduction is and why it is associated with "the Recovery Vision for mental health consumers" 2. Identify the different ways that FSP service providers understand harm reduction 3. Discuss how these different understandings impact the practice of harm reduction 4. Explain how variation in service provider understandings may be a barrier to effective health service delivery for homeless populations 5. Assess how harm reduction contributes to prevention and wellness for chronically homeless adults with serious mental illness

Keywords: Homeless Health Care, Service Delivery

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am currently a co-investigator of a federally-funded, mixed methods, comparative effectiveness study of California's Full Service Partnerships, which are programs aimed at reducing homelessness and promoting recovery among individuals with serious mental illness and often co-occurring substance use. I have been a researcher and analyst on multiple foundation and federally funded qualitative and mixed methods studies of patient and provider perspectives and interactions.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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