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Table 2 Evaluation Results from the British Columbia Harm Reduction Programme: lessons learnt, evidence of progress and opportunities for improvement, 2011–2014

From: Peer engagement in harm reduction strategies and services: a critical case study and evaluation framework from British Columbia, Canada

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)