A Safety Net of Recovery and Stability

Brandywine Counseling’s Safety Net Services program, now in its third year, is making a difference for Delawareans with high HIV risk and severe substance abuse and mental health issues. Safety Net is an umbrella program offering treatment and pre-treatment to people at various stages of readiness for help, who would otherwise be “lost in the cracks” of social services. The focus is specifically on reaching women and ex-offenders, two of Delaware's highest-risk populations.

In the past year, Safety Net has assisted with over 2500 outreach contacts and 248 HIV tests. Many of our referrals come from the BCI Outreach team, who upon identifying a contact from the target population, will introduce them to the Safety Net Intervention Specialist. The Intervention Specialist will then offer services, see the client through the admission process, and remain in contact throughout their treatment experience. Many referrals also come from the Emergency Room at the Wilmington Hospital, made possible by the unique partnership of BCI with Christiana Care. Both sources have proven to be very successful “front doors” to treatment admission. In the past year, we’ve seamlessly transitioned 74 clients to addiction and mental health treatment, with a total of 148 active clients in the Safety Net program.

Six months after admission, we measure several indicators of recovery and stability. Safety Net participants show good progress on all measures. 56% report no drug use, 80% report no alcohol use, and 52% report no alcohol or drug use. Many reporting HIV risk at admission report reduced risk, with 66% who reported high-risk sexual activity reducing or eliminating risk, and 66% of injection drug users ceasing use. Three-quarters of the clients not housed at admission are now housed. Of the clients reporting no income at admission, 39% now have income. Clients also improved their support system and social connectedness. Half of those without a support network at admission have developed one. 95% of clients have no new arrests. 90% of the clients on mental health medications are compliant with their medications.

Overall, Safety Net Services has enabled many Delawareans with severe addiction and mental health issues to achieve recovery and stability. Our approach is holistic, simultaneously addressing multiple critical issues. The result is a newly created network of services that effectively assists clients into substance abuse treatment and provides a safety net before, during, and after treatment engagement.

Safety Net Services is funded through a grant from the U.S. Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Treatment.

3 Years of Needle Exchange in Delaware: Saving Lives and Saving Dollars

The pilot Delaware Needle Exchange Program has had three very successful years. Over 700 people are enrolled, and over 38,654 needles have been exchanged. These potentially infectious syringes have been incinerated and destroyed. Not only have new infections been prevented, but participants have been successfully connected to substance abuse and HIV treatment services. Here are some more highlights, which we are also sharing with legislators today at the Joint Finance Committee budget hearings.

• 150 people have been referred to drug treatment, with an incredible follow up/success rate of 60%. Referrals have been made to methadone treatment, outpatient and inpatient drug treatment, and detoxification.


• Over 1200 people have been tested for HIV on the van. More than half were not needle exchange participants, but took advantage of the service being brought to their neighborhood. Testing has identified new HIV positive infections, as well as positives who know their status but are not in treatment. We are linking them to medical care and case management, which further reduces their risk of transmitting the virus.


• We have begun Pregnancy Screening on our van. Our goal is to reduce the infant mortality rate in Delaware by connecting drug abusing pregnant women to treatment immediately. This will ultimately save both the mother and the baby’s life. Delaware has an extremely successful record of preventing HIV infection among infants born to HIV infected mothers, with only one HIV-positive birth in the last 4 years. Expectant mothers with HIV in Delaware have access to comprehensive, high-quality care; yet, it remains imperative that we encourage them to be tested for HIV and to seek drug treatment.


• The needle exchange has made a difference for so many individuals in the past three years. Here is just one of those stories:
  
  "Cecilia" is a 24 year old Hispanic female who joined the needle exchange a little more than a year ago. She was an active drug user but was not ready for treatment. One day, after she had been with us about 6 months, Cecilia came on the van, tired and crying. She had finally had enough of the drug using lifestyle. We made her an appointment at the methadone clinic. She was having trouble signing up for Medicaid to handle her payments, so we helped her with that, and she was successfully admitted. At time of admission, she had a pregnancy test and found out she was 4 months pregnant. She stayed in treatment and gave birth to a healthy baby. Today Cecilia is still active in treatment and is also employed.


