Interaction and conflict between outreach workers and research officers in implementing collaborative action research in the field of harm reduction: a qualitative study

Background The effectiveness of collaborative approaches in health interventions is underlined in the literature. Given the serious challenges to adequately managing the HCV epidemic in people who inject drugs (PWID), and the need to improve existing harm reduction (HR) interventions in this population, it seems important to investigate how collaboration between stakeholders is ensured in action research interventions. The present study aimed to explore interactions between outreach workers and research officers collaborating in the implementation of an action research project for PWID entitled OUTSIDER. Methods Using three focus groups, we studied the views of 24 outreach workers involved in the implementation and evaluation of a harm reduction educational intervention to help PWID inject more safely in off-site settings. Results The analysis of participants’ discourses highlighted the mixed perceptions they had about OUTSIDER. Several limitations to collaboration emerged. Epistemological (theoretical vs. practical knowledge), methodological (science vs. intervention), axiological (standardised vs. adapted approach), and material (mobilised vs. available resources) issues all placed a burden on the outreach worker–research officer relationship. Outreach workers’ acceptance of the project’s intervention dimension but rejection of its scientific dimension highlights a lack of contractualisation between the stakeholders involved, and a more general problematisation of the role of outreach workers in implementing action research in HR. How collaboration was perceived and practised by outreach workers participating in OUTSIDER can be considered a reflection of the current challenges to implementing action research in HR. Conclusion This study of the interaction between the research and implementation dimensions of an action research project explored the tensions between different intervention stakeholders that must work together. Equitable participation and integration of the expertise, practices, and knowledge of all stakeholders involved is essential for successful action research. Given current HCV epidemiological challenges, new forms of cooperation are needed when developing healthcare services and when strengthening collaborative approaches.

Patient experience of telemedicine in addictions

AimsOpioid dependence has high risks and opioid substitution treatment (OST) improves outcomes and reduces deaths. Attendance at addiction specialist prescribers may be limited, particularly in rural areas. Telemedicine, such as videoconferencing, can reduce travel and improve access and attendance. Pre-COVID-19, we started a telemedicine service for patients with opioid dependence, prescribed opioid substitution treatment, requiring addiction specialist prescriber consultations. We present patient experience and assess whether patients recommend telemedicine.MethodHealth Research Authority approval for Randomized Controlled Trial of Telemedicine versus Face-to-Face (control) appointments in large semi-rural community addictions service (2500km2) using a modified Hub-and-Spoke (outreach). Adult opioid dependent patients prescribed OST and attending outreach clinics recruited. Participants received two consultations in group. Telemedicine delivered using Skype-for-business videoconferencing. Patients attended outreach clinic, where an outreach worker undertook drug testing and telemedicine conducted via the outreach workers laptop. Specialist addiction prescribers located remotely, at the Hub. Patients self-completed NHS Friends and Family Test (FFT) immediately after appointment, separate from the wider research study. Data collected Sept 2019– March 2020 (pre-COVID-19 lockdown), Microsoft Excel analysis, with qualitative thematic free-text analysis.ResultThirty completed FFTs were received, of which all participants were ‘extremely likely’ (n = 19;67%) or ‘likely’ (n = 11;37%) to recommend the Telemedicine service to friends or family, if they needed similar care. Two themes for reasons for recommending the service were; 1. Convenience (reduced travel, reduced travel time and reduced travel costs) and 2. Supportive Staff (including listening, caring and good support). One patient mentioned ‘it is a convenient way to communicate with medical staff, saving time and effort’. Regarding Telemedicine appointments, most participants responded that the timing of telemedicine appointments was good (n = 26;87%), given enough information (n = 30;100%), enough privacy (n = 28;93%), enough time to talk (n = 30;100%), involved as much as they wanted (n = 25;83%), given advice on keeping well (n = 28;93%), and NHS staff were friendly and helpful (n = 29;97%). No participants thought they were treated unfairly. When asked what went well, patient themes were: 1. Everything and 2. Communication (including listening and explaining). One patient stated ‘Everything better, telemedicing good, heard it well, everything improved this year’. In terms of what the service could do better, there were no issues identified.ConclusionThe Telemedicine in Addictions service was overwhelmingly highly recommended by patients. Patients recommended the service because of convenience and supportive staff. The use of telemedicine is acceptable to patients and could be considered more widely. Due to COVID-19, this technology may be beneficial access to addiction services.

