Programming Connection

Harm Reduction Satellite Sites Program 

Parkdale Queen West Community Health Centre
Toronto, ON
2020

How Does the Program Work?

The Harm Reduction Satellite Sites Program operates out of the two sites of the PQWCHC. The SSWs are located in residential buildings in the PQWCHC catchment area. The SSWs distribute harm reduction supplies and provide education (e.g., on safer injection practices) and information (e.g., community referrals, alerts on bad batches of drugs) to their neighbours in priority buildings (i.e., satellite sites).

Priority buildings for harm reduction supports were initially identified through a needs assessment with community members. A variety of additional information sources are now used to identify priority buildings, including:

  • street outreach teams
  • Toronto emergency services data on overdose calls to identify “hot spots” where supports are needed
  • communication with clients and community members who are using PQWCHC’s services
  • ongoing consultation with the broader community of people who use drugs through a community advisory group (CAG)

The CAG advises PQWCHC on all aspects of the program, ensuring the program always has “an ear to the ground.” The CAG is composed of community members from priority populations as well as representatives and peer workers from partner agencies. The CAG has eight to 12 members and meets approximately four times per year.

The program is staffed by SSWs who live in identified priority buildings. SSWs are recruited through word of mouth and referrals by community members, and potential SSWs may also be identified because they voluntarily visit one of the two sites of PQWCHC to pick up large quantities of supplies for their friends and/or neighbours. The recruitment process includes a job posting and an interview. The program coordinator and current SSWs do the recruitment (e.g., sharing job postings, conducting interviews) for the program. Recruitment for positions is targeted in and around identified priority buildings or areas. SSWs are well-known and trusted members of their communities and are knowledgeable about the local drug scene.

The PQWCHC program currently has 10 SSWs at the time of writing. All SSWs provide the same core services from within their residences:

  • distribution of harm reduction supplies
  • naloxone distribution
  • overdose response training
  • referrals to other services (e.g., referrals to primary care, legal supports related to housing needs, and peer health navigators who can accompany clients to appointments)
  • support and education on safer injection practices, including HIV and hepatitis C prevention, vein care and prevention of skin infections
  • sharing of important and time-sensitive information (e.g., information about contaminated batches of drugs, referrals to community services and information on “bad date” lists for sex workers)

In addition, some SSWs allow trusted clients to use drugs in their residence, providing peer-supervised drug use for safety in the event of an overdose or other adverse reaction. Some SSWs become satellite peer leads, who are SSWs with more work hours and responsibilities (e.g., completing health promotion outreach events in residential buildings).

SSWs pick up the harm reduction supplies that they distribute on a weekly basis, and they are expected to record the number of encounters they have and the supplies they distribute on anonymous weekly stats sheets. They establish their own work hours (can be flexible), which are often outside of regular community health centre hours. The expectation is that SSWs distribute supplies four to six hours per week. SSWs are not on-call, and efforts are made to ensure that they are not over solicited in their role.

People typically learn about the program through word of mouth. Most SSWs operate discreetly to protect their own privacy, although some SSWs choose to promote their services in a range of ways (e.g., flyer on their door) when they feel comfortable doing so.

Attempts to gain the support of the management/operator of a residential building are made only when the SSW feels that it would be useful and that the building management/operator would be receptive. Identified buildings are sometimes receptive to having a SSW because of the supportive role they can play (e.g., increasing safe needle disposal, overdose reversal). Gaining the support of housing providers can be a long-term and ongoing process. Additionally, the program coordinator, satellite peer leads or other outreach workers do outreach to identified buildings to build support or to address misconceptions about harm reduction.

SSWs play an informal role through the use of their own networks, and therefore there is no formal memorandum of understanding (MOU) created between the program and the buildings where SSWs operate. Often health promotion events (e.g., drop-ins, health fairs in building lobbies) or outreach nursing are held in certain buildings to build relationships with building management/operators and to introduce the building to harm reduction programs. An MOU is created for more formalized outreach events.

SSWs operate as independent contractors. They receive an honorarium in recognition of their time ($60–$90/a week depending on the extent of their responsibilities and hours worked), with any additional team meetings, trainings or orientation being compensated at an hourly rate ($15/hour). Payment is tied to the program’s current funding arrangements.

Satellite Support Worker Training and Support

The program builds upon the expertise and experience of SSWs by providing ongoing team trainings and other training opportunities. SSWs are required to complete a variety of trainings during an orientation period within the first few months of service and then on a periodic basis. A series of six to eight mandatory team trainings and workshops are provided to SSWs per year, covering topics such as:

  • safe needle handling/disposal
  • stimulant and opioid overdose response training, including the use of naloxone
  • asserting and communicating boundaries and the ethics of peer-based work
  • conflict resolution and crisis de-escalation
  • HIV and hepatitis C prevention, testing and treatment
  • making effective referrals and pathways to care
  • legal rights with police and the Good Samaritan Drug Overdose Act
  • sex worker rights

Training sessions on other topics (e.g., presentations on atypical overdoses, active listening) are provided as needs arise.

Support for SSWs, particularly in the context of the ongoing overdose and drug poisoning crisis, is a critical and central component of the program. The program coordinator does weekly individual check-ins with SSWs, in addition to providing support around operating their satellite sites and around asserting limits and negotiating boundaries with clients. Additional support is provided as required (e.g., facing conflicts with landlords, legal issues). The program coordinator holds regular team meetings to discuss and troubleshoot issues that the SSWs are facing and to provide a space to process grief over the loss of other community members.