• Lastly, we would like to share with you the cost benefit of needle exchange. Delaware’s program receives $211,000 from the Division of Public Health each year. We know from a recent CDC study that preventing one new HIV infection saves $221,365 in treatment costs. So, the prevention of one new HIV infection pays for the Needle Exchange Program for one year. In three years, Delaware’s needle exchange has prevented an estimated 10-12 new infections by connecting nearly 20 people to HIV care. Therefore, we saved an estimated $2 million that would have been spent on treating those individuals - and that is a modest approximation that does not include the infections prevented when someone is admitted to substance abuse treatment.

The success of the needle exchange is thanks to the inclusive and considerate work of our program staff at Brandywine Counseling, along with incredible support from the City of Wilmington, neighborhood associations, the Faith Community, the Division of Public Health and the Wilmington Police. This is an excellent example of what can happen when a community mobilizes.

We must keep up the work we’re doing. This epidemic remains a challenge, but we are making progress. 3,489 people are living with HIV/AIDS in Delaware. The Black community accounts for 20.9% of the state’s population, but 66% of our HIV/AIDS cases. While the number of new infections each year has declined, in Delaware, 1 in every 83 Blacks has HIV/AIDS.

Delaware’s Needle Exchange remains dedicated to the following goals:

• We must encourage HIV testing for all those who are at risk.
• We must encourage all of those that are infected to seek treatment.
• We must encourage those not infected to take measures to ensure they remain uninfected. Until then, many will continue to pass the virus without knowing it.

James on Living With HIV/AIDS: “This Does Not Stop You.”

James was one of the first clients I met when I started at Brandywine 8 years ago. He was our first client in the NSAFE program back in 1997. In this video interview, he talks about living with HIV/AIDS and the help he’s received from NSAFE. It is a pleasure to see how well he is doing today and to bring you his story.

World AIDS Day Calendar of Events

Today is World AIDS Day. The following is a list of events taking place today in Delaware, courtesy of the Division of Public Health.

New Castle County

AIDS Delaware
Westminster Church,1502 W. 13th St, Wilmington, DE 19801
7:30 p.m.
Interfaith Service and Candlelight Vigil - a moment of remembrance with the calling of names of those who have died from HIV/AIDS.

Beautiful Gate Outreach Center
Bethel A.M.E. Church Annex, 604 N. Walnut Street, Wilmington, DE 19801
9 a.m. – 7 p.m.
Encouraging HIV testing, outreach, free food and giveaways available.

Resurrection Center
3301 N. Market Street, Wilmington, De 19802
7 p.m. – 9 p.m. Prayer and Healing Service for Families and Friends Affected by HIV/AIDS.

Latin American Community Center (LACC)
Los Jardines, 100 West 5th Street, Wilmington, DE 19805(event location)
6 p.m. – 8 p.m.
The Latin American Community Center HIV Prevention Program will host a movie night event where participants will view a film dealing with the impact and stigma surrounding HIV/AIDS within the Latino community and use this film as a topic for discussion with participants to raise awareness and promote the importance of HIV/AIDS prevention education.Refreshments will be provided.

Kent County

Kent/Sussex Counseling Services
John Wesley A. M. E. Church, 217 West Division Street, Dover DE 19904
6 p.m. – 7:30 p.m.
Candlelight ceremony and reading of names along with speakers from the community. Light refreshments.

Faith, Hope & Love Christian Fellowship
218 N. Rehoboth Blvd. Milford, DE 19963
6:30 p.m. – 8 p.m.
An Evening of Remembrance service, community awareness and information.

Sussex County

CAMP Rehoboth
Art Reception: 37 Baltimore Ave, Rehoboth Beach, DE 19971
4:30 – 6 p.m.Line-up for the walk 6:15 p.m.Starts at 7 p.m. Kick-off will be with an art exhibit featuring exhibits by HIV+ artist.

Candlelight Walk: Rehoboth Beach Bandstand, Rehoboth Beach
The Candlelight Walk of Hope and Remembrance will step-off at 6:30 p.m.

The Service of Remembrance: All Saints Parish, 18 Olive Street, Rehoboth Beach
After the Candlelight Walk, All Saints Episcopal will host a Remembrance service with the reading of the names of community members who have died of AIDS. A light supper in the All Saints parish house will conclude the evening.

Kent/ Sussex Counseling Services
Christ United Methodist Church, 510 S. Central Ave.Laurel, DE 19956
6– 7:30 p.m.
Candlelight ceremony and reading of names along with speakers from the community. Light refreshments.

