Saying "Please Bring Me Your Used Needles!" Isn't Working.
January 5, 2012 4:31 PM Subscribe
I manage a harm reduction based needle exchange program that operates both from a fixed location (Mon to Fri, always the same hours) and via delivery (you call, we bring you your drug use supplies).
Our rate of return on the used needles is abysmally low - and I need to increase it. How can I convince people to bring me their used needles?
There are, of course, some special details. Since the program is harm reduction focused, I cannot require anyone to return used needles in order to get new needles. I also cannot afford to provide incentives for people who return used needles - there are no funds in the budget that can be allocated in that manner.
Some thoughts I've had - and mostly eliminated:
We provide (free) sharps containers in several different sizes - the smallest is one that fits easily into a purse/backpack and holds ~10 sharps and the largest is about the size of a 72L bin. Convenience, in this sense at least, is not a problem.
I would say that 90% of the clients we serve know about HepC and HIV, know why we promote the sharps containers, and could easily explain why the needle exchange exists in the first place. Knowledge of community safety is not a problem.
We have had no complaints about the containers - the people who take them do so regularly, so there's clearly nothing wrong with the function of the container or their use.
But there are definitely not enough people taking them in the first place and I can't seem to convince some people to take them at all. I can't figure out how to increase the number of containers going out - despite offering one to every single person who comes to get even a single needle at our location or to whom we deliver.
For those clients that do take the containers, I can't seem to convince them to bring me the filled containers for incineration. But the clients DO come back for more needles and works, so I know it's not just that they've stopped using or are going elsewhere for supplies. I've asked and they often tell me they'll bring them back 'next time' - which, of course, never happens.
Right now, the rate of return is about 30% - that's.. dismal. I want to increase the returns - but I feel like I'm missing some huge key (or maybe two?) that will get things going.
How can I increase the likelihood of people returning their used needles to me?
There are, of course, some special details. Since the program is harm reduction focused, I cannot require anyone to return used needles in order to get new needles. I also cannot afford to provide incentives for people who return used needles - there are no funds in the budget that can be allocated in that manner.
Some thoughts I've had - and mostly eliminated:
We provide (free) sharps containers in several different sizes - the smallest is one that fits easily into a purse/backpack and holds ~10 sharps and the largest is about the size of a 72L bin. Convenience, in this sense at least, is not a problem.
I would say that 90% of the clients we serve know about HepC and HIV, know why we promote the sharps containers, and could easily explain why the needle exchange exists in the first place. Knowledge of community safety is not a problem.
We have had no complaints about the containers - the people who take them do so regularly, so there's clearly nothing wrong with the function of the container or their use.
But there are definitely not enough people taking them in the first place and I can't seem to convince some people to take them at all. I can't figure out how to increase the number of containers going out - despite offering one to every single person who comes to get even a single needle at our location or to whom we deliver.
For those clients that do take the containers, I can't seem to convince them to bring me the filled containers for incineration. But the clients DO come back for more needles and works, so I know it's not just that they've stopped using or are going elsewhere for supplies. I've asked and they often tell me they'll bring them back 'next time' - which, of course, never happens.
Right now, the rate of return is about 30% - that's.. dismal. I want to increase the returns - but I feel like I'm missing some huge key (or maybe two?) that will get things going.
How can I increase the likelihood of people returning their used needles to me?
I have more questions instead of answers!
