OUTREACH STRATEGIES TRAINING The basic underlining principle of outreach is: to start where the client is - outside on the streets and in the community!
Basic Definitions OUTREACH is: An intervention/activity generally conducted by outreach workers, peer educators, and or health educators, out on the streets, face-to-face, with individuals at risk for sexually transmitted diseases, chemical dependency and or homelessness. Outreach activities attempt to provide prevention information, education, risk reduction counseling, referrals, and treatment options to the greater population(s) on the streets. The concept of outreach demonstrates an agency’s willingness to go to the community rather than wait for the community to come to the agency.
EFFECTIVE OUTREACH Is done by trained peer educators who: self-identify with members of the target population before entering the community to educate on prevention and the availability of social services. Peer educators provide life saving messages, and the dissemination of educational/harm reduction materials such as: pamphlets, safer sex cards, condoms, bleach kits, and sexual responsibility kits - free of charge - to targeted at high risk groups.
OUTREACH Efforts result in developing a liaison between the agency and the community. Outreach also fosters networking and collaboration between existing services and organizations. Most importantly, when conducted consistently, outreach can stimulate behavioral change and the implementation of risk/harm reduction modalities among the targeted groups.
THE TARGET POPULATION Is the population for whom the intervention was developed. Target population is described in terms of demographics, social, and behavioral characteristics. For example: gender, sexual orientation, age, race, ethnicity, geographic location, and behavioral status. An effective outreach program recognizes the extreme diversity of the target populations and the difference in economic and political circumstances of these groups.
COMMUNITY NEEDS ASSESSMENT A COMMUNITY NEEDS ASSESSMENT is a critical first step to any prevention and education program, including outreach. In order to provide outreach services it is important to understand how sexually transmitted diseases, substance abuse, homelessness and legal concerns (e.g., sex workers, narcotics, etc) affect your target population. It is also important to assess the current existing services available to the target community.
The following information would provide insight into the needs of the target community: demographic data, HIV seroprevalence data risk assessment data for other STDs and drug use homelessness statistics prevailing attitudes and policies of the legal authorities This assessment process will help incorporate and create new outreach programs and eliminate the duplication of services/programs. A needs assessment is an essential tool that can also be utilized for strategic planning, execution of services, program evaluation, and the overall program monitoring process.
In outreach, the data and surveillance reports gathered from the health departments and clinics can be a useful tool to orientate outreach workers on local populations and statistics, since the data is divided by exposure groups, sex, race, ethnicity, age, and sometimes area of residence.
COMMUNITY NEEDS ASSESSMENT Consists of outreach workers canvassing the local scene. During the assessment, outreach workers introduce themselves, the program, and the agency. Community assessments are part of an integral, ongoing process which contributes to the overall success rate of an outreach program. Outreach Workers disseminate educational/harm reduction materials, referral cards, and explain the mission/purpose of their efforts.
Outreach workers must utilize their listening skills in order to learn the community’s needs. Mapping out trends and learning the key players (“gatekeepers”) of the neighborhoods will help overall outreach efforts. Building trust within the community commences at the community assessment stage.
BUILDING RAPPORT/TRUST WITH THE COMMUNITY Building rapport/trust within the community is a critical prerequisite to conducting street/community outreach. Building rapport is helpful and contributes to the overall safety of the outreach worker while on the streets. This is a time consuming task and an on-going process. The following basic strategies should be applied in order to build trust and deliver services out on the streets: remain consistent, sensible, visible, sincere, respectful, genuine, nonjudgmental.
It is also important that the outreach workers “dress down” in order to blend in with the community. All these factors will help the process of building rapport/trust if applied appropriately. Active participation and presence of an outreach worker at the following local activities/events can also contribute to the process of building rapport/trust: block parties, street/health fairs, holiday festivities, community board meetings, public hearings Remember, an effective outreach program will advocate for its target population/community.
OUTREACH IN PAIRS Outreach in pairs offers stability to the program and can be a key strategy to conducting effective outreach. Ideally a community outreach pair should consist of a male and a female, and be reflective of the racial, ethnic, and linguistic make up of the target community. Partners can help each other in many ways. Some of the advantages of working in pairs are: safety, mutual support, encouragement, presentation of different view points, ideas, messages, and outreach techniques.
