Transcript EFFECTIVE DELIVERY

Community
Outreach Strategies
Derrick K. White, MHS
Director of Outreach Services
Unity Health Care, Inc.
WORKSHOP GOAL &
OBJECTIVES
Workshop Goal: This workshop is designed to familiarize the participants with the core body
of essential knowledge needed to conduct street outreach effectively, professionally, and
with a consistent message.
By the end of this workshop, you will:
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Identify the core group of topics essential to street outreach.
Have a working knowledge of street safety
Be familiar with engagement tactics
Understand the importance of confidentiality and ethics
Identify barriers to reinforcing prevention messages
Understand Intervention (risk assessment/reduction and crisis intervention)
Have a working knowledge of “burnout” and “relapse”.
CONFIDENTIALITY
AND ETHICS
An outreach worker is obligated to
adhere to accepted ethical and
behavioral standards of conduct and
professional development
CONFIDENTIALITY
AND ETHICS

Understand the importance of confidentiality to your mission
 Understand the differences of anonymous and confidential (be able to explain)
 Develop an awareness of, and respect for, the client’s right to confidentiality and
privacy
 Learn the federal, state and agency guidelines that govern confidentiality
 Be able to maintain confidentiality in public or semi-public encounters
 Judgment has no place here!! Put your moral judgments aside to best achieve
goals
LAWS & REGULATIONS
FAMILIARIZE YOURSELF WITH . . .
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Confidentiality laws
“ Duty to warn” laws
Local, state and federal laws
Legal issues concerning syringe exchange and condom
distribution
There are guidelines that govern the way health education and promotion activities are conducted
in a particular area. . .
Example: The School System doesn’t allow you to bring condoms or show any pictures of Drugs or
drug paraphernalia…..
OUTREACH IS . . .

The provision of health-related information and services to a target
population that is traditionally underserved and uninsured.
 A strategy for bringing services to a group, where they work and
live.
The success of outreach has been associated with the hiring and
training of individuals who live in and are familiar with the community.
OUTREACH WORKERS
“DO’s & DON’T’S”
This is not meant to be a list of safety procedures for
the outreach worker, but rather a useful reminder
to outreach professionals.
DO THESE
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Carry identification at all times
Canvas and evaluate area of high drug trafficking and intense drug activity
Be flexible in scheduling your outreach to contact as many people as possible
Establish contact with the police in all areas where outreach is conducted
Always notify someone of where you are or will be at ALL TIMES
Always work with a partner
Be aware of your surroundings
Be aware of your demeanor and how your partner is feeling
Have a contingency plan for emergency and dangerous situations
Learn to recognize some of the characteristics and behaviors of addicts
Know when it IS appropriate to engage with a client and when it is NOT.
DON’T DO THESE
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Wear expensive clothes, uncomfortable shoes, or jewelry
Carry valuables and large amounts of money or take your wallet out
Carry any kind of weapon
Carry, hold, handle, or sample any kind of controlled substance or drug paraphernalia
Pretend to be an active addict in order to ingratiate yourself (try to fit in) or gain information. Be honest
about your role.
Pass on information you have about where good drugs are being sold
Get high, have sex, or engage in criminal activities with clients (ethical standards)
Buy stolen goods – REMEMBER …Ethics! Ethics! Ethics!
Give or lend money to clients
Play “doctor” and try to diagnose HIV infection, AIDS, or STDs
EFFECTIVE DELIVERY

The Outreach Workers should reflect the ethnicity, gender, and
cultural diversity of the population being served.
 When appropriate, the outreach team should include a bilingual
and/or a bi-cultural member.
 Overcoming language barriers are very important in delivering the
information effectively.
EFFECTIVE DELIVERY

Familiarize Yourself With Interviewing Techniques (Use
open-ended questions)
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Understand Counseling Strategies
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Understand The Client Position (This helps you in selecting
an approach)
*Develop the willingness to collaborate
ENGAGEMENT IS . . .

Engagement is the physical act of client and outreach worker
participating in an activity that involves a positive interaction,
whereby the client is made to feel as comfortable as possible
while listening to and speaking with the outreach worker.
ENGAGEMENT INVOLVES . . .