Lared Health Center
The Georgetown Circle, Georgetown, DE 19947
12Noon- 5 p.m.
Free confidential HIV Counseling & Testing will be offered on the mobile test van.

5 – 7 p.m.
Program of remembrance & hope followed by a candlelight walk. Light refreshments.

Honors for BCI Staff

Two of our staff members are being recognized for excellent work.

Edna Maldonado of NSAFE will be honored for her diligence and commitment in the fight against HIV/AIDS at the 16th Annual Reach-Out Sunday, Nov. 22, 8 AM and 10:30 AM at Bethel AME Church, 604 N. Walnut St. Attendees are asked to bring a new clothing item for an adult male or female living with HIV/AIDS.

Chris Zebley of Christiana Care will receive the 2010 American Academy of Nurse Practitioners (AANP) Nurse Practitioner Award for Excellence. This prestigious award is given annually to a dedicated nurse practitioner in each state who demonstrates excellence in their area of practice. He will be recognized for this achievement during the 2010 AANP National Conference in Phoenix, Arizona.

Both Edna and Chris do an awesome job with a very challenging population, and deserve this credit. Congratulations!

Bill Gates Brings HIV Outreach to India

One of the counselors here directed me to a very interesting video on HIV prevention in India. Bill Gates’ foundation is partnering with the transgender Aravaani population to do some innovative and much-needed outreach work. We don’t often hear about HIV/AIDS in this part of the world or this population in particular. As you’ll see, they're using a prevention strategy that’s quite similar to the NIDA Community Outreach model BCI uses, in that a high risk population is being trained as peer educators, harmful behaviors are discussed candidly, and outreach workers are bringing services to where their clients are, like beauty salons. This looks like great work and hopefully it will have an impact.

Support BCI in the 2009 United Way Campaign

United Way of Delaware kicked off its 2009 campaign yesterday with a cheer by school students on South Market Street. The state's largest charitable campaign announced a goal of $20.5 million this year to benefit more than 100 member agencies including BCI.

Brandywine Counseling thanks you for supporting this year's campaign. There is no wrong way to give, whether your donation is large or small, whether you designate it to one agency or spread it around to many. We also know in this economy, it's not easy to be charitable, but it makes a difference for our clients.

What do United Way funds mean to member agencies? At BCI they support one full time position on our outreach team that goes out to do education, testing, and make referrals. We like to think of outreach as "opening windows of trust." Our clients are reluctant at first. It takes a friendly face, maybe a cup of coffee, bringing the services to them, and most of all, persevering and having patience. Because eventually, the light bulb will go on, and when someone is ready for help, we are ready to give it.

Like all member agencies, we measure outcomes. We report to United Way on the number of HIV tests we do, how many outreach contacts we make, and how many people reduce their risk. Results matter, and as a donor, you know your donation is going to a program that really works.
Your workplace probably runs a United Way campaign. If it doesn't, it’s easy to start! Contact United Way at (302) 573-3700 and they will set you up with everything you need. You can request guest speakers from member agencies for your campaign rally. There are many options to give, including payroll deduction or a one-time gift.

You can help not only through donating, but by spreading the word to others about BCI. The more we raise, the more we can help those in need. How can you spread the word? Here are some easy ways. Use email to send a post from our blog that will inspire people. Send friends to our Facebook page to see our photos, become Fans, and join the conversation. Or, just talk about us! When you're excited about BCI's work, other people will get excited, and they'll want to donate.

Thank you very much for your support this year. It saves lives, and it is really appreciated.

BCI Reaches Reluctant Clients by Creating "Windows of Trust"

BCI’s Safety Net Services is featured in this month’s CSAT Grantee Spotlight. We’re pleased to reprint it for you here. Pictured from left: Case Manager Sharon Brown, Nurse Joyce Bunkley, Nurse Practioner Chris Zebley, and NSAFE Manager Rhonda Swanson.

Basha Silverman is the Director of HIV Prevention Services at Brandywine Counseling in Wilmington, Delaware, and is the Project Coordinator of its Safety Net Services project. Sharon Brown is the Case Manager for the Safety Net Services project. We spoke with Basha and Sharon about this TCE/HIV grant and discussed their challenges, solutions, and lessons learned.

