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Long, Jean and Keane, Martin (2004) Outreach work. Drugnet Ireland , Issue 11, June 2004 , pp. 10-12.

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Definition

 

The outreach worker is the link person between drug users and harm minimisation services. The assumption behind outreach work is that individuals are ‘out there' using drugs and not in contact with existing harm minimisation or drug treatment services. These include young 'chaotic drug users', homeless drug users and drug users involved in the sex industry. Outreach work targeting individuals engaging with illicit drug use has tended to focus on these 'hard to reach' and 'hidden' populations of drug users. When outreach work was first introduced, the rationale underpinning this work was that users, once reached, could be persuaded to engage with treatment services. Over time, it became obvious that ‘the abstinence approach to treatment’ was not always feasible for individuals as a first treatment option. Currently, outreach workers place a strong emphasis on ‘a harm minimisation approach to drug use’.  According to Korf et al. (1999)1

  Outreach work in the drug field is a proactive method used by professionals and trained volunteers or peers to contact drug users. Its aims are to inform them about the risks associated with drug taking, to support them in reducing or eliminating such risks, and/or to help them improve their physical and psychosocial circumstances through individual or collective means. (p.85)  

 Evaluation of outreach work in Ireland

 There have been two formal reviews of outreach work with drug users in Ireland.  Each review examined different but complementary aspects of outreach services.  Between June and December 2002, Bunning2 examined the policy, planning and organisation of the services; between December 2000 and October 2001, Corr,3 in partnership with outreach workers, reviewed outreach activities and investigated the immediate effects of these activities on drug-users’ practice. The Eastern Regional Health Authority (ERHA) commissioned the evaluation done by Bunning in response to Action 64 of the National Drugs Strategy, while Corr at Merchants Quay Ireland (MQI) completed an internal evaluation.   

The main objective of Bunning’s review was to examine the role and functioning of outreach services in the drugs and AIDS services in the eastern region.  This involved reviewing the outreach service with respect to strategic aims and objectives, general management, service provision, quality control and monitoring systems.  The reviewer contacted: clients (20), outreach workers (20), senior outreach workers (4), representatives from community projects (10), and persons employed by the area health boards (21) whose work had links with outreach services. The review was carried out using the following methods: 

  • Observation of outreach workers during their day-to-day activities, which included home visits, street work, and community-based projects;
  • Group interviews with management of the addiction services, health professionals and community groups;
  • Individual interviews with outreach workers and clients;
  • Focus groups with senior outreach workers;
  • Feedback sessions with steering committee.  

The reviewer found that there was good commitment from staff across the addiction services to participating in the review. Outreach workers conceptualised their activities as: 

Initiating and maintaining contact with those who are not in contact with services, relating to them in an open manner and observing what is going on in the drug scene within different local communities (Bunning 2003: 10)  

The reviewer reported that, due to the unprecedented expansion in drug treatment services in the ERHA over the last four years, a lack of strategic planning for outreach had resulted. This meant that outreach work was out of focus and that outreach workers carried out a broad range of tasks that were often based on personal preferences and skills, rather than on clear policy choices or guidelines.

 The recommendations for the future development of outreach services within the eastern region include: 

  • Define a clear mission statement;
  • Prioritise primary and secondary tasks based on an allocation of time;
  • Develop wider needle-exchange networks that include options such as pharmacies and vending machines;
  • Develop clear links between clinical staff, outreach workers and clients;
  • Formalise the role of outreach workers as advocates for the clients;
  • Organise seminars to stimulate peer education, knowledge transfer and up-skilling;
  • Set up an outreach association that will work towards the professional development of outreach staff;
  • Provide management training to senior outreach workers;
  • Develop a monitoring system that includes quantitative and qualitative indicators;
  • Create a steering group to explore innovative approaches to outreach.  

 The second evaluation was conducted by Corr of the outreach service within Merchants Quay Ireland (MQI).  The outreach service was established in the late nineties to reduce the levels of drug-related public nuisance in the immediate locality. MQI is located in the south-west inner city of Dublin. The outreach service targets chaotic drug users in the locality and seeks to change their behaviour in the community through one-to-one interactions. The outreach teams work in pairs to ensure workers’ and clients’ safety. In order to minimise danger, the outreach workers carry mobile phones and identity cards. The majority of the outreach work is done on the streets. The team works on building rapport with clients and providing information on health issues and accommodation. The team uses motivational interviewing techniques to promote safer drug-using practices among clients. The ERHA and Dublin City Council fund the service jointly.

  A combination of quantitative and qualitative methods were used to evaluate the MQI service.  Between December 2000 and October 2001, outreach workers completed ‘contact sheets’ on all clients met each day.  In order to place the quantitative data collected in context with the day-to-day realities of outreach work, two outreach workers participated in in-depth interviews.  During the 10-month evaluation period, a total of 262 clients were contacted at least once. In total, there were 587 separate contacts with clients; 163 (62%) were contacted once only and 99 (38%) were re-contacted an average of four times.  Of those contacted, 31 per cent were female, 52 per cent were aged 24 years or under and 27 per cent were first-time contacts.  Three-quarters were homeless at some point during the year. Overall, 88 per cent reported using drugs (other than alcohol) and 96 per cent reported the streets as their most popular location for taking drugs.  Of those using drugs, 79 per cent were using heroin.  During the 10-month period, the outreach workers collected and disposed of 2,741 needles. The outreach workers reported that among the 99 clients who were met more than once, almost one-fifth had changed to safer drug-using practices and half had adopted less safe practices. In addition, the team reported that approximately fifteen per cent of clients contacted were referred to other drug treatment services.  The data presented in this document indicates that outreach workers were successful in contacting hard-to-reach drug users as a large proportion were homeless and half had never been in contact with drug treatment services. 

  Taken together, these evaluations highlight the need to develop the capacity of outreach staff and enhance the general management of the services. At the same time, the documents present the essential role of outreach workers and the positive outcomes of their work, such as success in locating hard-to-reach populations, an increase in numbers using safer injecting practices and modest numbers referred into treatment.  However, it may be useful to explore why 50 per cent of those participating in the Merchants Quay Ireland study developed additional unsafe injecting practices despite receiving safe injecting information.  

1. Korf D, Riper H, Freeman M, Lewis R, Grant I, Jacob E, Mougin M and Nilson M (1999) Outreach work among drug users in Europe: concepts, practice and terminology. Lisbon: EMCDDA.
2. Bunning E (2003) Outreach in Focus: review of outreach services in the Drugs/AIDS service in the eastern region.  Dublin: ERHA unpublished report.
3. Corr C (2004) ‘Engaging the hard-to-reach: an evaluation of an outreach service’. In Pieces of the jigsaw.  Dublin: Merchants Quay Ireland.  

Pieces of the jigsaw is available from Merchants Quay Ireland

Item Type:Article
Issue Title:Issue 11, June 2004
Date:June 2004
Page Range:pp. 10-12
Publisher:Health Research Board
Volume:Issue 11, June 2004
EndNote:View
Accession Number:HRB (Available)
Subjects:MP-MR Policy, planning, economics, work and social services > Social services > Outreach
VA Geographic area > Europe > Ireland
MP-MR Policy, planning, economics, work and social services > Programme planning, implementation, and evaluation > Programme evaluation

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