Identifying and making contact with members of the target
group in their natural environments
 Establishing a rapport
 Enlisting a commitment toward behavioral change
 Providing information about risk behaviors and strategies to
eliminate or reduce risk
SAFETY & AWARENESS
YOUR ENVIRONMENT
• Understanding street outreach tactics (working in pairs and
interviewing using the third person)
• Knowing the “do’s and don’ts” of outreach (all team members
should know the whereabouts of every team member)
• Have an emergency protocol for your team
KNOW YOUR
POPULATION (S)
• “NEEDS” vs. “WANTS”
Remember the Basic Needs of Life (Food, Shelter and Clothing)
• HABITS/BEHAVIORS
• RISK FACTORS
• REINFORCE CHANGE (Harm Reduction)
• SOCIAL HABITS
CULTURAL SENSITIVITY

Cultural sensitivity is a set of
attitudes, practices, or policies
that respect – rather than merely
show – that you are receptive to
different cultures of people. This includes a
thorough knowledge of a particular group’s
values, norms, morals, traditions, customs,
arts history, folklore and institutions.
MEETING “AT RISK” INDIVIDUALS IN
THEIR NEIGHBORHOODS
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Common Ground
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Mobility/Migration
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Knowledge of City
Services
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Strong Referral Network
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Know Your Limitations
Recognizable Presence
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Respect
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Professionalism/Quality
RISK ASSESSMENT
Risk Assessment is an ongoing process
through which the outreach worker
collaborates with the client to determine what
the client is doing or has done to put him or
herself at risk, as well as, what triggers
“risk taking” behavior.
YOU MUST BE ABLE TO BREAK DOWN BARRIERS
RISK ASSESSMENT
• Familiarize Yourself With Risk Assessment (what role does it play
in behavior change?) I can only change it if I know it’s there
• Understand Ongoing Assessment (Assess, Assess, Assess)
• Be knowledgeable regarding the most current assessment
instruments
INDIVIDUALS ARE MOST LIKELY TO
CHANGE BEHAVIORS WHEN . . .
• They can identify which risky behaviors they believe they can
reduce or eliminate
• They understand what steps they might take to make a behavior
change
• Realistic opportunities to practice new behaviors are
presented/suggested
• They receive reinforcement for making a behavior change (No behavior
too small)
YOU MUST BE ABLE TO BREAKDOWN BARRIERS
STRATEGIES TO REDUCE
INJECTION-RELATED RISK
• Advocate for entry into drug treatment & reduced drug use (number of injections or use
frequency)
• Recommend using a new, sterile needle for every injection
• Demonstrate how to sterilize injection equipment (when new equipment is unavailable)
• Educate clients to understand that sharing injection paraphernalia such as cookers, cotton,
and rinse water in addition to sharing syringes can increase risk of infection (HIV)
Risk Assessment is an ongoing process through which
the outreach worker collaborates with the client to determine
what the client is doing or has done to put him or herself at risk,
as well as, what triggers the “risk taking” behavior.
STRATEGIES TO REDUCE SEXUAL
RISK
 CONDOM USE (FEMALE/MALE)
 NOT HAVING SEX
 ENCOURAGE HAVING SEX WITH ONE PARTNER WHO ONLY HAS SEX WITH
YOU
 DO NOT USE DRUGS OR ALCOHOL
 DEMONSTRATE CORRECT USE OF MALE/FEMALE CONDOMS
 ENCOURAGE CONSISTENT CONDOM USE
 ENCOURAGE REDUCTION IN THE NUMBER OF SEXUAL PARTNERS
Risk Reduction: Risk reduction involves a collaborative process through
which the outreach worker and client identify risk behaviors and
develop strategies to achieve healthy alternatives
CLIENT
SUPPORT
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Client support is the process of
facilitating the client’s
utilization of available support
systems and community
resources to meet individual
needs
CLIENT SUPPORT
REFERRALS FOR SERVICES
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Have a good working knowledge of the service organizations
available to you
Understand the mission, function, and quality of services
Have an understanding of the criteria for receiving services
Make person-to-person contact with service providers (this is
important during follow-up
*Be an advocate for your client!
TREATMENTS
Options for substance abuse treatment include:
• INPATIENT
• OUTPATIENT
• OUTPATIENT DRUG-FREE
*Understand the warning signs of relapse! Understand the disease of
addiction!
SUPPORTING
YOURSELF
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An outreach worker must develop
and utilize strategies to maintain
his or her physical and mental
health.
SUPPORTING YOURSELF
& YOUR TEAM!
BURNOUT PREVENTION
Teamwork is
the key!!
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Understand the difference between burnout and depression
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Familiarize yourself with stress
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Practice strategies that reduce burnout (ongoing training,
staff support, meetings, job diversity)
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Don’t be afraid to ask for help (co-workers, supervisors and
outside support systems)
CRISIS INTERVENTION
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Understand the differences between crisis intervention and other kinds of
therapeutic interventions
 Familiarize yourself with the legal obligation of the “duty to warn” law
 Familiarize yourself with crisis resolution steps
 Develop the capacity to be non-judgmental in the contest of assessing and
resolving a crisis.
 Recognize personal and professional limitations
*The appropriate response is CRITICAL in situations where harm might occur to
the client (suicide ) or to another person (homicide)
PREVENTION & POST-TEST
COUNSELING
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Familiarize yourself with information about laboratory testing & results
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Familiarize yourself with the ways infectious diseases are transmitted &
prevented
The outreach worker is responsible for providing detailed information about the test performed
(HIV/AIDS, TB, Hepatitis, and many other services that are offered to at risk groups) and
available treatment options
PREVENTION & POST-TEST
COUNSELING
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Understand public health concepts
 Familiarize yourself with health providers and support groups
to assist people who receive “positive” test result
 Develop well-rounded skills to ensure comprehensive post
contact information is obtained to ensure clients receive test
results (this information well serve well during follow-up)
4…3…2…1—GET TESTED!
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Syphilis rates are on the rise in DC!
DC’s HIV rates are still the highest in
the nation! (Syphilis is a sexually
transmitted infection that can cause
serious organ damage or death if
untreated. If treated with antibiotics
syphilis is curable.)
4…3…2…1—GET TESTED!
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April is STD (Sexually Transmitted
Disease) Awareness Month and we’re
making it easy to take control of your
sexual health with fifteen hours of free,
confidential HIV and syphilis testing
throughout DC, Prince George’s and
Arlington counties! On April 3, 2009,
get tested for free at the following sites:
Time
Location
Service Provider
Bachelor’s Mill
1104 8th St SE
Us Helping Us
www.uhupil.org/
11am-3pm
H Street & 8th Street NE
DC DOH Healthy Start
doh.dc.gov
1pm-3:30pm
Nannie Helen Burroughs
Parkway & Division Ave NE
PreventionWorks!
www.preventionworksdc.org
1:30pm-4:30pm
Georgia Ave. & Park Rd. NW
Family and Medical Counseling Services
www.fmcsinc.org
3pm-8pm
21st Street & Maryland NE
The Women’s Collective
www.womenscollective.org
4pm-8pm
Lamont Park
16th Street & Park St. NW
The Mary’s Center
www.maryscenter.org
5pm-9pm
Whole Foods
1440 P Street NW
Unity Healthcare
www.unityhealthcare.org
5pm-10pm
Columbia Rd & 18th St NW
Andromeda Transcultural Health
www.andromedatransculturalhealth.org
9pm-1am
Dupont Circle
17th Street Safeway NW
Carl Vogel Center
www.carlvogelcenter.org
10pm-2am
Town Dance Boutique
Florida Ave & 8th St NW
Whitman Walker Clinic
www.wwwc.org
April 2, 2009
10pm-2am
April 3, 2009
Syphilis in DC

