Institutional Logics in Syringe Service Programs

Background:

Syringe service programs (SSPs) are harm reduction programs that provide unused needles, resource referrals, and basic needs services to the drug-using population. While early iterations of SSPs were peer-led and relied on mutual aid, SSPs began to professionalize as their proven effectiveness in reducing bloodborne infections resulted in increased external state funding.

Using the theory of institutional logics, I describe how SSPs adopt different behaviors depending on their governing logic. Institutional logics provide the organizing context of a field and shape behaviors of actors (individuals, organizations or groups of organizations). Scholars have described seven ideal types of institutional logics: profession, religion, family, market, corporation, state and community, each of which is tied to different societal institutions with varied guidelines, norms, symbols and practices. Specific to this project, I look at how SSPs manage competing institutional logics in the field. SSPs were originally conceptualized using community logics, emphasizing the role of mutual aid, volunteerism, and reciprocity. However, the increased interest from government and corporate funders provides some tension in the field between competing state and professional logics, which focus on bureaucratic methods and professional expertise, respectively.

Methods:

This paper uses data from 26 qualitative interviews (77 percent of the SSP population) from SSP employees in a Midwestern state. SSPs are run by community-based nonprofits, grassroots volunteer-run organizations, and state-run health departments: all have recently received an increase in state funding resulting from a change in executive leadership and an increased acceptance of harm reduction across the state. Interviews were conducted in April-September 2020. Qualitative interview questions focused on the operations and collaborations of the SSPs. Data was professionally transcribed and analyzed using NVIVO software. Constructed grounded theory was used as the primary analytical framework in data analysis.

Results:

Half of the respondents came from community-based and volunteer-run SSPs, while the other half worked at public health-run SSPs. All SSPs benefited from the increase in state funding for their work. For community and volunteer SSPs, respondents expressed frustrations around restrictions that often accompany government funding. Specifically, they resented some new bureaucratic requirements of data reporting (state logics) that they believed reduced their ability to continue their mutual aid and community work. Others expressed concern that the expertise of peers inherent to the implementation of SSPs was being replaced by medical professionals (professional logics). However, unlike community and volunteer SSPs, their focus on bureaucratic and professional protocol exacerbates tensions with their clients. As such, public health SSPs have had more difficulty in attracting clients to their program.

Conclusion:

SSPs working in the same field have expressed concerns on having to adopt opposing logics in their work. While the use of hybrid logics within a field is possible, organizations appear to work in logic silos, which may result in tensions that inhibit organization collaboration. This has implications for how stigmatized clients experience services from SSPs. The understanding of these logics also reflects upon the profession of social work, which itself experiences tensions between the professional, state and community logics present in the field.