Taking wonders to the margins ( Maravillas al Margen )

Translated into English for the first time, this article by film educator and outreach worker Alicia Vega describes her experiences conducting a series of Cinema Workshops in highly disadvantaged communities across Chile, which sought to provide younger children with early, formative understandings of cinema. A rich account of the experience, incorporating a variety of images drawn from the workshops, the article provides an intimate, detailed reflection on a remarkable film education and humanitarian endeavour. It concludes with a series of testimonials from children who participated in the project, as well as from their parents and other participants.

Introduction to the Digital Street

The first chapter introduces the concept of the digital street. The author argues that a digital form of street life plays out alongside the neighborhood on social media. The author discusses how the traditional boundaries of street life and the street code in particular have shifted as neighborhood space extends online. Black and Latino teenagers now experience their neighborhood differently from previous generations. The author explains the fieldwork this book is based upon. The author describes meeting “Pastor” and becoming an outreach worker in his peace ministry and then taking on additional roles online and offline with teenagers and concerned adults. This introductory chapter also gives background on access to smartphones and the Internet. A brief description of the contents of each chapter and the order of the chapters is provided.

The Digital Street

This book delves into the street-level experience of a set of African American and Latino teenagers and adults worried about or after them. It argues that the risks and opportunities associated with a poor urban neighborhood get filtered through smartphones and popular social media sites like Twitter and Facebook. The book shows that street life in Harlem plays out on and across the physical street and the digital street among youth, neighborhood adults, and the authorities. Each chapter examines the parallels, differences, and crossovers between these two layers of social life that bear out the “effects” of a neighborhood. From roughly five years of firsthand research as an outreach worker and in other roles in the community, the author illustrates the online and offline experiences of girls and boys of color coming of age in the shadow of the Harlem Children’s Zone and sweeping gentrification when social media came to permeate all aspects of life. The Digital Street addresses the role of communication and technology in the transformation of an urban neighborhood.

Developing a ‘Classroom as Community’ Approach to Supporting Young Children's Wellbeing

INTRODUCING THE IDEA OF THE ‘classroom as community’, a class of six- to eight-year-old children engaged with a project, The Wellbeing Classroom (McInnes, Diamond & Whitington, 2014), which intended to support and advance their social and emotional development. This paper examines how the notion of ‘classroom as community’ informed the thinking and actions of the adults involved, and identifies six key elements of the approach employed. The teacher employed five strategies over a year: professional learning and reflection; building trust with children and modelling emotional self-regulation; teaching social skills across the day; accessing regular outreach worker support; and involving parents. Led by an upskilled teacher, the ‘classroom as community’ approach was found to have successfully supported children's social and emotional development, particularly those with difficulties. The project's reach included parents, thus extending its effects. This article reports on the significance of the concept of classroom as community to the project's success.

Medication compliance

Differing terms are used for compliance, including concordance and adherence. This chapter examines the range of obstacles to compliance, including side effects, lack of insight, lack of effectiveness, and resistance to being reminded of the illness. The influence of family and friends is also considered. We believe it is often best to avoid complex explanations, and just accept that it is difficult to remember to take medicines regularly for months and years. Several strategies exist to improve compliance, including depot preparations, psycho-education, and efforts to strengthen the therapeutic relationship. Compliance therapy, based on motivational interviewing, is described in detail. The outreach worker is also uniquely able to rely on prompting and support as well as careful monitoring and structuring the clinical interview to ensure that compliance is regularly assessed. Supporting compliance is a long-term commitment, not a once-off intervention.

Outreach in Community Mental Health Care

The last 50 years has witnessed a radical change in the care of the severely mentally ill as asylums have closed and care has moved to the community. Two developments have marked this transition. The first is the development of multidisciplinary community mental health teams (CMHTs). The second is an increasing reliance on outreach to engage and support the most seriously ill patients. This book is a guide for those, whatever their professional background, who work in CMHTs. It focuses on the practicalities of the job—what they all need to know, whether coming to it from social work, nursing, or psychology. It is based on our decade of working together in an assertive outreach team and our backgrounds in nursing and psychiatry in a range of CMHTs.The book is in three parts. The first addresses the underlying principles of the practice and its variations. It explores the themes that are common to all outreach work and the specific thinking and practice characterizing different teams and settings. The second section addresses the range of problems faced by the outreach worker. These include the challenges presented by different diagnoses, plus those of hostility, homelessness, suicidality, and the omnipresent complications of drug and alcohol abuse. Psychosocial interventions aimed to promote employment and social stability are outlined with clinical examples. The third section explores the structural issues of managing the team, providing effective supervision, and conducting research. We draw on relevant research when appropriate, but the style of the book is practical, based primarily on accumulated experience.