XXXXXXXXXX PEER DELIVERED
SYRINGE EXCHANGE PROGRAM
Policies and Procedures Manual
DATE
Table of Contents
Topic
Page
Purpose
3
Recruitment of Peers
3
Training of Peers
3
On Site Training
4
Needs Assessment and Outreach/Peer Delivered Syringe Exchange Plan
5
Conducting Peer Delivered Syringe Exchange during Training
5
Conducting Peer Delivered Syringe Exchange After Training is Completed
6
Security of Supplies
7
Street safety
7
Evaluation
8
Expansion
8
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Purpose:
The proposed program of expanded peer delivered syringe exchange will improve access
to free, new syringes for Injection Drug Users who do not use a SEP but who are
members of a social network which includes SEP participants. This initiative serves as
an enhancement to our already existing efforts to stop the spread of HIV/AIDS and
Hepatitis C epidemics in our communities. XXXXXXXXXX believes healthier drug
using behaviors should emerge from the very community that is actively using drugs and
in that sense in promoting self-efficacy and empowerment to those we strive to serve.
Recruitment of Peers:
Policy:
XXXXXXXXXX’s SEP will actively strive to recruit active injection drug
users (former users will be recruited if and only if they have demonstrated knowledge and
engagement skills of currently existing active injection drug users’ networks.
Procedures: Through the conducting of SEP participants screenings in the form of
interviews, XXXXXXXXXX’s SEP will identify a motivated team of injectors/former
injectors to become SEP outreach and enrollment workers for the Peer Delivered syringe
exchange program. Screening of peers will include an evaluation of the following:
1) Previous work experience and training in HIV/AIDS and Hepatitis C;
2) Any history with agency - reliability, dependability, honesty;
3) Ability to communicate clearly - both verbally (to clients) and in writing (for
reporting purposes);
4) Ability to learn and complete assigned tasks; and
5) Access to extensive IDU social networks.
Identified candidates will complete applications, sign confidentiality agreements, and
undergo all required trainings in order to be eligible to begin to work.
Training of Peers:
Policy:
XXXXXXXXXX’s SEP will thoroughly train all involved parts in the
Peer delivery project in an array of fundamental topics/issues in order to insure the
quality of services’ provision and the safety of all program staff and peers.
Procedures: Once the peers are identified, the agency will conduct intensive training
including the following topics:
1) HIV/AIDS and Hepatitis C prevention, transmission and treatment
2) Syringe Exchange Program: Overview of New York State SEP history and
regulations, as well as XXXXXXXXXX-specific regulations, SEP policies and
procedures, hours and locations
3) Safer injection techniques
4) Syringe Exchange Practicum: Practical training on the use of all SEP forms and
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procedures, with an emphasis on enrollments and transactions forms
5) Reporting requirements: Training on state and agency reporting requirements
6) Safe disposal of syringes: Methods of syringe disposal, presented as a hierarchy
of risk
7) Safer Injection: Techniques and equipment for safer injection, and methods for
teaching them to others.
8) Effectively cleaning syringes and other injection supplies
9) Safer Sex: Use of male and female condoms and dental dams, and how to provide
demonstrations of use
10) Availability/use of other Harm Reduction Supplies: Use and demonstration of
safer crack stems and other assorted harm reduction equipment
11) Conducting client recruitment/outreach: Methods and ethics of recruitment and
program promotion
12) Street Safety and Security: Maximizing street safety during outreach, including
what to do if stopped by law enforcement
13) Expanded Syringe Access Demonstration Program (ESAP): Overview of the
statewide program and information on local pharmacies, including purchasing
procedures.
14) Needle stick injury prevention: Training to be provided by New York State AIDS
Institute, to include all topics required by State regulations
To be certified, individuals who have completed the training will need to demonstrate
understanding of the topics listed above by conducting successful enrollment role plays
with the trainer. A certificate of completion will be issued for those peers who
satisfactorily complete the training sessions and pass the practicum section. Upon
graduation, the peer trainees will be given an agency picture ID, tongs and biohazard
containers for safe used syringe disposal, outreach bags and unlimited metrocards.
