WITHDRAWN Turning Individual Growth into Organizational Change: An Analysis of Harm Reduction Learning Collaborative Implementation Methods Resulting in Organizational Change

Background and Significance

Harm reduction (HR) is an evidence-based, person-centered, non-coercive approach to social services that aims to reduce negative consequences associated with drug use at interpersonal, organizational and community/systems levels. HR approaches reduce transmission of drug use-related infectious disease, such as HIV and Hepatitis, and increase engagement in health and social services among people who use drugs. By foregrounding the role of structural oppression in vulnerability to drug use-related harm, HR is central to an anti-oppressive approach of supporting people who use drugs. Successful implementation of HR in organizational contexts requires comprehensive training and capacity building interventions that translate into sustainable organizational change. The current study builds on the authors’ previous work developing and implementing an intensive six-month learning collaborative with leaders of HIV service organizations (LEARN HR) in which participants receive HR training, funding and implementation coaching support for HR organizational change projects. Previous research found statistically significant increases in participant HR knowledge and skills. The current study uses qualitative evaluation data to: 1) examine how participation in LEARN HR facilitated organizational-level culture and structural changes related to HR, and 2) examine participant-identified LEARN HR intervention strategies that were central to translating individual-level knowledge into organizational-level change.

Methods

Researchers conducted eight in-depth qualitative interviews with 14 intervention participants. Interviews lasted between 45 to 75 minutes. 68% of participants were African American/Black, 32% were cisgender women, and 16% were transgender or genderqueer. The semi-structured interview protocol addressed participant experiences in LEARN HR, the impact of participation on individual knowledge, skills and organizational change, and feedback for intervention facilitators. Data were analyzed by multiple coders using thematic analysis.

Results

Participation in LEARN HR resulted in several concrete changes to organizational structures, such as mission statement changes, changes in organizational leadership, new HR services, and revised policies and procedures. Data also revealed shifts in organizational culture such as increased use of person-centered language, decreased use of stigmatizing language, and shifts in power dynamics that better support staff with lived experience of drug use. LEARN HR intervention strategies that facilitated transfer of HR knowledge and organizational change included diversity of participating organizations, which expanded participants’ conceptualization of organizational change, project-based learning with implementation coaching, and the facilitators’ ability to model a HR approach when engaging with LEARN HR participants.

Conclusions

This study suggests that learning collaboratives can be structured to translate gains in individual knowledge and skills into sustainable organizational change. This is essential for the implementation of service approaches, such as HR, which touch every aspect of an organizational context. The research team is currently using the findings of this study to further refine the intervention in preparation for regional scale-up in pursuit of more effective, equitable and accessible HIV service organizations.