Multisectoral Organizational Collaboration: The Case of Syringe Service Programs in a Midwestern State

Background:

Multisectoral collaboration involves the coming together of varied actors from different organizational sectors (government, nonprofit, corporate, academic, mutual aid) to solve problems that may affect a particular community (Hardy et al., 2006). Multisectoral collaboration is one approach proposed to address “wicked problems,” inscrutable problems with 1) no clear solution, 2) that logical problem-solving cannot solve, and 3) which requires tackling from multiple sectors (Jacquet et al., 2020). Increasing overdose rates stemming from illicit substance use is an example of a wicked problem (McRea, 2019), one which has seen an increase in the United States since 2020 (CDC, 2022). Syringe service programs (SSPs) have been proposed as an effective solution to stem the overdose crisis and have been receiving increased resources. As SSPs are delivered through different sectors, there have been efforts to understand how these organizations perceive and engage in multisectoral collaboration. To explore perceptions of multisectoral collaborations, I ask: What are the benefits and challenges to executing multi-sectoral collaborations, particularly among organizations addressing “wicked” problems?

Data:

This project involves 26 semi-structured, qualitative interviews with SSP employees at 22 SSPs in a Midwestern state in 2020. The SSP sample includes thirteen SSPs run by public health departments, and nine community-based SSPs. Interview questions focused on the inception of the SSPs, service practices, definitions of harm reduction, and how the SSP engaged in collaborative activities with other organizations. Transcribed interviews were analyzed using NVIVO software. An interpretive framework with thematic analysis was used to analyze the data, and member checking was used to confer rigor.

Findings:

There is a state-wide multi-sectoral collaboration to address the overdose crisis, which includes the state Department of Health and Human Services, academic partners, mutual aid organizations, public health departments, nonprofit organizations, drug users’ unions, and law enforcement. These actors meet monthly via Zoom to discuss issues they incur as they work to address overdose via harm reduction modalities. Among the most significant sticking points was the lack of a cohesive definition of goals around harm reduction. While respondents share a similar definition of harm reduction—that of reduction of harm from drug use—they differ on how these services are implemented in practice. Employees at 11 of 13 public health department SSPs describe their harm reduction efforts exclusively in terms of risk reduction of the harms of drug use and indicate a preference for referring participants to abstinence-oriented services.

In contrast, employees at community-based organizations described harm reduction in bodily autonomy terms, including self-determination in the right to use drugs. These conflicting perspectives were expressed during the monthly meetings, often without agreement on a solution. These tensions left some members feeling disenchanted, distancing themselves from the collaboration.

Implications:

While many respondents spoke positively of the collaborative partnership, some evident tensions emerged, leaving some collaborative partners disillusioned with its effectiveness. As such, suppose this multisectoral collaboration cannot address inter-organizational conflicts. In that case, this will have implications for addressing the overdose crisis, even with the increased resources provided to solve the problem.