"We do it ourselves": strengths and opportunities for improving the practice of harm reduction.

BACKGROUND: Unprecedented increases in substance-related overdose fatalities have been observed in Texas and the U.S. since the onset of the COVID-19 pandemic and have made clear there is considerable need to reduce harms associated with drug use. At the federal level, initiatives have called for widespread dissemination and implementation of evidence-based harm reduction practices to reduce overdose deaths. Implementation of harm reduction strategies is challenging in Texas. There is a paucity of literature on understanding current harm reduction practices in Texas. As such, this qualitative study aims to understand harm reduction practices among people who use drugs (PWUD), harm reductionists, and emergency responders across four counties in Texas. This work would inform future efforts to scale and spread harm reduction in Texas. METHODS: Semi-structured qualitative interviews were conducted with N = 69 key stakeholders (25 harm reductionists; 24 PWUD; 20 emergency responders). Interviews were transcribed verbatim, coded for emergent themes, and analyzed using Applied Thematic Analysis with Nvivo 12. A community advisory board defined the research questions, reviewed the emergent themes, and assisted with interpretation of the data. RESULTS: Emergent themes highlighted barriers to harm reduction at micro and macro levels, from the individual experience of PWUD and harm reductionists to systemic issues in healthcare and the emergency medical response system. Specifically, (1) Texas has existing strengths in overdose prevention and response efforts on which to build, (2) PWUD are fearful of interacting with healthcare and 911 systems, (3) harm reductionists are in increasing need of support for reaching all PWUD communities, and (4) state-level policies may hinder widespread implementation and adoption of evidence-based harm reduction practices. CONCLUSIONS: Perspectives from harm reduction stakeholders highlighted existing strengths, avenues for improvement, and specific barriers that currently exist to harm reduction practices in Texas.

Liderazgo resiliente de los trabajadores sociales en tiempos de COVID-19

Ante el contexto pandémico y pospandémico producto del COVID-19 los trabajadores sociales deben considerar nuevas formas de actuación para cumplir con su misión de ayudar a los más necesitados. Este trabajo tiene como objetivo proponer una serie de orientaciones que contribuyan a una gestión resiliente de los trabajadores sociales en tiempos de COVID-19. Se desarrolló bajo la modalidad de investigación documental cumpliendo los procesos de selección, comparación, organización y análisis del material recolectado. Los resultados develan ventajas de los trabajadores sociales en la prestación de servicios de apoyo en el contexto actual sobre otros profesionales. Se concluyó que los trabajadores sociales deben fortalecer su gestión resiliente en la dimensión personal, social y operativa con el fin de prestar un servicio de calidad en pro de las personas y comunidades más vulnerables.Alternate :Given the pandemic and post-pandemic context resulting from COVID-19, social workers must consider new forms of action to fulfill their mission of helping those most in need. This work aims to propose a series of guidelines that contribute to a resilient management of social workers in times of COVID-19. It was developed under the documentary research modality, fulfilling the processes of selection, comparison, organization and analysis of the collected material. The results reveal advantages of social workers in providing support services in the current context over other professionals. It was concluded that social workers must strengthen their resilient management in the personal, social and operational dimension in order to provide a quality service for the most vulnerable people and communities.