TEAM & TABLE OUTREACH The concept behind this strategy is to produce visibility as well as to facilitate team building. During this outreach activity, a coordinator and the outreach workers set up a table on a corner in the heart of a high-risk targeted neighborhood. A Banner and/or poster displaying the agency’s name, address, and telephone number is also set up. Educational/harm reduction materials (condoms, dental dams, female condoms, bleach kits, literature, referral cards, etc.) and promotional materials (key chains, pens, note pads, pins, etc.) are neatly placed on the table.
A couple of outreach workers remain behind the table to answer questions, provide information, make referrals, arrange appointments, and demonstrate the correct way to use a condom and/or bleach kits. The other outreach workers walk around the neighborhood saturating it with information about HIV/STDs, location and telephone numbers of clinics, treatment/rehab programs, shelters, other social services and distributing educational/harm reduction materials. This strategy helps to raise community awareness and to increase skills in risk reduction.
All materials should be informational and educational, culturally sensitive and nonjudgmental. The approach is always one of harm reduction and is never threatening or coercive both of which are antithetical and counterproductive to the philosophy and strategy of street outreach. Police should be notified beforehand of the time and place of the team/table outreach activity; not only for safety reasons, but also, to keep them away in order to be effective within the community.
BUILD RELATIONSHIP WITH LOCAL POLICE PRECINCTS The program director or coordinator should build and establish a working relationship with the Community Affairs Officer and the local precincts in those communities where outreach activities are being conducted. This relationship should be on-going and informative. It is recommended that the program director or coordinator visit each roll call on a regular basis to introduce the agency, the outreach program, the program’s mission and the employees. The presentation should point out the benefits/advantages of conducting outreach in their community and with the target populations.
These presentations help outreach workers to avoid harassment by the police officers when working in a high risk or high drug trafficking area. Outreach workers should not make the presentations to the police precincts for the simple reason that if a client witnesses the outreach worker entering and/or exiting the local police precinct it will stir up suspicion and may ruin the outreach worker’s credibility/rapport within the community. An outreach worker/program must respect the client’s rights and not breach confidentiality.
Outreach efforts provide risk reduction messages and services outside of the traditional health/social care settings to at high risk individuals, groups, and communities. The level of interventions of an outreach worker/program can range from one-on-one client services to services to groups of various sizes, to interventions directed at changing community wide norms. The ability to effectively conduct outreach is one of skills, talents, and commitment. Outreach workers should be respected and recognized as health care professionals.
Outreach interventions have had direct impact on behavioral and social level theories in a variety of risk reduction and prevention activities. Via outreach we have learned and can continue to learn the reasons why people behave as they do. Outreach workers have assisted in developing/identifying interventions that can influence health and social risk behaviors due to their ability to identify with the target population as well as to document results. Training, staff development, and capacity building are recommended to outreach workers/programs on an on-going basis in order to remain effective when providing prevention and education services.
Dos & DO NOTs The street outreach tactics (DOs & DO NOTs) presented in the following pages are general techniques that should or should not be applied when conducting street/community outreach.
DOs Do conduct needs assessments and evaluate areas where your target populations hangs out and there is intense activity. Do be flexible in scheduling. Do accommodate target populations. Do establish contacts with police precincts in all areas where you conduct outreach. Do carry identification at all times. Do let someone know where you are at all times.
Do work with a partner and be aware of your surroundings. Do be aware of how you are feeling and how your partner is feeling as well. Do have contingency plans for emergencies and dangerous situations. Do accept offers of help from community residents. Do find a hook or a way to engage people in conversations on the streets. Do learn to recognize some of the characteristics and behaviors of the target populations.
Do know “avoid & approach” techniques. Do know when it is appropriate to engage with a client and when not. Do avoid entering shooting galleries and other areas where people are getting off. Do behave respectfully to addicts, dealers, pimps, sex workers and all other clients in order to win personal trust and confidence. Do know the sex workers stroll areas and their hours of operation.
Do have good listening skills; hear people out. Do dispel myths and misconceptions about AIDS, drug abuse and other social ills. Do distribute literature that is culturally appropriate. Do suggest that clients pass along their literature, extra condoms, and bleach kits to their friends, families and loved ones. Do distribute literature that is culturally appropriate. Do describe treatment options and make them available to clients in the streets.
Do be ready to direct clients to social services. Do assure clients that you will maintain confidentiality. Do provide follow-up and deliver promises. Do tell clients when you will be back and where you can be reached. Give them a hotline or work phone number.
DO NOTs Do not wear expensive clothes jewelry or uncomfortable shoes. Do not carry valuables or large amounts of money, or take your wallet out. Do not use a beeper in a visible way. It makes clients nervous and the police may think you are a runner. You must keep it hidden and in the vibrate/silent mode. Do not carry weapons. Do not carry, hold, handle, or sample any kind of controlled substance or other merchandise such as works and/or other drug paraphernalia.
