Barriers to the Implementation of Harm Reduction Practices in Rural Domestic Violence Shelters

Background and Purpose: While the use of substances is a common method of coping for people experiencing domestic violence (DV), the question of how to best support those impacted by DV and using substances is currently a strongly debated topic. Harm reduction was defined in the study as removing the barrier of sobriety to accessing shelter services, where stopping the use is not necessarily the goal. As DV shelters consider implementing low-barrier policies, including harm reduction, some find it difficult to balance the rights of clients who use substances, clients who do not use substances, and the rights of staff to a safe work environment. The objective of this mixed methods study, which addresses a gap in the literature, is to identify the barriers to implementing harm reduction from the perspective of frontline rural DV shelter staff.

Methods: Frontline social services staff (N = 13) at a rural DV shelter completed an anonymous Qualtrics survey, developed based on the literature, rating 11 potential barriers to safely practicing harm reduction within their workplace. Staff (N = 5) were also invited to participate in individual interviews to share their perspectives in greater detail. Interview transcripts were interpreted through thematic analysis. A priori codes were developed based on the literature/survey. Two researchers independently coded the data for a priori and emerging codes, identifying thematic patterns across responses.

Results: All respondents indicated that there are barriers to implementing harm reduction and that there are issues with the way harm reduction has been implemented. Significant barriers identified include the safety of other clients (20%), the safety of children within the shelter (15.4%), single staffing (13.8%), staff perceptions of personal safety (13.8%), and lack of support services in the area (9.2%). Several themes were noted from the qualitative data, including lack of services or resources needed to implement harm reduction, concerns of safety for staff and clients, ineffective safety policies, and tensions between the role of the organization in contrast to harm reduction policies. Several emerging subthemes were noted, such as clients who do not use substances choosing to return to their abuser rather than residing in a shelter that practices harm reduction. Interviewees shared a few ideas, such as developing regional infrastructure before implementing harm reduction policies, for how to solve the problem of providing support to clients seeking safety, regardless of substance use.

Conclusions and Implications: This is among the first studies that have provided empirical evidence of the barriers to implementing harm reduction in rural DV shelters from the perspective of frontline staff. The findings of this study highlight the importance of staff consultation when creating policies that affect the operation of their workplace. In the future, it may be beneficial to study the impact of harm reduction practices on clients who do not use substances. Future studies should explore the perspectives of staff from a variety of rural shelter environments.