Harm Reduction and the Provision of Homeless Services to Youth

Harm reduction approaches can be seen as controversial when working with many populations, including unaccompanied youth. Some will cite reasons pertaining to the illicit nature of certain substances, the age of maturity, psychosocial development and the like. Others hold on to the “just say no” mantra.

Harm reduction has gotten a bad rap in some circles because it is not well understood. Some erroneously think it is willy-nilly state sanctioned consumption and participation in risky behavior without consequences.

Let’s try working with this definition:

Harm reduction is an action-oriented response through policy and programs that reduces the harmful effects of behavior. It uses a range of approaches that aim to be non-judgmental. Harm reduction employs strategies that increase skills, resources, knowledge and supports for individuals, their families and communities. The individual, their family and community can thereby make decisions to be safer and healthier.

A harm reduction approach is pragmatic. It aims to acknowledge the dignity of all people. It is neutral – it neither condones nor condemns the activity that is causing the harm. It focuses on the harm to the individual and the community. It prioritizes the ability to meet immediate needs, while also encouraging a range of intervention options (which can include reduction, less risky use, and working towards abstinence if that is the individual’s desire). It believes that people who have experience with higher risk behaviors have an important voice in shaping programs. In addition, harm reduction approaches have public health benefits, decrease policing costs, and also decreases emergency room, ambulance and hospital costs.

The time has come for a more reasonable and responsible discussion on harm reduction approaches when working with homeless and at-risk youth. First of all, members of the medical community, in reviewing the issue of harm reduction amongst youth, have concluded “a harm reduction approach is consistent with what we know about adolescent development and decision-making.”

Secondly, there is some research to suggest that youth who have experience with behaviors that may be considered “high risk” will be better able to help other youth than an adult with an authority-laden approach to providing service and supports. This is in keeping with a key principle of harm reduction, which values the voice of persons with lived experience.

Thirdly, being a youth is a natural time of experimentation and risk-taking. This will take various forms from exploring one’s sexuality to use of alcohol and drugs. This is why programs like Drug Abuse Resistance Education (DARE) have been proven in several studies to not produce the desired effect of “just say no” because it is not a natural expectation of youth development to resist experimentation and risk-taking. (see Beck, J. or Lynam DR, et al.)

Fourthly, peer reviewed studies of various types of harm reduction approaches with “out of the mainstream youth” (e.g., unaccompanied youth that are homeless, street involved, engaged with sex work, etc.) have proven to be successful. The Street Teen Alcohol Risk Reduction Study was designed to decrease alcohol and drug consumption using motivational interventions. (see Baer, J. S., Peterson, P. L., Wells, E. A.) Needle exchange programs for youth in California have demonstrated decreases in sharing needles and syringes. (see Guydish, J., Brown, C., Edgington, R., Edney, H.)

Finally, substance use as a youth does not predict a lifetime of substance abuse. There is research that demonstrates that the likes of alcohol problems with youth are often intermittent and can stop without formal treatment and may not progress to adulthood. (see Sobell, L.C., et al and, Tucker, J. A., et al)

For a service system to be effective there needs to be a range of service options. That means prevention education and abstinence through to treatment and harm reduction. Given the participation of homeless youth in activities that may present greater risks (e.g., sexual intercourse without protection and/or with multiple partners; alcohol consumption; inhaled, injected or orally consumed narcotics; etc) we need to be sure that our homeless and housing service delivery systems are not excluding youth who are currently or who have in past participated in these activities and that programs do not discharge youth to homelessness for participation in these types of activities.  Our ability to be effective in meeting their needs depends on it. And the evidence is pretty clear that it is warranted.

Iain De Jong is the President & CEO of OrgCode Consulting. Previously he directed one of the world’s largest Housing First programs, which included services specifically for homeless youth. A pragmatic, evidence-based and evidence-informed practitioner, he embraces a non-judgmental approach to effectively meeting people where they are at to achieve long-term housing stability.