Assessing the feasibility, acceptability and accessibility of a peer-delivered intervention to reduce harm and improve the well-being of people who experience homelessness with problem substance use: the SHARPS study

Abstract

Background For people experiencing homelessness and problem substance use, access to appropriate services can be challenging. There is evidence that the development of trusting relationships with non-judgemental staff can facilitate service engagement. Peer-delivered approaches show particular promise, but the evidence base is still developing. Methods The study used mixed methods to assess the feasibility, acceptability and accessibility of a peer-delivered, relational intervention to reduce harms and improve health/well-being, quality of life and social functioning, for people experiencing homelessness and problem substance use. Four Peer Navigators were employed to support individuals (n = 68 total, intervention participants). They were based in outreach services and hostels in Scotland and England. Qualitative interviews were conducted with intervention participants, Peer Navigators and staff in services, and observations were conducted in all settings. Quantitative outcomes relating to participants’ substance use, physical and mental health, and quality of the Peer Navigator relationship, were measured via a ‘holistic health check’ with six questionnaires completed at two time-points. Results The intervention was found to be acceptable to, and feasible and accessible for, participants, Peer Navigators, and service staff. Participants reported improvements to service engagement, and feeling more equipped to access services independently. The lived experience of the Peer Navigators was highlighted as particularly helpful, enabling trusting, authentic, and meaningful relationships to be developed. Some challenges were experienced in relation to the ‘fit’ of the intervention within some settings. Among participants there were reductions in drug use and risky injecting practices. There were increases in the number of participants receiving opioid substitution therapy. Overall, the intervention was positively received, with collective recognition that the intervention was unique and highly valuable. While most of the measures chosen for the holistic health check were found to be suitable for this population, they should be streamlined to avoid duplication and participant burden. Conclusions The study established that a peer-delivered, relational harm reduction intervention is acceptable to, and feasible and accessible for, people experiencing homelessness and problem substance use. While the study was not outcomes-focused, participants did experience a range of positive outcomes. A full randomised controlled trial is now required to assess intervention effectiveness. Trial registration Study registered with ISRCTN: 15900054.

Peer and lay health work for people experiencing homelessness: A scoping review

“…Most programs [ 23 ] engaged peer health workers as employees [ 16 , 18 , 19 , 22 , 28 , 30 , 32 , 34 – 39 , 41 – 43 , 46 , 50 , 52 , 53 , 55 ]. Four programs recruited the peer health workers as volunteers [ 14 , 27 , 45 , 47 ].…”

“…Ten programs did not report employment status [ 14 , 29 , 31 , 40 , 46 , 48 , 49 , 51 , 56 , 57 ]. 13 programs trained the peer workers via classroom and following a specified curriculum dependent on the programs’ intervention [ 14 , 19 , 28 , 30 – 32 , 40 , 43 , 44 , 49 , 50 , 52 , 53 ]. For example, Resnik et al .…”

A peer-delivered intervention to reduce harm and improve the well-being of homeless people with problem substance use: the SHARPS feasibility mixed-methods study

“…PIEs aim to help people make changes to behaviours on their own terms using supportive relationships. 70 PIEs as a concept is continually developing, but the most recent version (2.0) identifies five key areas: (1) developing greater psychological awareness of the needs of service users; (2) valuing training and support for all staff, volunteers and service users; (3) fostering a culture of learning and enquiry, which considers evaluation and improvement; (4) enabling 'spaces of opportunity' that seek to view the environment from service users' perspectives; and (5) fine-tuning the rules, roles and responsiveness of the service, which focuses on managing and improving relationships. 71 Services implementing a PIE approach may, for example, change their reception areas to make them feel safer/ more inviting, provide staff with opportunities for reflective practice, and review evictions protocols to allow for greater flexibility when there is an issue of compliance.…”

Commentary: Responding to the Opioid Crisis in Congregate Encampments

“…In working with congregated living scenarios (i.e., "tent cities"), it has been recognized that such situations provide an avenue for peer-based care, security, and support for individuals using substances (Parkes et al, 2022). Such a support structure is beneficial in the availability and efficacy of naloxone administration.…”