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Background Harm reduction programs often lack community-based support and can be controversial, despite data demonstrating effectiveness. This article describes one small Alaskan community’s development of a harm reduction managed alcohol program (MAP) in the context of a city-run quarantine site for individuals experiencing homelessness. The MAP was developed to support quarantining by COVID-19-exposed or COVID-positive individuals who also experienced chronic homelessness, a severe alcohol use disorder, and heightened health risks related to potentially unsupported alcohol withdrawal. Method Five interviews with key informants involved in planning or implementation of the MAP were conducted using rapid qualitative analysis and narrative analysis techniques. Outcome This study documents the planning and implementation of an innovative application of a managed alcohol harm reduction intervention in the context of the COVID-19 pandemic. In this instance, a MAP was used specifically to limit hospital admissions for alcohol withdrawal during a surge of cases in the community, as well as to mitigate spread of the virus. Key informants report no residents enrolled in the MAP program as a part of quarantine required hospitalization for withdrawal or for COVID symptoms, and no shelter resident left the quarantine site while still contagious with COVID-19. Additionally, the level of community support for the program was much higher than originally expected by organizers. Conclusions This program highlighted an example of how a community recognized the complexity and potential risk to individuals experiencing structural vulnerability related to homelessness and a severe AUD, and the community at large, and was able to create an alternative path to minimize those risks using a harm reduction strategy.

Unaccompanied homeless youth (< 25 years of age) are the group most likely to be underreported in annual point-in-time (PIT) counts of unsheltered individuals. This practice note reviews the process of a collaborative partnership between a university and community to conduct a successful youth PIT count outreach that more accurately reflected the number of homeless youth. In addition to almost doubling the number of unsheltered homeless youth who were identified between 2013 and 2014, several positive outcomes for students, providers, and faculty resulted through the project's efforts. These outcomes, including increased student exposure and interest in this vulnerable population, are reviewed.

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