Why is it important for them to bring the needles back? I don't mean that rhetorically, I mean it genuinely. Are those reasons being communicated to your clients? Could you perhaps include some sort of reminder statement on the sharps container, or on the packaging for the new needles?
posted by KathrynT at 4:38 PM on January 5, 2012 [1 favorite]
Why is it important for them to bring the needles back? I don't mean that rhetorically, I mean it genuinely. Are those reasons being communicated to your clients? Could you perhaps include some sort of reminder statement on the sharps container, or on the packaging for the new needles?
posted by KathrynT at 4:38 PM on January 5, 2012 [1 favorite]
So if you're doing delivery anyway, would it be feasible to have your delivery folks offer to pick up sharps containers?
posted by nebulawindphone at 4:38 PM on January 5, 2012 [3 favorites]
posted by nebulawindphone at 4:38 PM on January 5, 2012 [3 favorites]
You can't force people to take a container as a condition of getting what they want, but can you package the new works together with a sharps containers so that people get given both as a unit? They might just get trashed as soon as your clients open the package, but you'd quickly see if it did make a difference.
posted by crabintheocean at 4:40 PM on January 5, 2012 [4 favorites]
posted by crabintheocean at 4:40 PM on January 5, 2012 [4 favorites]
Also, I know this isn't helpful, and perhaps you're comparing your return rate to other similar programs, but as just a random person who doesn't know the numbers on these things I was surprised your return rate is so high.
posted by crabintheocean at 4:43 PM on January 5, 2012 [7 favorites]
posted by crabintheocean at 4:43 PM on January 5, 2012 [7 favorites]
If you haven't already, I'd try briefly interviewing the people during pickup/delivery and find out what happened to the needles they got the last time, what they did with them, why they did that with them, and what would have made it easier to bring them back.
Similarly, ask the people who take the containers what they think about them, where their old ones are currently sitting, why they don't bring back old needles in them, etc. You never know what you might find out if you ask this to enough people. Plus, if you ask the questions every time, it might help plant a seed in your clients' heads and help them remember.
Obviously it's important to ask these questions without making them feel guilty or ashamed; just show your honest interest and empathize with those who say they forgot, it's hard to remember, it's embarrassing to carry around, etc.
posted by joan_holloway at 4:45 PM on January 5, 2012 [7 favorites]
Similarly, ask the people who take the containers what they think about them, where their old ones are currently sitting, why they don't bring back old needles in them, etc. You never know what you might find out if you ask this to enough people. Plus, if you ask the questions every time, it might help plant a seed in your clients' heads and help them remember.
Obviously it's important to ask these questions without making them feel guilty or ashamed; just show your honest interest and empathize with those who say they forgot, it's hard to remember, it's embarrassing to carry around, etc.
posted by joan_holloway at 4:45 PM on January 5, 2012 [7 favorites]
are they concerned about giving you something tainted with drugs and their fingerprints? it's one thing to get over the paranoia to get new needles, but quite another to open yourself to that potential risk. also, a lot of the more hardcore drug users i know are hoarders and keeping their detritus is comforting at some level.
i don't know how you'd combat that, but it's something to think about.
posted by nadawi at 4:46 PM on January 5, 2012 [3 favorites]
i don't know how you'd combat that, but it's something to think about.
posted by nadawi at 4:46 PM on January 5, 2012 [3 favorites]
Have you asked the people who refuse a container why they do so?
posted by jacalata at 4:46 PM on January 5, 2012 [1 favorite]
posted by jacalata at 4:46 PM on January 5, 2012 [1 favorite]
How long has your program been in existance? Maybe your clients just need time to pick up the habit, as it were. The Harm Reduction program where I work has over 100% returns. I'd be happy to put you in touch with them.
posted by ThatCanadianGirl at 4:49 PM on January 5, 2012 [2 favorites]
posted by ThatCanadianGirl at 4:49 PM on January 5, 2012 [2 favorites]
Best answer: Do you work with other agencies in your city that might see the same clients? If 40% of your clients also stop by Agency C, maybe Agency C would put a drop box in their lobby for clients to return their used sharps containers--your agency would still be responsible for maintaining/emptying it. Not sure if you have the funds or the relationships to establish something like this, but it might be a good outreach effort. Libraries, shelters, churches, foodbanks, bus or train stations?