Do not pretend to be an active addict, sex worker, etc. in order to ingratiate yourself or gain information. Be honest about your role. Do not pass any information you may have about where drugs are being sold. Do not get high, have sex, or engage in criminal activities with clients. Do not buy stolen goods. Do not give or lend money to clients.
Do not act pretentious, be honest, be yourself. Do not come on too strong, pressuring clients to change behavior and/or accept materials. Do not counsel on the streets or act as a social worker, nurse, etc. Use your referral network to direct clients to services. Do not play doctor or clinician and try to diagnose infections, or any ailment or mental health issue.
Do not expect all clients to achieve immediate results and implement behavior change. Concentrate on helping them reduce risk and acknowledge whatever changes and/or progress they have accomplished/demonstrated. Do not make promises on the streets that you can not deliver.
SAFETY ON THE STREETS The safety and well being of the outreach workers, in general, cannot be guaranteed while out on the streets. The reason for this is that outreach is mostly always conducted in high risk areas such as: high drug trafficking areas, gang war areas, and high crime areas. This might pose a danger to anyone’s well- being and safety. Also, the behavior of substance abusers, mentally ill, chemically dependent and homeless clients, needs to be addressed tactfully.
This is not to insinuate that all areas and target populations are dangerous. However, it is intended to raise awareness with reference to the reality that outreach workers are always at risk due to the unforeseen. Outreach workers must literally watch each other backs while on the street/communities.
Outreach programs can implement and adhere to field safety guidelines such as the following to ensure some degree of safety/well being: Carry picture identification at all times, including the agency’s name, name of project, outreach worker’s name and title. Work in pairs so that while one outreach worker is engaging in dialogue with a client, the other must literally “watch their backs” and surroundings. Remember to have the program director or coordinator establish a relationship with the local police precincts. Make contingency plans for worst case scenarios. These plans should be shared with partners and agreed on by teams.
Get a TB skin test and retest periodically. Be aware of weather conditions and be prepared for natural occurrences. Design and adhere to a schedule. Avoid drinking alcohol or buying, receiving, sampling, and doing any drugs while conducting outreach. Establish a mechanism to keep supervisor(s) aware and informed of your locations and activities at all times. Always call the office/supervisor at the end of shift. These recommendations are designed to be a working tool and are not engraved in stone; therefore, they may be amended as deemed necessary and appropriate for your outreach program.
COMMUNITY BARRIERS Stigmas, myths and misconceptions Drugs and behaviors Politics Lack of support Lack of trust Lack of funds Community barriers to effective outreach will always exist. However, outreach workers should take every opportunity to explain in clear, culturally appropriate terms the goals of their outreach efforts.
The view of distrust that exists in communities in which outreach efforts are performed, makes community relations an indispensable part of outreach work. Active listening will help you learn what your clients’ needs are and how to better serve them.
PERSONAL BARRIERS Negative attitudes, prejudices, homophobia, sexism, etc. Being judgmental toward clients/target populations Lack of respect for clients, agency, or outreach efforts Health conditions Relapse and/or substance abuse problems Personal barriers to effective outreach will also always exist.
It is the responsibility of the outreach worker to give his/her target population 100% while on the streets. Outreach workers must remain nonjudgmental and present information, treatment options and harm reduction materials regardless of personal feelings, beliefs, and experiences. Note. It is also the responsibility of the coordinator/supervisors to provide their staff with a safe space to discuss issues in relation to prevention case management, stress management and relapse prevention.
ADVANTAGES OF OUTREACH Raise awareness about prevention, treatment, care and social services for HIV/AIDS/STDs, chemical dependency, homelessness, etc. Create support for the target populations and communities. Provide resources and referrals of current services. Advocate for target population(s), available services, and increase funding. Educate community in general. Provide life saving information and messages.
Foster networking and collaboration. Gather findings/data for research. Build self-esteem among targeted population. Change attitudes to hopefully foster behavioral modification and/or implementation of harm reduction strategies. Overall, outreach efforts are important for effective prevention programming.
The information provided in this training guide is intended to strengthen the capacity of outreach workers. This is a reference tool and you are encouraged to apply, and amend information as deemed appropriate. Remember, while the basic outreach strategies may be universal there are also specific tactics, techniques, and strategies that need to be applied according to the target population, proposed interventions, and program’s objectives.