5. All we can do - Emergency Shelter' staff positioning regarding alcohol related problems in thecontext of a new harm reduction intervention

People in homeless situation admitted in Emergency Shelters prove to be highly challenging for staff, as for the risk of withdrawal syndromes, for the intoxication behavioural changes, and for the subsequent need of medical treatment. During the COVID19 pandemic, this population was particularly at risk of life-threatening withdrawal syndrome for constraints in access to usual alcoholic beverages. The implementation of an adapted harm-reduction (HR) pharmacological intervention introduced new dynamics on the newly created teams, and allowed for a different approach to this group. How did the staff react? What new opportunities arrived? What were the constrains in its implementation?

In this part of the PLACE retrospective, mixed methods, observational study, a qualitative analysis adapted from the Consolidated Framework for Implementation Research Constructs (CFIRC) is applied to a focus group with 11 emergency shelter workers.

The introduction of this approach in the context of the beginning of the SARS-Cov2 pandemic was abrupt and without clear understanding of its implications. Globally it allowed for an easier management of risky residents, a bridge toward treatment programs but also for a turning versus HR approaches in AUD in these settings. Testimonies concerning the 5 domains from CFIRC are presented (Intervention Characteristics, Outer Setting, Inner Setting, Characteristics of Individuals and Process).

These results illustrate the importance of understanding and evaluating the development of a local implementation of a new AUD approach. In particular, further HR initiatives must take into account fully preparation of staff and their natural heterogeneous opinions.