Grantee Profile
Brandywine Counseling provides behavioral health services to individuals with substance abuse problems and their families. It is Delaware’s largest provider of outpatient addiction treatment services.

Brandywine provides opioid treatment, drug-free treatment, mental health treatment, and case management. It includes pregnant and parenting women’s services, a drug court program, an infectious diseases clinic, and an HIV prevention unit.

Safety Net Services is a multicomponent project offering integrated addiction pretreatment, treatment, and HIV/AIDS services. It incorporates outreach, HIV education and testing, medication management, and co-occurring disorders treatment. This grant targets women and ex-offenders and creates a safety net for at-risk and HIV-positive substance abusers at various stages of readiness to enter addiction treatment.

What are your unique challenges?
Clients have unique patterns of willingness, readiness, and commitment to treatment. They become interested, engaged, and disinterested, and leave, return, and cycle back and forth.

When engaged, clients visit us often, bring their babies, visit our clothes closet, and use our dropin services. We view these as special windows of opportunity to make use of clients’ motivation to change. But these windows can close quickly, challenging our ability to remain engaged.

Co-occurring mental health issues are notable challenges. When clients don’t have rapid access to mental health medications or professionals, their windows of opportunity can rapidly close and their treatment needs may be left unmet.

How do you address these challenges?
Since client willingness and readiness are dynamic processes, we make engagement methods flexible and dynamic. We meet clients where they are, not where we want them to be.

When clients stop coming to us, we reach out to them. But they shy away if outreach is coercive or pushy. Thus, we use gentle motivational interviewing techniques during outreach. We meet clients at times convenient to them. They are often on the street in the early mornings.

Our Case Manager will conduct outreach between 4:00 a.m. and 7:00 a.m. At such times, clients are often tired and willing to talk and join the Case Manager for coffee and donuts and discuss treatment. Many clients are willing to enter treatment on the spot. Since our program accepts intakes at 5:30 a.m., the Case Manager can take advantage of windows of opportunity and help admit clients immediately.

To enhance outreach effectiveness, our Case Manager has multiple roles. All of our clients are assigned a counselor and a Case Manager. Our Case Manager is an active part of the counseling team and conducts follow-up locating and outreach. Thus, clients already have a relationship with her. She is a friendly face.

We promote treatment-on-demand to address mental health challenges. CSAT funding helped us expand the roles and hours for our nurse and nurse practitioners. They previously worked only with HIV clients but now work with HIV clients and those with co-occurring disorders. We were also able to increase physician and psychiatrist time. These changes increased access to psychiatric evaluations and medication management. Having our Case Manager coordinate appointments further increased access and reduced waiting lists.

What lessons would you like to share?
Program and client goals can be at odds. A program may seek to achieve 80 percent abstinence, which is commendable. But clients may have such goals as getting a home or a job, leaving an abusing spouse, or reuniting with their children. They may want to be better spouses or parents.

We can improve the lives of our clients best if we use goals and milestones that are client-centered, realistic to each client, and take into consideration the resources in the community and clients’ lives.

We implemented several process improvements that resulted in reduced waiting time and increased admissions. To do so, we had someone anonymously walk through the admission process and experience it from a client’s perspective. This revealed delays to make appointments, complete the intake and assessment paperwork, enter treatment, and receive lab tests.

We convened a committee to analyze the processes. We took steps to reduce appointment times, shortened the admission process by eliminating duplicate admission and assessment paperwork, and reduced lab delays from weeks to hours by using same-day lab tests.

How has GPRA data collection helped you?
Asking the GPRA tool questions fosters thoughtful and probing discussions with clients. It helps to create relationships with clients and opens up windows of trust and intimacy. Asking the GPRA questions helps us to better understand clients’ lives, experiences, treatment needs, and resources.

This article is reprinted with permission from CSAT Discretionary Grantee News, July 2009.

BCI Tests 56 for National HIV Testing Day

Saturday June 27 was National HIV Testing Day. The BCI outreach team took part in Each One Teach One’s 6th Annual Health Hookup Community Festival, held at Wm. Hicks Anderson Community Center.

The event offered screenings for a range of important health issues, and we were responsible for the HIV testing. Guests were encouraged to visit all the exhibit tables and receive a sticker, which they could then exchange for lunch, including burgers, hot dogs, and chips.

