A Harm Reduction Approach to Informed and Compassionate Care
By Dani York, LCAT, RDT, S:US Director of Clinical Support & Enhancement, Recovery & Treatment and
Elan Quashie, S:US Director of Opioid Overdose Prevention Program, Recovery & Treatment
Behavioral Health News
Fall 2025
Harm Reduction allows us to consider and implement practices that help individuals make safe, viable choices in support of overall wellness. Harm Reduction is also “a movement for social justice built on a belief in, and respect for, the rights of people who use drugs”[i] and is “a key pillar in the U.S. Department of Health and Human Services’ Overdose Prevention Strategy.”[ii] Each definition implicitly places an emphasis on select primary tenets of person-centered, trauma-informed care. These include empowerment and choice, mutuality, respect for the individual’s values, preferences and expressed needs, information and education, access to care, and trustworthiness and transparency. Engaging through a harm reduction lens expands its foundation beyond substance use recovery and into varied aspects of recovery and treatment.
Services for the UnderServed (S:US), one of the largest community-based health and human services organizations in New York State working intentionally to right societal imbalances by providing comprehensive and culturally responsive services, utilizes a harm reduction approach to engagement across programs including shelters, respites, clinics, housing, Clubhouse, and transitional residences. Programs at S:US provide direct service delivery with access to resources for individuals living with a range of unmet needs from mental health and substance use challenges to the felt impact of oppression and social determinants of health. Successful (the ability to make contact) and meaningful (the ability to contribute to change through healing relationship) engagement is at the core of our work with participants through the agency’s programs.
S:US’ Recovery & Treatment Division deploys outreach teams to expand engagement beyond the walls of our program sites. S:US leverages multiple grant streams to expand and sustain harm reduction services. These grant-funded teams connect individuals with lifesaving resources and strategies to mitigate against negative outcomes of high-risk behaviors, symptoms, and circumstances. In practice, this allows for attunement to nuanced needs of the programs’ populations by category, i.e. unhoused, dually diagnosed, in substance use recovery, and unique individuals receiving services from the teams. Commitment to advancing health equity and reducing harm among vulnerable populations is demonstrated through comprehensive, evidence-based harm reduction frameworks.
Services are designed to engage individuals with dignity, compassion, and practicality. The Recovery & Treatment Division’s Brooklyn outreach teams embody harm reduction through the lens of collaboration. This is accomplished through referring, accompanying, facilitating, and connecting; each team relies consistently on the strengths of others to provide individualized person-centered, trauma-informed, and culturally humble care. Team staffing is intentionally geared towards the diverse levels of support needed during a recovery journey. A key component is the inclusion of Peer Specialists, who bring lived experience, insight, and credibility to their interactions with enrollees; as well as licensed practitioners, Credentialed Alcoholism and Substance Abuse Counselors (CASACs), and case managers.
The Opioid Overdose Prevention Program (OOPP) has trained and enrolled over 60 programs agency-wide in opioid overdose prevention measures, distributes Naloxone to empower immediate overdose intervention, and provides a broad range of supplies in service of safer use practices.
Elan Quashie demonstrates how to safely administer Naloxone at a 2024 training session hosted by NYC Health + Hospitals/Woodhull. Photo credit: NYC Health + Hospitals.
The Medication Assisted Treatment (MAT) Program supports individuals with Opioid Use Disorder through integrated medical and behavioral health services. Beyond linkage to prescribers for medications for Opioid Use Disorders (MOUD), the MAT team takes a compassionate approach to engagement through pacing conversations around recovery that focus on fear and discomfort that may accompany decreased use and consistent follow-up for shifts in perspective and desire via group work, individualized community care, and direct collaboration with S:US’ Certified Community Behavioral Health Clinics (CCBHCs).