Between 2000-2005 the rate of syphilis in DC
increased 200%.
 The number of cases among whites has been
increasing while the number of cases among
African Americans has been decreasing.
 The male to female ratio in 2006 was 18 to 1.
 In 2007 there were 181 cases of syphilis with
35-44 y/o the most affected (in 2001 there
were 42 cases of syphilis)
Syphilis
Primary, Secondary, Early Latent
1st Stage – primary symptom is a small painless lesion
at the site of infection. It appears 1-12 weeks after
sex and lasts 1-5 weeks. The lesion heals but
syphilis remains as does the ability to transmit
syphilis.
2nd Stage – secondary symptom is usually a painless
rash on the body-often on the palms of hands or
bottoms of feet. It appears 1-24 weeks after
primary lesion heals and lasts 1-6 weeks. The rash
heals but syphilis remains as does the ability to
transmit.
Early Latent – Any period of time in the first year of
infection when symptoms are not present. Usually
between the first and second stage
Syphilis
Late stages
-Late Latent stage: the period of time in
which there are no symptoms but a person
has been infected for longer than a year.
-Late stage: Syphilis has traveled to the
blood and major organ systems causing
damage that can not be undone to the heart,
brain, liver, eyes, joints, nerves and bones. It
can also lead to death.
Primary syphilis-penile chancre
Complications of Syphilis
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If left untreated Syphilis will travel through
the blood stream, damage major organs and
could lead to death.
 Damage to the Central Nervous System that
can result in difficulty controlling your body
movements or psychosis.
 Damage to the heart
 Tumor like lesions anywhere inside the
body.
Syphilis and Pregnancy
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A mother can pass syphilis to her child during
pregnancy or delivery.
 Possible complications: miscarriage, still birth
or death shortly after birth.
 An infant can be born without symptoms and
still be infected. Serious complications occur
for infants who remain untreated such as
serious developmental delays, seizures, or
death.
Testing and Treatment of Syphilis

A simple blood test (RPR)
 A simple injection of a strong antibiotic can
cure syphilis.
 If syphilis is in the later stages of the disease
more doses of the medicine may be needed
to cure syphilis.
 Any damage to the body is not fixed with this
medicine; the damage is permanent. This is
why it is so important to be treated for syphilis
quickly after infection.
Prevention

Condoms, when used consistently and
correctly can reduce your risk of getting
syphilis
 Condoms are not as effective as with other
STDs and HIV as the infectious lesion may be
outside the area the condom covers
 Barriers during oral and anal sex are
important