We tested 56 people at this event. A lot of young people came out that day, which was a good thing. Unfortunately, we found no new positives, but everyone learned their status and ways to stay negative.

Delaware's Division of Public Health (DPH) and BCI want you to know that free, rapid HIV testing continues to be available at sites throughout the state all year long. Get tested at any Needle Exchange site or call 655-9880, ext. 21 for an appointment.

9 1/2 Minutes HIV Awareness Campaign

Every 9 1/2 minutes (on average), someone in the United States is infected with HIV, the virus that causes AIDS. CDC has launched a new Nine and a Half Minutes campaign to raise awareness of this fact and promote prevention.

Where did 9 1/2 minutes estimate come from?

In 2008, CDC developed new estimates for the annual number of HIV infections—which suggest that about 56,300 new HIV infections occur each year. This estimate is a national average. CDC arrived at the 9½ minutes figure by dividing the number of minutes in one year by the 56,300 new HIV infections that were estimated for 2006. This result indicates that, on average, one new HIV infection occurs every 9.34 minutes in a year. For more information on the 56,300 estimate visit the HIV Incidence section of the CDC HIV Web site.

CDC offers information on how you can prevent HIV, avoid the onset of AIDS if you have HIV, and spread the word about the 9 ½ minutes campaign.

They also provide this useful testing widget you can place on your Web site to find a testing site near you. Get yours here.

Delaware Needle Exchange Enrollment Reaches 500

As of today, we have 507 unduplicated clients enrolled in the City of Wilmington's Needle Exchange Pilot Program, who have exchanged more than 17,450 needles in two years and some change. This means that we have incinerated over 17,450 potentially infectious syringes and removed them from our streets. Since it is a one-for-one exchange, there is virtually no needle litter problem anymore.

231 participants self-reported that they were referred by another needle exchange client. This proves that word-of-mouth advertising is what works with this population.

Caucasian clients make up 71% of the caseload; however, we are working on increasing the participation of African Americans.

1087 Rapid HIV tests have been completed on the van. 182 HIV tests were NEP clients. The other 905 were community members who accessed HIV testing because we brought the service to them. As a result of our success with reaching the community residents where we target injection drug users, we are planning to begin offering the combination Hepatitis A and B vaccine on the NEP in the coming weeks.

Other noteworthy numbers:

• 11 HIV Positives have been identified on the van.
• 40 formal referrals to treatment.
• 25 confirmed linkages to drug treatment.

5 Questions for Cheryl Ervin-Edwards, Counselor/Case Manager

5 Questions is our ongoing feature where we introduce you to the people who make Brandywine Counseling run, spotlighting a different staff member every two weeks.

Name: Cheryl Ervin-Edwards
Job: Counselor/Case Manager, NSAFE
Time with BCI: 2 years


1. What brought you to the addictions field and to your present job at BCI?
I am a recovering addict myself. With God’s will, September 17, I’ll have 15 years of sobriety. I started working in the field in 2002 up in Chester, Pennsylvania. It was inpatient, so this is my very first time working in an outpatient facility. Working in that inpatient facility helped me to realize this is where I need to be. This is my niche in life.

When I first got hired at Brandywine Counseling and started working in the Drug Diversion program, I was the court liaison. I was a drug and alcohol counselor, and my job entailed going to court on a weekly basis to present reports to the judge as to what the client’s progress was in the program.

Then in February of 2009, I moved over to the NSAFE program and I am now a case manager here. In that position I do outside community referrals for clients that need special services, such as dental, eye care, food closet, and things of that nature. A typical day is receiving phone calls from clients, assisting clients with getting food from the NSAFE food closet, or assisting my supervisor or my co-workers with some things, because I am new in this position, so I’m just acclimating my way into the NSAFE program right now.

2. How is the economy affecting your clients right now?
Working in this capacity here, there are people that need assistance with their utilities, with food. Because if they do manage to pay their utilities based on the income that they’re receiving within that household unit, they don’t have enough to provide food for their families. Or for themselves, because it could be just single people. And they don’t have enough money to buy food and clothing for themselves. With this tough economy here, whoo! It’s rough. We keep our food closet at NSAFE pretty well stocked, and if we don’t have everything here that they can utilize as far as nutritional items, we refer them to outside community agencies so that they can receive food.