Although I'm not your target population, I am notoriously terrible at remembering to return things, etc.; especially if there's no punitive consequence for not returning that thing. If you're just dealing with forgetfulness, increasing your visibility might help. Placing yourself (meaning your agency's logo, drop-box, whatever) in your clients' day-to-day life might help as a visual reminder.
Also, maybe I've just been watching too much of The Wire lately, but are your clients' living situations stable enough that returning a used sharps container is high on their list? I know many of my friends who are case workers are often dealing with a high proportion of transient or homeless users, and that might be a factor here.
posted by stellaluna at 4:51 PM on January 5, 2012 [4 favorites]
Although I'm not your target population, I am notoriously terrible at remembering to return things, etc.; especially if there's no punitive consequence for not returning that thing. If you're just dealing with forgetfulness, increasing your visibility might help. Placing yourself (meaning your agency's logo, drop-box, whatever) in your clients' day-to-day life might help as a visual reminder.
Also, maybe I've just been watching too much of The Wire lately, but are your clients' living situations stable enough that returning a used sharps container is high on their list? I know many of my friends who are case workers are often dealing with a high proportion of transient or homeless users, and that might be a factor here.
posted by stellaluna at 4:51 PM on January 5, 2012 [4 favorites]
Use sharps disposal units in convenient public places. We do this in Calgary. Users don't "exchange" needles at the DOAP office or wherever; they are apprised of where sharps disposal sites are. Come to Calgary and see them at pretty much every park in the core.
There are, in short, better ways of getting your sharps back than requiring the IDUs to actually carry around their used ones- that just strikes me as poor planning on your agency's part.
posted by ethnomethodologist at 4:52 PM on January 5, 2012 [4 favorites]
There are, in short, better ways of getting your sharps back than requiring the IDUs to actually carry around their used ones- that just strikes me as poor planning on your agency's part.
posted by ethnomethodologist at 4:52 PM on January 5, 2012 [4 favorites]
I'm actually shocked that your return rate is 30%. (I've only worked with one-to-one needle exchanges, so have never faced that.) I would say that for ANY population, of ANY people, without penalties, returning anything at all would totally top out at like, 10%. That you're hitting almost 1 in 3 seems to me amazing!
And yup, there it is, just above me: create diverse points of return. (Clinics, city agencies, etc.) Think of it the 3D glasses at the movies. The only reason they get those returned is that there's a big-ass basket outside the theater. (Convenient to site of use. Heh.) Otherwise they'd all go into the trash, or carried home, etc.
posted by RJ Reynolds at 5:02 PM on January 5, 2012 [1 favorite]
And yup, there it is, just above me: create diverse points of return. (Clinics, city agencies, etc.) Think of it the 3D glasses at the movies. The only reason they get those returned is that there's a big-ass basket outside the theater. (Convenient to site of use. Heh.) Otherwise they'd all go into the trash, or carried home, etc.
posted by RJ Reynolds at 5:02 PM on January 5, 2012 [1 favorite]
Offer cash for full (of needles) sharps containers.
posted by the man of twists and turns at 5:05 PM on January 5, 2012
posted by the man of twists and turns at 5:05 PM on January 5, 2012
I wonder where your users are using the needles? Perhaps not in the same place they'd keep a sharps container, even a small one. If they're scoring on the street or in a park, they'd probably want to use right there and I could see them not caring about throwing the old needle away (or just being too high to keep track of it? Not sure exactly how that might work). So I agree with the above advice that you need to put the containers where the usage happens and take care of picking them up and replacing them on your own, independent of each user.
posted by marylynn at 5:05 PM on January 5, 2012 [2 favorites]
posted by marylynn at 5:05 PM on January 5, 2012 [2 favorites]
To what extent are you connected to any of the harm reduction technical assistance programs out there? Are you connected to any of the other syringe access programs around? I don't know where you're located, but I would suggest talking to the Harm Reduction Coalition first of all, NASEN second, the HARMRED list serv if neither of those get you good suggestions and best practices.
