CAReTeam Integrated Services (CTIS)
CAReTeam Integrated Services (CTIS)
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The CAReTeam Integrated Services (CTIS) is a unit within the Division of Public Health of the Santa Cruz County Health Services Agency. CTIS provides a wide range of harm reduction and direct client services including disease education, prevention, access to supplies investigation and case management. Additionally, CTIS also administers the County’s Syringe Services Program (SSP).
Syringe Services Program (SSP)
Syringe Services Program (SSP)
Syringe Services Program (santacruzhealth.org)
"The primary goal of the SSP is to work in partnership with the community to help prevent the spread of infectious diseases associated with injection drug use and to address the community's concern regarding improperly discarded syringes".
SSP provides essential harm reduction supplies, besides clean syringes, that will reduce the potential disease and infection risks associated with the re-use of injection equipment. Other supplies offered at the SSP include sharps containers, bandages, condoms, lubricant, caps/cookers, tourniquets, water, cotton, alcohol wipes, antibiotic ointment, razors, and toothbrushes. SSP also educates participants on available countywide drug treatment options, provides naloxone overdose prevention and reversal training, and offers referrals for HIV/HCV C testing, contraceptives, as well as enrollment in health care.
Restrictive Model to Syringe Exchange
Limitations of SSP include their use of a restrictive model of syringe exchange. SSP is required to adhere to strict County guidelines, including their 1-for-1 syringe exchange policy. For each used needle a participant brings into the exchange, the participant receives one clean needle in return. One participant can receive up to 100 needles for themselves, but are also allowed to do a secondary exchange for up to two other individuals, with the 1-for-1 policy and cap at 100 for each participant still enforced. The Office of AIDS within the California Department of Public Health Center for Infectious Diseases published a report, Guidelines for Syringe Exchange Programs, which brings awareness to the positive impacts of needs-based syringe access. The report states, “Public health research has consistently found that restrictive models increase syringe reuse and sharing among program participants'' (CDPH, Office of Aids). This restrictive model impedes on the program’s mission to reduce the likelihood of syringe reuse. Additionally, the SSP program provides referrals to HSA medical clinics for a clinical assessment to be provided or prescribed clean syringes when a participant presents themselves to the exchange without syringes. Since this connection to the clinic breaks anonymity for the participant, many people decline. Therefore, this serves as an additional barrier to SSP.
Needs Based Model Of Harm Reduction - Demonstrated at the Santa Cruz County Harm Reduction Coalition
Needs Based Model Of Harm Reduction - Demonstrated at the Santa Cruz County Harm Reduction Coalition
Harm Reduction Coalition of Santa Cruz County (HRCSCC) works collaboratively with the Health Services Agency (HSA) and currently partner on a MAT Access grant. HRCSCC models needs-based syringe access, meaning participants are not limited on the amount of syringes they are able to receive. HRCSCC prioritizes low-barrier and accessible harm reduction services. According to the HRCSCC , “Syringe services should be low barrier. For some individuals, nurses or medical staff can be seen as a barrier”. Furthermore, HRCSCC overcomes barriers such as transportation by providing harm reduction delivery services.
COMMUNITY PARTNERSHIPS TO IMPLEMENT UPSTREAM APPROACHES
Homeless Persons’ Health Project (HPHP)
Homeless Persons’ Health Project (HPHP) is a primary care medical clinic serving the homeless and low-income populations. HPHP administers Healing the Streets, which serves the homeless and low-income community through a mobile health van.
This community partnership enables CareTeam Integrated Services (CTIS) to help overcome the barrier of transportation when obtaining healthcare services, as well as aiding the cost burden of health care.
Front Street
Front Street
Front Street specializes in behavioral health and provide services such as housing and mental health support.
Community partnerships like these enable CTIS to address social determinants of health such as lack of affordable housing and mental health care.
Downtown Streets Team
Downtown Streets Team is made up of people experiencing homelessness working to improve the community through environmental efforts, and in return they receive case management, vouchers, etc.
CTIS and SSP partners with environmental agencies to address the environmental determinants of health and to remove improperly discarded syringe litter.
Integrating People Who Use Drugs into the WorkForce
Integrating People Who Use Drugs into the WorkForce
During my experience working under CTIS, staff hired individuals that have a history of drug use and/or have been unhoused to do outreach education and conduct in-depth interviews with PWUD in Watsonville. The staff was able to overcome major barriers to employment such as one of the individuals not having a social security number. Published by the Brandeis University Heller School for Social Policy and Management, Upstream Opportunities for Reducing the Harm of Alcohol and Drug Use, conveys “employment training, services, and support targeted at chronic drug users leads to attacking a root cause of chronic drug use and addiction”. CTIS has managed to go beyond providing safer drug supplies and focus on the multitude of structural barriers and social determinants that drive individuals to engage in drug use. During my account of this in my field notes, I recorded conversation between two of the staff members which conveyed the following, "[staff member] also thinks [the new hires with lived experience] will help understand what the ‘physical, structural, behavioral, cultural barriers are to accessing clean syringes and properly disposing of used ones’. [Staff member] said that getting people with lived experience is definitely key to success for their programming” (Field Notes, Tuesday November 1st).
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