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THE WALLICH COMMUNITY HOUSE
is a
unique homelessness project specifically for
people with co-presenting mental health and
substance use issues. We provide semi-
independent supported accommodation for 33
service users across eight properties, and
place an emphasis on harm reduction.
A key aspect of the
Working together to
reduce harm strategy 2012
is the development
of ‘take-home’ naloxone. After working with
service users with dual diagnosis, I noticed
there was very little motivation to attend the
training despite initial interest. Very few service
users had taken up the training in the 18
months I had worked at the project.
An initial survey revealed that one in four
service users could not accurately describe
what naloxone was. According to the non-fatal
overdose questionnaire, 58 per cent of service
users had experienced non-fatal overdose
involving an opiate, with over 85 per cent of
these accidental. Despite this, there were only
three kits among current IV users in our eight
project houses.
I developed a new initiative for engaging and
training people with dual diagnosis in overdose
awareness and naloxone. The purpose of this
pilot was to make naloxone training more
accessible in an attempt to increase safety in
the project houses. It was also important to
empower service users to be more responsible
for reducing harms associated with substance
use by increasing their knowledge and
confidence in dealing with overdose. The aim
was to have a minimum of one trained person
and kit available in each house.
I started the initiative by using the Welsh
Assembly Government naloxone poster
campaign to raise awareness in the houses in
the weeks before training started. However
planning too far in advance or putting signs up
with dates and times of training did not have as
much success as talking to clients face to face
and making arrangements to do training within
the next couple of days. Groups consisted of
between one and four service users, and
training was offered in their own homes with
refreshments provided.
The training was approximately 45 minutes to
an hour, depending on group size, and consisted
of a presentation adapted from the original
training to make it more service user friendly.
Emphasis was placed on overdose information,
myths and risk factors, before discussing
naloxone, practising injecting on an orange, a
naloxone DVD, and a question and answer
session on the important points to remember. The
sessions concluded with further discussion of first
aid, CARA and practising the recovery position.
I worked in partnership with Jo Simmons of
the CAU to facilitate prescription of naloxone, so
that each prescribed service user received two
kits, one of which is kept in a communal area
known to all other residents.
I also used the naloxone training as an
opportunity to promote the Wallich in-project
needle exchange and harm reduction advice. I
took a portable ‘needle exchange’ selection with
me and provided paraphernalia to those who
needed it. This provided opportunities to
intervene in any poor injecting practices, and
promote foil and sterile water. It also created an
opportunity to provide people living in the same
accommodation with different colour
‘nevershares’ to reduce likelihood of accidental
sharing among residents. The uptake of our
needle exchange was previously quite low and
has now increased significantly.
Forty per cent of clients took up the first train-
ing session offered in their shared accommoda-
tion and the feedback was good. Residents liked
the fact the training was brought into their own
homes and was more relaxed. Twelve service
users were eligible for naloxone prescription,
bringing the total to 15 trained service users with
naloxone kits among the eight project houses,
with a minimum of one trained person with a kit
in each house (compared to only three kits in the
eight houses previously). Three new staff
members were also trained.
This form of intervention needs intense staff
preparation, implementation and time. I would
like to get all staff trained and involved in
delivering the training in line with service user
support plans, and make it part of the role of
project workers within our team. I would also
like to get service users involved in the delivery
of training.
I conducted a questionnaire before and after
to gauge knowledge and confidence in dealing
with overdose, and it identified that all clients
felt they had learnt something new. Knowledge
in regard to recognising overdose and about
naloxone had increased from 76 per cent to 90
per cent, and confidence in dealing with an
overdose situation increased from 79 per cent
to 93 per cent.
I think the approach is working for a number
of reasons – I took an assertive approach and
made the training more accessible and less
formal by conducting it in clients’ homes. I also
made the training flexible and responsive to the
needs to service users.
In the future, I would recommend regular
weekly training sessions, especially if there is a
high turnover of clients. Naloxone training
should be discussed with service users during
induction, as this pilot helped identify people at
high risk of overdose and allowed for more
intensive interventions.
Natasha Bray is a project worker at the
Wallich Community House
If you have a bright idea or a successful initiative
to share with other readers we’d love to hear from
you. Please email DDNexchange@cjwellings.com
12 |
drinkanddrugsnews
| September 2013
Practice exchange|
Naloxo
ne
www.drinkanddrugsnews.com
Life-saving
knowledge
Launching our DDN
good practice exchange,
Natasha Bray
of the
Wallich Community House
Team in South Wales
shares how she delivered
a successful naloxone
training initiative