What other syringe access providers have you talked to? Are you a member of NASEN and on their list serv? There are a lot of people who have these conversations all the time, but you're not necessarily going to reach them on Metafilter.
I'm assuming from your description that you're in the US, but if not, please say where you are, and I'll try to link you to resources in your country.
posted by gingerbeer at 5:06 PM on January 5, 2012 [1 favorite]
What other syringe access providers have you talked to? Are you a member of NASEN and on their list serv? There are a lot of people who have these conversations all the time, but you're not necessarily going to reach them on Metafilter.
I'm assuming from your description that you're in the US, but if not, please say where you are, and I'll try to link you to resources in your country.
posted by gingerbeer at 5:06 PM on January 5, 2012 [1 favorite]
A couple of other comments: in my state, syringe possession is generally viewed as a crime, and syringe access programs can only carve out a small exemption from that. Particularly for people on parole or probation, carrying syringes can cause them a lot more trouble from the police than from the nice harm reduction staffer at the exchange. You may be paddling upstream on that, and you don't necessarily want to be demanding that they put themselves in legal jeopardy to satisfy your grant requirements. In which case, I recommend pushing back against those requirements.
One way to do that is to document that the syringes are being disposed of appropriately, just not with you. And to find that out, you're going to have to ask people. Do a survey of where and how people are disposing of their syringes, and work with that information. If people are dropping them down sewers or putting them in the trash, yes, you may want to figure out something different. But if those syringes are in fact ending up disposed of correctly, count it as a success, document it for your funder, and be happy.
posted by gingerbeer at 5:13 PM on January 5, 2012 [1 favorite]
One way to do that is to document that the syringes are being disposed of appropriately, just not with you. And to find that out, you're going to have to ask people. Do a survey of where and how people are disposing of their syringes, and work with that information. If people are dropping them down sewers or putting them in the trash, yes, you may want to figure out something different. But if those syringes are in fact ending up disposed of correctly, count it as a success, document it for your funder, and be happy.
posted by gingerbeer at 5:13 PM on January 5, 2012 [1 favorite]
I'm so sorry-- you're in Canada, and it says so right in your profile. NASEN's still a good resource, and it's worth talking to HRC, although they may have limited resources for you.
posted by gingerbeer at 5:14 PM on January 5, 2012
posted by gingerbeer at 5:14 PM on January 5, 2012
Best answer: I'm pretty sure that's a better return rate than the exchange I used to volunteer at, so this may be of no use. But one thought... Have you tried offering thick plastic containers that are. *not* sharps containers? Detergent bottles, kitty litter containers, etc.? We always had some clients who were using in secret and didn't want to keep a big red medical waste container in their apartment lest parents/friends/partners see it. But they were sometimes willing to take a more easily hidden/overlookable container and use that instead.
Ultimately, though, the fear of getting pulled over carting a load of used needles back to us was a huge deterrent and there wasn't much we could do about that except teach people how to dispose as safely at possible at home, if they had to.
Is it a funding issue, where more returned needles = more funding? If so, a pragmatic response might be to also cater to diabetics for needle disposal. We had a few regular diabetic clients. And I brought my diabetic cat's needles in for disposal, figuring a few hundred returned needles could only help the numbers. As far as I know no one ever recorded anywhere that they were from a diabetic cat, not a person.
posted by Stacey at 5:31 PM on January 5, 2012 [1 favorite]
Ultimately, though, the fear of getting pulled over carting a load of used needles back to us was a huge deterrent and there wasn't much we could do about that except teach people how to dispose as safely at possible at home, if they had to.
Is it a funding issue, where more returned needles = more funding? If so, a pragmatic response might be to also cater to diabetics for needle disposal. We had a few regular diabetic clients. And I brought my diabetic cat's needles in for disposal, figuring a few hundred returned needles could only help the numbers. As far as I know no one ever recorded anywhere that they were from a diabetic cat, not a person.
posted by Stacey at 5:31 PM on January 5, 2012 [1 favorite]
Best answer: How about some non-financial incentives?
