SunCloud Health is proud to introduce its new harm reduction IOP. Through this program, our goal is to reach more individuals in need of quality care in a group setting, with a focused effort on improving quality of life, reducing harm around certain behaviors, and providing education and enhanced connection to a greater population.
Video: Introducing SunCloud Health’s New Harm Reduction Program – hear from Rachel Goodwin, LCPC, LMHC, CEDS, Director of Virtual IOP at SunCloud Health.
What Does Harm Reduction Mean?
Harm reduction is an important part of a comprehensive approach to addressing substance use disorders, eating disorders, and other maladaptive behaviors through prevention, treatment, and recovery — and empowering people to reach their own goals, through incremental change. Organizations who practice harm reduction incorporate a spectrum of strategies that meet people where they are, on their own terms, and may serve as a pathway to additional health and social services, including additional prevention, treatment, and recovery services.
At SunCloud Health, this means working with clients who may not be ready or able to stop engaging in certain behaviors that might go along with presenting concerns, helping to improve their quality of life as defined by the patient in order to fully engage them in the process. What’s best for the client may not be abstinence based, which is why our harm reduction approach instead reduces risks or harm at whatever level they are willing, to ensure a patient-led and centered program.
Ultimately, harm reduction minimizes the inherent harms associated with specific disorders and acknowledges that reducing harm can take different forms for different people at different points, including with the use of medications to treat substance use disorders. Harm reduction is also inclusive of abstinence as a chosen pathway but not inclusive of abstinence as a coerced pathway.
Video: What is harm reduction? Hear from Michelle Duda, MS, LCPC, CADC, Director of Outpatient Treatment Center Chicago (Lincoln Park) at SunCloud Health.
Why Is Harm Reduction Important to Treatment?
As a vital element of the continuum of care, harm reduction provides a comprehensive strategy of prevention, treatment, recovery, and health promotion while recognizing the complex relationship people may have with substances, food behaviors, and other maladaptive behaviors, from initial onset and throughout intervention and/or treatment.
With harm reduction as part of our treatment approach, we’re better able to seek to prevent problems before they start, such as by reducing exposure to triggers, reducing risk factors, and strengthening protective factors at the individual, relationship, community, and society levels. Prevention also seeks to stop or delay the progression of substance use to a substance use disorder, eating struggles to eating disorder, etc., as well as prevent other harms associated with the disorder.
Video: Introducing SunCloud Health’s New Harm Reduction Program, by Michelle Duda, MS, LCPC, CADC, Director of Outpatient Treatment Center Chicago (Lincoln Park) at SunCloud Health.
Video: Rachel Goodwin, LCPC, LMHC, CEDS, Director of Virtual IOP at SunCloud Health, on serving a broader spectrum of patients at SunCloud Health.
Pillars of Harm Reduction
Harm Reduction…
Is led by individuals with lived experience of a disorder
Evidence-based harm reduction interventions have been innovated and largely implemented by people with substance use disorder, eating disorder, or other condition. Through shared decision-making, people with lived experience are empowered to take an active role in the engagement process and have better outcomes. Put simply, the effectiveness of harm reduction programs is based on the buy-in and leadership of the people they seek to serve.
Organizations providing harm reduction services should have a formal mechanism to meaningfully include the voices of people with lived experience in the design, implementation, and evaluation of those services. Adopting at least two of the following specific mechanisms of inclusion is mission critical: employment of people with lived experience in both intervention and administrative roles, advisory boards of those individuals, and the consultation of CHRPs or any other peer-led organizations.
It is important to note that while people in recovery and people who formerly experienced the mental health disorder have valuable experience, centering the perspectives of people who currently struggle (and the intersectionality with other historically marginalized individuals) and have a working understanding of the current, dynamic, and rapidly changing landscape of the related behaviors in a particular community in which an organization is working, is essential to successful engagement and outcomes. This is exemplified in the provision of OEND Programs.
Embraces the inherent value of people
All individuals have inherent value and are treated with dignity, respect, and positive regard.
Harm reduction initiatives, programs, and services are trauma informed, and never patronize nor pathologize clients, nor their communities. They acknowledge that struggles such as substance use happens, and the reasons a person uses drugs are nuanced and complex. This includes people who use drugs to alleviate symptoms of an existing medical condition.
Commits to deep community engagement and community building
All communities that are impacted by systemic harms are leading and directing program planning, implementation, and evaluation.