On Site Training:
Policy:
Peers will work in tandem with SEP staff at the existing SEP storefront
and at the various street sites in order to enhance team building and a supportive
environment where the latter are assisted by trained and experienced SEP staff members
into conducting successful syringe exchange transactions and documentation.
Furthermore, no peer will be sent to the field without undergoing on-site trainings such as
Needle Stick Prevention, Harm Reduction, Hepatitis C, Buprenorphine, Naloxone and
HIV prevention.
Procedures:
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1. Peer trainees will conduct enrollments and syringe exchange transactions and
complete the necessary paperwork under the aegis of SEP staff members or
trainer. These situational assessments to determine work readiness will continue
until the SEP staff/trainer feels that the peer trainee is sufficiently prepared to
conduct syringe exchange enrollment and transactions off-site;
2. Peer trainees will undergo role playing and formal in-house group trainings
scheduled by SEP staff.
Needs Assessment and Outreach/Peer Delivered Syringe Exchange Plan:
Policy:
To have a thorough understanding of active injection drug using areas (hot
spots) in Bronx and neighboring areas that are un/underserved.
Procedures:
1. The SEP component will identify appropriate outreach locations based on the
findings of the recent DPHO study; outreach staff, SEP workers and peer trainees
will also identify appropriate outreach locations for conducting peer delivered
syringe exchange enrollment and transactions.
2. From needs-assessment in the form of community surveys and of in-house group
discussions, a strategic plan will be created. The plan will prioritize areas in
greatest need of peer delivered syringe exchange. SEP staff and peer trainees will
be assigned to work in tandem by specific location, day and time.
Conducting Peer Delivered Syringe Exchange during Training:
Policy:
In order to guarantee peers’ preparedness for delivering syringe exchange
services on the field, XXXXXXXXXX’s SEP coordinator and staff will supervise all
peer outreach efforts until peer solidity and comfort levels are verified.
Procedure:
1. Before going out for a session, SEP staff and peer trainees will gather the
enrollment and transaction forms, SEP identification cards, and harm reduction
supplies that they anticipate will be needed for the peer delivered exchange
session. Syringes will be discreetly packaged in multiples of ten. Syringes that
are removed from the agency’s supply will be deducted from the agency’s
inventory log and unused ones will be added back in upon return. Each peer
trainee will be issued an outreach bag for supplies and a notebook. One person on
each team will also carry a sharps container for safe disposal of used syringes that
are collected during the session.
2. Initially, the SEP staff and peer trainee will travel to the assigned area and
conduct client recruitment and program promotion activities. People interested in
becoming SEP participants will be enrolled, issued an ID cards and offered the
appropriate number of syringes and harm reduction supplies. Trainees will
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complete the necessary enrollment forms and transaction logs. New SEP
participants will be provided with information regarding the other services
available at the agency and the hours and location of SEP operations. Once the
trainees complete their work, they will return to the SEP to deposit sharps
containers and unused syringes. At this time, they will submit completed
enrollment and transaction logs.
Conducting Peer Delivered Syringe Exchange After Training is Completed:
Policy:
After conducting these activities successfully, peers will be eligible to be
considered for independent work with supervisions being provided by SEP staff/trainer.
Procedures:
XXXXXXXXXX’s SEP will conduct the following in order to ensure the
success of these independent interventions:
1) Peer workers will meet weekly with the Syringe Exchange Coordinator and staff
as a form of group supervision to discuss their experiences in the field. During
each meeting, each peer attendee will receive weekly stipends of $214.00,
provided that all paperwork is up to date, work obligations have been fulfilled. In
addition to the transactions logs and enrollment forms, peers will be asked to keep
records of the outreach contacts that did not include transactions, and to keep the
team informed about the number of encounters and any significant occurrences in
the field. This will help the group have a better idea of what all peers are dealing
with and hopefully will help into encouraging the group for on-going
improvement. More clearly still, the weekly meetings will include skills-building,
supportive discussions and conversations about improving service delivery.