- If you bring in used needles, you go to the front of the line.
- If you bring in used needles, you get to skip the mandatory literature and discussion of why it's important to bring back needles.
- Punch card-- you get a punch every time you bring back needles. Ten punches buys you a chip. Ten chips buys you... something?
Have you tried putting up a white board with your goal on it, maybe in the form of one of those fundraising thermometers? Or a "dashboard" that had a running count and percentage target? Maybe that would help people get more involved in the "game" aspect of it.
posted by charmcityblues at 5:42 PM on January 5, 2012 [6 favorites]
- If you bring in used needles, you go to the front of the line.
- If you bring in used needles, you get to skip the mandatory literature and discussion of why it's important to bring back needles.
- Punch card-- you get a punch every time you bring back needles. Ten punches buys you a chip. Ten chips buys you... something?
Have you tried putting up a white board with your goal on it, maybe in the form of one of those fundraising thermometers? Or a "dashboard" that had a running count and percentage target? Maybe that would help people get more involved in the "game" aspect of it.
posted by charmcityblues at 5:42 PM on January 5, 2012 [6 favorites]
First of all, awesome work on your behalf!
I think some form of reward would be a good incentive. Particularly some form of financial or otherwise neglected needs many addicts face. Perhaps you could partner with some donor who may know a food store or small deli (you get my drift) for something edible.
The discrete containers are also an awesome idea.
The other great point was just ask them why they won't exchange the needles or how do they dispose of their used needles. This would allow you to come up with possible obstacles to over come to get your clients to exchange.
Always educate, that raises awareness and hopefully it will click. Explain the dangers that improperly disposed needles pose for themselves and others. Emphasize that you care.
posted by handbanana at 6:02 PM on January 5, 2012
I think some form of reward would be a good incentive. Particularly some form of financial or otherwise neglected needs many addicts face. Perhaps you could partner with some donor who may know a food store or small deli (you get my drift) for something edible.
The discrete containers are also an awesome idea.
The other great point was just ask them why they won't exchange the needles or how do they dispose of their used needles. This would allow you to come up with possible obstacles to over come to get your clients to exchange.
Always educate, that raises awareness and hopefully it will click. Explain the dangers that improperly disposed needles pose for themselves and others. Emphasize that you care.
posted by handbanana at 6:02 PM on January 5, 2012
Folks don't need you to bring them in sharps containers necessarily, that could be a hangup for people. We had people bring their sharps in coffee cans and laundry detergent bottles -- I think the fact that they weren't obviously for needles was helpful for some folks, less obvious. The trick is that you have them open the container to dump it in one of the larger sharps bins, so you don't get yourself stabbed.
Are the cops really bad around there? What's the legality of your exchange? Getting detained with 200 needles in a sharps container is a little problematic, and will really deter people from bringing things back.
This feels a little like a relationship askme: the answer is to ask the clients what's up with what's going on. also, if you aren't in contact with the Harm Reduction Coalition, network with other exchanges.
ps. I know you said there are no funds, but you might need to hustle some donations (shit, Walmart donated to the needle exchange, weirdly) to make incentives for folks. bringing it all back in a sharps container gets you extra supplies?
posted by circle_b at 6:03 PM on January 5, 2012
Are the cops really bad around there? What's the legality of your exchange? Getting detained with 200 needles in a sharps container is a little problematic, and will really deter people from bringing things back.