The Grant for the Benefit of Homeless Individuals (GBHI) provides harm reduction and recovery support to individuals experiencing homelessness and complex life challenges. GBHI understands that contributing factors to being unhoused and/or substance use often derive from trauma and include re-traumatization through racism, daily microaggressions, barriers to care, and the impact of untreated symptoms of mental illness. Additionally, there is a correlation between stressors and symptoms of anxiety and depression. “Stress has direct effects on mood. Early initial symptoms of lowered mood can include irritability, sleep disruption, and cognitive changes, such as impaired concentration. However, the indirect effects of stress are often what causes depression to take hold.”[i] Through a keenly developed lens accentuated by way of internal trainings and external partnerships, GBHI refers individuals to S:US’ CCBHCs, Care Coordination, and Clubhouse for wrap-around support and structured treatment planning. These referrals cultivate spaces for destigmatization and provide opportunity for processing underlying factors that contribute to mood symptoms therefore reducing the impact of stressors themselves.
The first New York City Public Health Vending Machine (PHVM) offers 24/7 access to harm reduction supplies, including Naloxone, hygiene kits, and safer use materials, reducing barriers to care. PHVMs are an emerging strategy to support low-barrier access to harm reduction and wellness supplies free of charge. To strengthen community-based harm reduction, staff from MAT and GBHI have undergone specialized training in opioid overdose response using Naloxone as well as drug testing with Fentanyl and Xylazine test strips. These essential skills equip outreach teams to respond to the ongoing opioid crisis and provide life-saving education to vulnerable populations. Holistically, MAT and GBHI offer robust support through training sessions and individualized counseling, ensuring that services are accessible and tailored to the needs of each participant. Each team is dedicated to education on suicide safer practices including safety planning, wrap planning, and lethal means reduction for those at risk, fostering connections to community and family supports and challenging internal biases while maintaining awareness of complexities of care.
In partnership with NYC Department of Health and Mental Hygiene, S:US launched the city’s first public health vending machine in 2023.
The Brooklyn grants teams understand that harm reduction is needed to empower individuals to make choices that will lead to personal growth, stability, and joy. This involves an invitation to explore complex contributing factors to diminished wellness and consider options beyond those initially available. Options that promote well-being through authentic engagement are more impactful when delivered through warm handoffs by staff who have developed trust within their working relationships. “…This transparent handoff of care allows patients and families to hear what is said and engages patients and families in communication, giving them the opportunity to clarify or correct information or ask questions about their care.”[1] As teams conduct referrals across programs, participants experience mutuality and a breakdown in the implicit power dynamics inherent in the patient/client dynamic, providing participants with the acknowledgement that the provider is not an expert, while empowering creative solutions that better fit their needs. This pathway increases valued shared decision making in recovery and treatment.
Harm Reduction is a foundational framework for care throughout S:US. The outreach teams bridge gaps in community healthcare through tailored community engagement and connections to the most appropriate service types. Over the last three years, hundreds of individuals across underserved communities have connected with the Brooklyn outreach teams to receive services and support. Ongoing communication with program leadership and direct service providers systematizes treatment for participants identified as most at risk based on screenings and assessments, individual narratives, and disclosures and documentation. The Recovery & Treatment Division has seen success through teams’ co-facilitation of harm reduction workshops, preparing staff and participants to respond to high-risk behaviors. Success lies in individuals accepting invitations for psychotherapy, processing traumatic experiences, developing safer support systems, and invigorating internal strength-based strategies. Beyond Substance Use Disorder (SUD) support, harm reduction is harnessed through evidence-based practices, purposeful engagement, and treatment interventions delivered by CCBHCs. Each program shares a singular goal—to support people in making informed decisions to save their lives and co-create pathways to meaningful futures.
References
1. National Harm Reduction Coalition. Principles of Harm Reduction. https://harmreduction.org/about-us/principles-of-harm-reduction/.
2. U.S. Department of Health & Human Services. Overdose Prevention Strategy. https://www.hhs.gov/overdose-prevention/.
3. Boyes, Alice (2013). Psychology Today. Why Stress Turns Into Depression. https://www.psychologytoday.com/us/blog/in-practice/201303/why-stress-turns-depression.
4. Agency for Healthcare Research and Quality. Warm Handoff: Intervention. https://www.ahrq.gov/patient-safety/reports/engage/interventions/warmhandoff.html.
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