Lastly, during these meetings, collection of returned syringes and distribution of
new ones will take place and recorded by the SEP Outreach Specialist. If a peer
cannot attend a weekly meeting, special arrangements must be made with the SEP
staff and approved by the SEP Coordinator.
2) Peer workers will also meet individually with the Syringe Exchange Coordinator
in order to have biweekly individual supervisions. Just as with group meetings, if
a peer cannot make it to the individual supervision, arrangements must be made
with the SEP staff and approved by the SEP Coordinator.
3) Group-wise or individually, the peer workers will also attend additional skills
building activities and trainings as available through XXXXXXXXXX or other
training providers.
Security of Supplies:
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Policy:
To guarantee program staff will keep track of all supplies used by peer
deliverers and to guarantee peers’ safe disposal of personal syringes.
Procedures:
As stated in the previous section, syringes will be collected and distributed at weekly peer
meetings or at XXXXXXXXXX SEP site during normal operating hours. Inventory will
be tracked on peer-specific forms, and reconciled by SEP staff with existing peer-specific
supplies inventory logs.
On-site, peers will follow all safety and security procedures outlined in the
XXXXXXXXXX SEP operations manual. While they are off-site, peers will keep
syringes in designated outreach bags, and will keep used syringes properly secured in
marked biohazard containers. Each bag will include tongs, a one-quart biohazard
container, puncture-resistant gloves, Peer-delivered Transaction logs, Peer-Delivery
Enrollment forms a clipboard, safer sex safer injection and safer crack-smoking kits.
Peers will follow universal precautions when conducting exchanges with their
participants: that is, they will have participants count and safely dispose of their used
syringes in the biohazard containers.
Lost or stolen syringes should be immediately reported to SEP staff, who will inform
SEP Coordinator. Peers who report lost syringes will be asked to sign brief written
incident reports to explain the circumstances of loss. SEP Outreach Specialist and SEP
Supervisor will monitor losses, and will be responsible for discontinuing the participation
of any peer deemed to be responsible for unreasonable or easily preventable losses or
thefts.
Street Safety:
Policy:
outreach.
To guarantee peers’ safety at all times while conducting street-based
Procedures:
In addition to receiving ongoing training and support around street safety, peers will be
trained on when to call 911, and provided with phone numbers for SEP Staff, SEP
Coordinator. Peers will be encouraged to work in teams, to inform SEP program staff or
fellow peer workers where and when they are conducting outreach, to use good judgment
when assessing crisis situations for the possibility of violence, to keep jewelry and other
valuables hidden or at home, and to use caution and restraint in any contact with the
police. They will be fully trained in providing information to police officers about
XXXXXXXXXX, syringe exchange, and their roles as peer educators, and instructed to
use XXXXXXXXXX staff phone numbers and AI verification phone numbers if
necessary.
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Evaluation:
Policy:
XXXXXXXXXX will strive to assess and evaluate its peer delivery
methods through the collection and analysis of peer recruitment, peer training, on and off
site job training, needs assessments, and actual peer delivered SEP services. SEP’s
Coordinator will perform these duties.
Procedures:
1. Evaluate the process of:
a. amount of trainings provided;
b. trainings’ peer attendance and number of transactions per peer (Individual
Level evaluation);
c. amount of sites (networks) visited and/or “discovered” by peers.
2. Draw an outcome evaluation of these three aspects one year after the date the peer
delivery model expansion started.
3. As contractually stipulated, XXXXXXXXXX will submit all collected data to the
AIDS Institute for reporting purposes on a monthly and quarterly basis using the
AIRS database.
4. XXXXXXXXXX SEP will cooperate with the AIDS Institute in all program
evaluation requirements.
Expansion:
Policy:
To further develop the Peer Delivery initiative in an aim to improve the
team efficacy in engaging injection drug users that are not enrolled in Syringe Exchange
Programs.
Procedures:
XXXXXXXXXX will keep AIDS Institute informed of new peers who are hired, by
providing their names in monthly narrative reports.
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