This feels a little like a relationship askme: the answer is to ask the clients what's up with what's going on. also, if you aren't in contact with the Harm Reduction Coalition, network with other exchanges.
ps. I know you said there are no funds, but you might need to hustle some donations (shit, Walmart donated to the needle exchange, weirdly) to make incentives for folks. bringing it all back in a sharps container gets you extra supplies?
posted by circle_b at 6:03 PM on January 5, 2012
My first thought is that it's inconvenient for the users, and right after shooting up, they aren't really focused on saving the used sharps in order to return them. If I were a user, I wouldn't feel safe walking around with drug paraphernalia for fear that I'd be stopped and busted by police. Is that a legit concern, or is there police cooperation in your city? I'd ask the users what prevents them from returning used sharps and get their ideas. Also, try to determine what makes the 30% successful. How do they manage to return sharps? Ask them what inspires them, and what might work better.
posted by Sal and Richard at 6:10 PM on January 5, 2012
posted by Sal and Richard at 6:10 PM on January 5, 2012
Our program picked up needles in the shooting galleries for a long time while people got used to bringing their needles in. I believe they left containers behind to collect later. Now more needles come into to the office during regular hours than during the evening outreach. Last time I paid attention to their stats they gave out something like 140,000 needles per year, and took in 150,000. It's higher now.
posted by ThatCanadianGirl at 6:18 PM on January 5, 2012 [2 favorites]
posted by ThatCanadianGirl at 6:18 PM on January 5, 2012 [2 favorites]
Make it a one-to-one exchange, and be firm about it - bring a needle, get a needle in exchange. If I remember correctly, it's how the original needle exchange programs in New Haven and Boston ran, with the goal of getting dirty needles off the street; the needle exchange programs that I know of that have a good rate of return did the same.
posted by noonday at 6:47 PM on January 5, 2012
posted by noonday at 6:47 PM on January 5, 2012
Oh god no. One-to-one has only ever worked as a politically expedient compromise. It's absolutely lousy at achieving the public health goals of getting people to use a new syringe for every injection. It's not good harm reduction and it's not good public health. Yes, it's how a lot of exchanges, including the one I volunteer for, started, but only because we all believed that that was the only way to get political and community support for the programs. It's been discredited as anything resembling effective public health.
posted by gingerbeer at 8:27 PM on January 5, 2012 [5 favorites]
posted by gingerbeer at 8:27 PM on January 5, 2012 [5 favorites]
Best answer: Hey Violet. I was in Harm Min in Australia for years before having littlies. Some things we realised: our clients were mostly using public transport or rather dodgy-looking cars and were frequently being harassed by the police as they travelled with their fits. So they decided not to. The containers were bulky and yellow and obvious.
I, with assistance from local businesses, left sharps containers in the private alleys nearby where clients were injecting and replaced them regularly.
I also explained to many clients the terror and danger of garbage folk who get stuck inadvertently while picking up their household garbage bins. Most Australians have great affection for their garbos.
And to the others I explained how all it would take would be one spill of the garbage system outside the house and all neighbour's, the council and very quickly the police would know their private business.
So I encouraged them to call me for a pickup when we delivered or to bring them back. We had a lot of the small black fit packs that only those in the know knew.
(Happy to bounce ideas around with you. I'm on an iPhone in the car with sleeping ToddlerTaff so it's hard to write more or type accurately. Email me if you like. )
posted by taff at 8:57 PM on January 5, 2012 [4 favorites]
I, with assistance from local businesses, left sharps containers in the private alleys nearby where clients were injecting and replaced them regularly.
I also explained to many clients the terror and danger of garbage folk who get stuck inadvertently while picking up their household garbage bins. Most Australians have great affection for their garbos.
And to the others I explained how all it would take would be one spill of the garbage system outside the house and all neighbour's, the council and very quickly the police would know their private business.
So I encouraged them to call me for a pickup when we delivered or to bring them back. We had a lot of the small black fit packs that only those in the know knew.
(Happy to bounce ideas around with you. I'm on an iPhone in the car with sleeping ToddlerTaff so it's hard to write more or type accurately. Email me if you like. )
posted by taff at 8:57 PM on January 5, 2012 [4 favorites]
Response by poster: I'm a bit stunned - I expected a tiny hand full of responses! I'll try to answer all the questions - but I'm loving some of your advice already.
