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From the Doorstep to the Sitting Room : 

From the Doorstep to the Sitting Room John Craven Senior Outreach Counsellor/Worker Addiction Services Health Services Executive Dublin Mid-Leinster (Dublin South East, East Wicklow and Dun Laoighaire) Mobile Needle Exchange /Harm Reduction Service

What is Outreach : 

What is Outreach Outreach could be defined as a community orientated activity undertaken in order to contact individuals or groups from a particular target population, who are not effectively contacted or reached by existing services, or through traditional health education channels’

Purpose of Outreach Service. : 

Purpose of Outreach Service. To provide Pragmatic and effective harm reduction interventions to address drug related issues placing priority on reducing the negative consequenses of drug use rather than trying to eliminate drug use or enforce abstinance.( Abstinance does have its place)

Static Exchanges : 

Static Exchanges Services run from Health Centres. Community Addiction Teams. Specialised Projects. (DAISH Bray Travellers Group)

Models of Exchange services provide by HSE East Coast Area : 

Models of Exchange services provide by HSE East Coast Area Static exchanges (since 1989) Backpacking (since 1999) Mobile service (Since 2002) Emergancy packs ( Since the beginning of time)

Background to backpacking. : 

Background to backpacking. 1995 Addiction services expanded into area 10 covering Bray as far as Carnew Closest needle exchanges were Baggot Street or Merchants Quay. Anecdotal evidence suggested that sharing of equipment was commonplace

Because of the lack of exchange services in these rural areas, individuals were taking more risks than neccessary, local resistance fuelled by misinformation hindered any traditional attempts at the provision of exchange services locally. : 

Because of the lack of exchange services in these rural areas, individuals were taking more risks than neccessary, local resistance fuelled by misinformation hindered any traditional attempts at the provision of exchange services locally.

Comments From Contacts : 

Comments From Contacts “Whats the point of having a drug service which can only give information when we cant even access clean needles “Its terrible its not helping us to stop taking any risks of the hep and AIDS” “Its not always possible to get to Dublin because of transport, money,and work commitments” “We got barrels and spikes from the back of a vets car, when they were blunt we would sharpen them on a stone on the beach or with a match box” “I use old works and boil them for 10 minutes, that should kill the virus, shouldn’t it “I just share with some lads I know they don’t have the hep” “I don’t share with anyone except my brother and partner” “I don’t care I probably have the virus by now” “Look me arms are in bits I have to use me groin”

Something had to be done : 

Something had to be done Opposition and resistance from local communities. Visable evidence of poor injecting techniques. Lack of equipment and riskier practices Lack of Provision of safer injecting information.(NOTHING TO OFFER)

EnterBackpacking Harm reduction Service1999 : 

EnterBackpacking Harm reduction Service1999 Two Outreach Workers Two ruck sacks Own transport Service was taken off the doorsteps and into homes (from back yard into sitting room) Delivery of services tended to be more relaxed Better opportunities to provide safer injecting advice Increased returns of used equipment.

Backpacking to Mobile Service 2002 : 

Backpacking to Mobile Service 2002 E.U directive governing transport of hazardous waste. Health and Safety Authority legislation Purchase of small van All staff driving van had to undertake training for licence to allow them to transport bio-hazard waste

Mobile service : 

Mobile service Small van equipped to carry clean sterile injecting equipment and also store used equipment. Service is allocated to different areas each day at a given time. Mobile number specifically for van. Service is run by two Outreach Workers always Service complies with H.S.A regulations on the transport of biohazard materials.

Paraphanalia Provided : 

Paraphanalia Provided Sterile swabs Sterile water Sterile needles Sterile barrels Sterile cups Sterile filters Sterile tournequet Sterile citric acid Sterile tin foil Condoms/safer sex. Contact for Outreach Referrals Safer drug use info Safer injecting Advice re complications

Backpacking/Emergancy services. : 

Backpacking/Emergancy services. Harm reduction services provided by two Outreach Workers on a given day in a given area/or on request. All service users are contacted by text and clean injecting equipment is prepacked. Returns are collected when Mobile service is in area,or through Static services.

Exchange client totals for 2007 : 

Exchange client totals for 2007 Needles out 68,873 Needles in 52,631 Outstanding 11,242 Total encounters 2,793 Per encounter 4 Total clients 377 Outstanding per client 27

Exchange client totals 2008East Coast Area : 

Exchange client totals 2008East Coast Area Needles out 66610 Needles in 60020 Outstanding 6580 Total encounters 3003 Per encounter 2 Total clients 394 Outstanding per client. 17

The Beginning : 

The Beginning

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