Developing a Comprehensive Inventory to Define Harm Reduction Housing.

Area of Science:

• Public Health
• Urban Planning
• Social Work

Background:

• Boston faces substance use challenges, increased homelessness, and changes in illicit drug supply.
• Six low-threshold harm reduction housing (HRH) sites were established to support people who use drugs (PWUD) and address encampment issues.
• HRH provides transitional supportive housing with a "housing first" approach, prioritizing harm reduction services over abstinence.

Purpose of the Study:

• To address the lack of understanding regarding the specific characteristics and operations of HRH sites.
• To catalog common features of Boston's HRH sites.
• To generate a comprehensive inventory tool for evaluating harm reduction strategy implementation in transitional housing.

Main Methods:

• Collected data between June and September 2023 through semi-structured qualitative interviews with HRH staff (n=19) and ethnographic observations at six HRH sites.
• Derived candidate inventory components through data triangulation and refined a draft inventory with expert review.
• Pilot tested the inventory with 3 HRH residents and further validated its performance in a survey of 106 residents.

Main Results:

• Identified best practices, resources, and policies including overdose prevention, behavioral policies, security, and harm reduction supply distribution.
• Developed a 32-item inventory of services, policies, and best practices, refined through expert and participant feedback.
• Residents valued harm reduction services and medical supports, though medical support utilization was lower than perceived value.

Conclusions:

• The HRH inventory comprehensively assesses harm reduction provision, resident awareness, and perceived helpfulness of HRH operational components.
• This tool aids in standardizing the concept and practice of HRH for PWUD.
• The inventory can assist other cities in planning and implementing effective harm reduction housing strategies.