The program has been in existence for almost a decade, I believe, with varying levels of success and varying levels of agency support (at times the needle exchange was absolutely not a priority). There was a complete change-over in staffing in May (though I had been volunteering there for a year prior to that, so there was some continuity) and another agency was brought in to partner up. As a result of this new partnership, and with having two managers of the program, we're trying to build things up in a really strong way, paying close attention to clients' needs, community needs, etc. Delivery service is new. Sex worker outreach is new. Clients definitely know about us, and we have a fairly solid mix of dedicated clients and regular new clients appearing.
Absolutely cannot switch to a one-for-one exchange. Totally out of the question and against our policies.
The needle return rate is not directly tied to any funding, thankfully. That said, the joint agencies (two) that are responsible for the needle exchange do want to be able to prove that we are increasing public safety in addition to the health of our users - for our funders and for our detractors in the community (of which we have blessedly few who are vocal).
We want the needles returned from a practical/health standpoint - needles that are tossed into sewers, chucked into kitchen garbage bags, or dropped in parks are a health risk for everyone. Our mandate is to prevent the transmission of Hepatitis C (HCV) and HIV, not just for substance users but for everyone. When we have needle stick injuries, in children and adults, making the news on occasion, we get flack from the community for handing out needles in the first place (the usual flawed logic). Our clients know that we provide all of our services for this goal. That said, many of them are in denial about their own risks for HCV/HIV.
When asked, clients often respond that they "have a bunch of containers at home" or "will bring them back next time" or "don't need pick up right now, but I'll call you". We know this is mostly untrue based on our local stats (ours + other agencies that offer the service) but I can't really start chanting about "pants on fire", so I can only gently prompt again. When we do deliveries and ask about picking up used needles, we're told "the bin isn't full yet" or "I dropped them off last week" - but our delivery service is very new, so this might change as we continue promoting it.
Packaging supplies with an included sharps container is iffy. Most of the clients we have want very specific configurations of their works - so, it's not as simple as "1 needle + 1 water + 1 cooker + 1 alcohol + etc." tucked into a container. We have had packages made before and had a lot of negative feedback around it (clients were very concerned with waste). That said, I'm wondering about whether we can somehow find way to configure it differently/better.
Legalities may be an issue for some, definitely. Interestingly, the fixed location where we're working has an occasional police presence - and many clients have zero issue with asking for supplies, and putting some into their bags, while standing two feet away from an officer (who can, and does, see what's happening). The police know what we do. I can understand that returning things, however, is different. I will definitely need to explore this.
Asking clients would seem like the best option here, but many of them literally run in, grab stuff, and run out - - and yet those are the clients we most need to get on board with the returns. Those who do regularly return their sharps often say, "It's safer" or "I'm coming here anyway!" so I'm thinking there's more planning and foresight/insight around the returns - which may not be possible to prod into the other users who are more rushed (for a variety of reasons).
posted by VioletU at 7:45 AM on January 6, 2012
The program has been in existence for almost a decade, I believe, with varying levels of success and varying levels of agency support (at times the needle exchange was absolutely not a priority). There was a complete change-over in staffing in May (though I had been volunteering there for a year prior to that, so there was some continuity) and another agency was brought in to partner up. As a result of this new partnership, and with having two managers of the program, we're trying to build things up in a really strong way, paying close attention to clients' needs, community needs, etc. Delivery service is new. Sex worker outreach is new. Clients definitely know about us, and we have a fairly solid mix of dedicated clients and regular new clients appearing.
Absolutely cannot switch to a one-for-one exchange. Totally out of the question and against our policies.
The needle return rate is not directly tied to any funding, thankfully. That said, the joint agencies (two) that are responsible for the needle exchange do want to be able to prove that we are increasing public safety in addition to the health of our users - for our funders and for our detractors in the community (of which we have blessedly few who are vocal).
