Life-saving knowledge

Natasha Bray

 Launching our DDN good practice exchange, Natasha Bray of the Wallich Community House Team shares how she delivered a successful naloxone training initiative.

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

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