Funding agencies and funded programs support and sustain community cultural practices, and value community wisdom and expertise. Agencies and programs develop through community- led initiatives focused on geographically specific, culturally based models that integrate language revitalization, cultural programming, and Indigenous care with dominant-society healthcare approaches.
Promotes equity, rights, and reparative social justice
All aspects of the work incorporate an awareness of (and actively work to eliminate) inequity related to race, class, language, sexual orientation, and gender-based power differentials.
Pro-health and pro-social practices that have worked well for specific cultural and/or geographic communities are aligned with organizing and mobilizing, providing direct services, and supporting mutual aid.
CHRPs are often the best-placed organizations to respond to communities or individuals on racial justice and health equity issues, and provide services for Black, Latino, American Indian and Alaska Native persons, Asian Americans, Native Hawaiians, and Pacific Islanders, and other persons of color; members of religious minorities; LGBTQI+ persons; persons with disabilities; persons who live in rural areas; and persons otherwise adversely impacted by persistent poverty or inequality.
Offers most accessible and noncoercive support
All harm reduction services have the lowest requirements for access.
Participation in services is always voluntary, confidential (or anonymous), self-directed, and free from threats, force, and the concept of compliance. Any data collection requires informed consent and participants should not be denied services for not providing information. This means using low-threshold evaluation and data collection systems to measure the effectiveness of harm reduction programs.
Focuses on any positive change, as defined by the person
All harm reduction services are driven by person-centered positive change in the individual’s quality of life.
Harm reduction initiatives, programs, and services recognize that positive change means moving towards more connectedness to the community, family, and a more healthful state, as the individual defines it. There are many pathways to wellness; substance use recovery is only one of them. Abstinence is neither required nor discouraged.
Harm Reduction or Abstinence-Based?
What is our treatment approach at SunCloud? Is it harm reduction or abstinence based?
“Abstinence based” and “harm reduction” mean different things to different people, so it’s important to consider the specific situation. The short answer is, “it’s complicated,” because it depends on the patient and the whole picture. Our sophisticated psychiatrists begin with a risk-benefit analysis that includes the whole team, with input from family and patient and school, which altogether guides individualized treatment approaches.
Above all, we individualize treatment and risk stratify in order to determine the best approach for each person. Ultimately, the provider in charge of the case confers with the treatment team, including the therapist, dietitian, mileau staff, and patient’s family, as well as reviews medical weights and vitals to determine the most appropriate treatment plan for the patient. So … it depends.
For example:
- Person X who is struggling to compete a meal plan but has normal labs and VS, is engaged and coming to care, bmi 18 or 17.5 and steady, is a different matter than someone with abnormal VS or labs losing weight and doing the same behavior, even if at a higher bmi.
- Someone reducing THC use week over week, who comes and is engaged and making progress but still using periodically or not using pills and alcohol, and using a vape pen at night but not coming high to program and making progress. We keep working with that person.
- If someone is relapsing on illicit pills or heroin, we take immediate action, because that person could potentially die tomorrow.
- Are any of the person’s symptoms improving while in treatment? If so, that could be a basis to continue working with that individual even if they still might be engaging in some behaviors.
What about 12-step approaches?
12-step facilitation is a manualized, highly evidence-based treatment for adult AUD—and we don’t administer TSF; we DO support patients in engaging mutual support groups if and when they are available to them (such as young peoples’ AA, Alateen, others as applicable like ANAD; NAMI or families anonymous for parents, etc). The guiding principle is to increase sense of community/connection and to decrease shame and isolation.
We do teach principles of recovery adopted from 12-step principles, such as honesty, hope, willingness, accepting help, sharing with and connecting with others, behavioral changes in relationships, mindfulness, and doing the work to change how the adolescents feel about themselves.
Last but not least, 12-step programs are peer-run, mutual support groups, not professional, and are fundamentally harm reduction in nature. Membership requirement for any of them is simply a desire to not use that day. People who are using/continue to use are welcome to continue attending.
Explaining SunCloud’s Integrated Model Why is an integrated treatment model essential to successfully treating patients?
Dr. Kim Dennis, Co-Founder and Medical Director at SunCloud Health, discusses the vital role the integrated model (that she is pioneering at SunCloud Health) plays in the success of treating patients with co-occurring disorders and underlying trauma. How does SunCloud create an authentic culture of patient support?