We want the needles returned from a practical/health standpoint - needles that are tossed into sewers, chucked into kitchen garbage bags, or dropped in parks are a health risk for everyone. Our mandate is to prevent the transmission of Hepatitis C (HCV) and HIV, not just for substance users but for everyone. When we have needle stick injuries, in children and adults, making the news on occasion, we get flack from the community for handing out needles in the first place (the usual flawed logic). Our clients know that we provide all of our services for this goal. That said, many of them are in denial about their own risks for HCV/HIV.
When asked, clients often respond that they "have a bunch of containers at home" or "will bring them back next time" or "don't need pick up right now, but I'll call you". We know this is mostly untrue based on our local stats (ours + other agencies that offer the service) but I can't really start chanting about "pants on fire", so I can only gently prompt again. When we do deliveries and ask about picking up used needles, we're told "the bin isn't full yet" or "I dropped them off last week" - but our delivery service is very new, so this might change as we continue promoting it.
Packaging supplies with an included sharps container is iffy. Most of the clients we have want very specific configurations of their works - so, it's not as simple as "1 needle + 1 water + 1 cooker + 1 alcohol + etc." tucked into a container. We have had packages made before and had a lot of negative feedback around it (clients were very concerned with waste). That said, I'm wondering about whether we can somehow find way to configure it differently/better.
Legalities may be an issue for some, definitely. Interestingly, the fixed location where we're working has an occasional police presence - and many clients have zero issue with asking for supplies, and putting some into their bags, while standing two feet away from an officer (who can, and does, see what's happening). The police know what we do. I can understand that returning things, however, is different. I will definitely need to explore this.
Asking clients would seem like the best option here, but many of them literally run in, grab stuff, and run out - - and yet those are the clients we most need to get on board with the returns. Those who do regularly return their sharps often say, "It's safer" or "I'm coming here anyway!" so I'm thinking there's more planning and foresight/insight around the returns - which may not be possible to prod into the other users who are more rushed (for a variety of reasons).
posted by VioletU at 7:45 AM on January 6, 2012
Prepackaging supplies never worked for us for the reason you're citing. We did keep a few prepacks around for the very end of the day, so if people turned up after we closed we had *something* to offer them even if we'd packed up most of our stuff. I think we tucked small sharps containers in with those. I don't know if the return rate was any better, though.
I wonder, do you have a waiting line? (Ideally not, but if you're half as underfunded/staffed as we were, there's always a wait.) People who run in/run out might be willing to fill out a short anonymous survey if they're stuck standing in line anyway. That was the only downtime we ever had to reach the super-quick clients who just wanted to grab and run. Or maybe you could tuck a survey form in the bag and hope they might bring it back next time - you're probably not going to get a great hit rate on that, but maybe some of them will do it, if their issue is really more about getting pulled over with used works rather than about the time crunch/lack of preplanning.
I don't know. We never really figured out the answer. But it sounds like you've got a great service - I wish we could have done a lot of the things you're talking about, but we never had the support. Good luck!
posted by Stacey at 8:59 AM on January 6, 2012
I wonder, do you have a waiting line? (Ideally not, but if you're half as underfunded/staffed as we were, there's always a wait.) People who run in/run out might be willing to fill out a short anonymous survey if they're stuck standing in line anyway. That was the only downtime we ever had to reach the super-quick clients who just wanted to grab and run. Or maybe you could tuck a survey form in the bag and hope they might bring it back next time - you're probably not going to get a great hit rate on that, but maybe some of them will do it, if their issue is really more about getting pulled over with used works rather than about the time crunch/lack of preplanning.
I don't know. We never really figured out the answer. But it sounds like you've got a great service - I wish we could have done a lot of the things you're talking about, but we never had the support. Good luck!
posted by Stacey at 8:59 AM on January 6, 2012
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posted by cestmoi15 at 4:35 PM on January 5, 2012 [2 favorites]