3. What is your biggest challenge in doing your job?
Being limited with resources. That’s the biggest challenge, because if we don’t have the resources, say for instance, if we run out of food, if we call out to an outside agency, a lot of times the agencies do not have funding where they can supply food for our clients. So that’s the biggest challenge here, having to make the phone calls, and being discouraged because you may make several phone calls to different agencies, and you get the same reply. “We don’t have any funding.” But when that happens, they can always give us somewhere else to call, and we eventually find somebody who can help.

4. Last month, the Division of Public Health reported Delaware now has fewer new HIV infections and more HIV tests being done. What’s your reaction to this news?
I think that’s a good thing, and I think a lot of that has to do with the Safety Net program we have, and the Needle Exchange that we have within Brandywine Counseling. Education is the key to having a decrease in AIDS or HIV, being educated about it from every angle. There’s a lot of people in this program that contracted HIV through intravenous drug use. And with the needle exchange and Safety Net program and NSAFE program working together and educating the people and letting them know that there’s a better way to life, I think that’s a good thing.

This Monday we had a training over at the Safety Net program where the nursing staff, Chris Zebley and Joyce [Bunkley] -- they are part of Christiana Care -- they conducted a training session for NSAFE to educate us as to how we can better educate the clients for safer sex practices. And if they’re going to continue with their drug use, they don’t have to use the same needles, they don’t have to share needles with people that may possibly be infected with HIV or AIDS or put themselves at high risk like that.

5. What would people be surprised to know about your job?
We are very compassionate, and we do everything that we could possibly do to assist people in living productive lives in the community. They think that it’s just about coming here, getting food, getting referrals, and things of that nature, [but] we also give them the option to sit here, to talk about situations, or problems that they may have. So it’s not just about them coming in and out. And we do not just only service the NSAFE clients, we also service the Core clients, because if some of the Core counselors have clients that are short on food, they refer their clients over here to NSAFE and we assist them as well.

Basha Silverman's Testimony at State Budget Hearings

My name is Basha Silverman. I am the Director of HIV Prevention programming at Brandywine Counseling in Wilmington. I am here to call your attention to the importance of the Needle Exchange Program on behalf of the Division of Public Health and the many individuals at risk of contracting HIV in Delaware. I understand you have some very difficult decisions to make this year, so I wanted to arm you with some information that may help you.

The Needle Exchange program does not only provide access to sterile equipment; it is a bridge to other services.

• In just 2 years, this mobile program has been extremely successful at identifying at-risk and HIV-infected individuals, and connecting them to medical care and substance abuse treatment.


• We are reaching a very, very hard to reach population that might not receive or follow through with services if the services were not brought to them.


• We have tested over 900 individuals on the van.


• To date, we have identified approximately 20 HIV positive individuals, and linked them to HIV treatment and case management.


• Additionally, we have successfully linked 62% of those ready for substance abuse treatment to a treatment center.


• Almost 40% of participants are women. When we connect a woman to treatment, especially a pregnant woman, we increase her chance of giving birth not only to a healthy baby, but one that is not HIV infected.

Why Needle Exchange?

• In Delaware, it took over a 10 year battle to pass such a significant piece of legislation.


• In the late 80s, methadone treatment was our best intervention known to combat HIV/AIDS. Today, needle exchange is the most widely studied and has proven to be most effective intervention to combat the spread of HIV.


• Needle exchange is not just HIV prevention, it is pre-treatment.


• Studies also show that once a person learns they are HIV positive, they are approximately 60% less likely to infect another person. Therefore, the testing efforts on our van are unquestionably a significant service that should not be cut.


• Lastly, just a reminder of the cost benefit. The needle exchange program costs roughly $200,000 a year to provide services on the van and make linkages to other services and programs designed to increase the overall health of Delawareans. In comparison, the estimated cost to treat ONE individual infected with HIV over their lifetime ranges from $300,000 to $600,000, depending on how long he or she lives. In two years, we prevented an estimated 10-12 new infections by connecting nearly 20 people to HIV care. Therefore, for $200,000, we saved an estimated $3 million that would have been spent on treating those individuals - and that is a modest approximation that does not include the infections prevented when someone is admitted to substance abuse treatment.

Thank you for listening. Thank you Senator Henry!

