Table 2 Evaluation Results from the British Columbia Harm Reduction Programme: lessons learnt, evidence of progress and opportunities for improvement, 2011–2014
Construct | Lessons Learnt | Evidence of progress | Opportunities for improvement |
|---|---|---|---|
GOAL: | Supportive environment | (How were barriers and facilitators to engaging addressed? | |
Community Building activities | • Reported feelings of exclusion among peers • Lack of trust or legitimacy built early on members and other peers | • Introduced various team-building activities and ice breakers to build trust & openness • Included Aboriginal opening and closing ceremonies, and pre-meeting dinner social | Form peer advisory group that is engaged with HRSS committee throughout the year |
Planning in advance | • Peers unaware of role and expectations; some informed of meeting with too short of notice | • Invited multiple peers at least six weeks in advance • Arrangements provided for transportation, accommodation, local support (i.e. methadone) | Develop list/map of commonly accessed resources in host community |
Structure of Schedule | • Lack of opportunity to develop rapport and trust with committee • Inconsistency of information | • Agenda modified based on feedback provided by peers before, during and after meeting • Meeting agenda more flexible with less content | Develop agenda together (i.e. with peers and committee) |
GOAL: | Equitable participation | (How were experiences represented and respected?) | |
Representativeness at the table | • Unequal representation from health authorities due to staffing issues or lack of commitment from region | • Shifted to inviting two peers per health region • Caravan project traveled to rural regions to meet peers “where they’re at” | Form peer advisory group engaged with BCHRSS throughout the year |
Power Dynamics; Distribution of voices | • Inequitable distribution of power among peer groups and across | • Provided peers with cash stipend based on wage • Extra attention paid to distribution of power, people at the table, voices being heard • Discussions captured on flipchart so peers could see their voices being heard and respected • Shorter duration of roundtable updates allowed time and space for peers to voice their concerns | Consider options for peers to communicate their thoughts in non-verbal ways or in smaller groups; routine check-ins with peers during breaks |
Flexible Facilitation | • Heterogeneous representation of peers at the table • Rural/remote regions need attention | • Attention paid to the attitudes during activities; able to adapt based on energy/positivity in room • Kept discussion positive and solutions-based | Ongoing need for strong but flexible facilitator |
GOAL: | Capacity building & empowerment | (How did capacity increase over time and how was it built on?) | |
Community Building | • Lack of opportunities initiated outside the BCHRSS meetings • Staffing issues remain a problem | • Peer engagement activities supported financially through funds offered in each health authority • Beginning of peer-based harm reduction supply distribution & education | Develop sustained, ongoing funding mechanism e.g. for work contracted to peer organizations |
Social Capital; skills &ability; confidence | • Inability to build on existing capacity within communities | • Peers create EIDGE group with illicit alcohol users • Peer groups organize around key issues: social housing, anti-harm reduction by-laws, methadone formulation change | Social capital is strongest in urban peer groups; knowledge transfer needed with rural peer groups |
Enhanced Peer networks | • Efforts fragmented across province • Some drug user organizations dissolved due to lack of support | • Peer network in BC grows via BCHRSS meetings, HR activities; opportunities for growing peer-run orgs | Build organizational capacity to increase autonomy from any group of peers |
GOAL: | Improved policy & programming | (How engagement impact programming and policy?) | |
Improved harm reduction programming | • Identified inconsistent access to harm reduction supplies • Lack of capacity building and training for peer workers, service providers and decision makers | • The Caravan Project • Expanded range of supplies to include safer inhalation supplies • Introduced BC Take Home Naloxone program • Developed specialized harm reduction trainings; posted training manual online • Introduced annual harm reduction client survey | Budget and other organizational constraints limit the expansion of comprehensive harm reduction services – (frustrating for peers) |
Improved policies | • Lack of peer engagement at other tables outside BCHRSS • Lack of best practices on best ways to engage peers | • Developed one-page guidelines for providers on inviting peers to meetings • Peer engagement literature review (Ti et al., 2012 [7]) • Improved documentation and dissemination of HRSS policies and research for lay audiences | Develop best practice guidelines for services to meaningfully engage peers |
Activities | • No formal process or evaluation of peer engagement in BC • Inconsistent effort to implement processes, sustain initiatives | • Obtained financial support for peer engagement research in BC • Presented results and reports on peer engagement to stakeholders across the province | Evaluate best practice guidelines to ensure acceptability in different contexts (regions, populations) |