Needle Exchange and Law Enforcement: The Secrets of Our Success

Last week, BCI's Basha Silverman was a co-presenter at a symposium by the Yale Center for Interdisciplinary Research on AIDS called "Aligning Criminal Justice and HIV Prevention: From Conflict to Synergy." Allan Clear of the Huffington Post has written a detailed recap, which I encourage you to check out.

Here is the portion pertaining to Brandywine:

"From the service provider and government sector, Basha Silverman from Brandywine Counseling, a drug treatment/ needle exchange program in Wilmington, Delaware and Maxine Phillips and Mary-Ellen Cala from the New York State Department of Health AIDS Institute explained the secrets of their success in working with law enforcement. Strategically speaking the tactics are simple; relentless relationship building comprised of community and civic association meetings, meetings with police chiefs/captains and their support staff, joining sub-committees and inviting police onto advisory boards, arranging visits to treatment and exchange programs, working with community relations police, and training, training, and more education. Ideally, these efforts would foster the creation of feedback loops so that it is clear what works, what does not work, and would aid in the establishment of a strategy for furthering more effective community partnering. At all times it is critical to acknowledge law enforcement's own perspective on community drug issues and to emphasize the benefits that they can derive in supporting syringe exchange, such as minimizing risk from a needle stick. The relationship between providers and police can, and should, be a bi-directional initiative."

5 Questions for Tom Bell, Outreach Worker

5 Questions is our ongoing feature where we introduce you to the people who make Brandywine Counseling run, spotlighting a different staff member every two weeks.

Name: Tom Bell
Job: Outreach Worker, HIV Prevention and Needle Exchange
Time with BCI: 7 years

1. What’s your job at BCI and what do you enjoy about it?
I’m a member of the team doing outreach and needle exchange. The mission is to help reduce the spread of HIV/AIDS, targeting injecting drug users, and then also offer harm reduction education and information. We’re out there in the community 4 days a week, which is Tuesday-Friday. We also do HIV rapid testing on that van. It’s totally confidential. And one doesn’t have to be in the needle exchange program to receive testing, one can just come on, get an HIV test. If they need referrals, then we’ll make those as well, give them help wherever we can. Also pass out condoms, to help slow down the spread of STDs. Right now we’re trying out a new pilot program. It's called the LINK program, and we offer some incentive, as far as introducing drug-injecting people to the program.

And I kind of like it, because it’s out there helping the community and trying to change their thinking. We understand most people will do what they’re gonna do, but not being knowledgeable of what they’re doing. [So] we try some education in that area, because we know that we can’t stop folks from doing what they do. I like doing it, because I myself was drug dependent at one time. I went through an organization, and aftercare, and a 12 Step program to get my life back, and change my mindset, and become a productive member of society. So we try to instill hope in them that they don’t always have to live like this.

2. The Delaware Division of Public Health announced recently there are now fewer new HIV infections in the state and more HIV tests being done, thanks in part to the needle exchange. What’s your reaction to this news? Do you think progress is being made?
Yes I do. My take on that is, the word is spreading, and it’s a plus.

3. What would people be surprised to know about your job?
It’s not just drug and alcohol related; we help out wherever we can. We help with clothing, food, shelter, referrals, whatever way we can help. I can remember the times when I was drug dependent, and I was just wishing and hoping someone could just help, just not knowing where to go or how to ask for help. And now with this outreach program, we’re out there meeting folks just where they’re at, so some of the things they might not want to ask, or don’t have the courage at that time, or maybe they think it’s gonna take too much time, we’re there to step in and kind of reevaluate their thinking.

4. What’s the fun part of your job?
(Laughs) You say the fun part… Being in this field, the fun part is in the beginning. Maybe meeting someone for the first time, and they don’t really like you, because sometimes you have to be stern and practice a little tough love at some point. But the gratitude is when you see them later on down the line, and they have changed their mindset, and [are] starting to do different things, starting to become a productive member of society, not so much drug dependent, and starting to get their life back together. That’s the joy, you know, that’s the reward, in all. And I love that.

And then, I also have those same individuals come up to me later on, maybe a month or a year later, and say, “Why, thank you. Thank you for being there, thank you for puttin’ up with all that you put up with.” And I in turn say, “You’re welcome, and thank you for puttin’ up with all that you put up with.” (Laughs) So, that’s the fun part.

5. Since you joined the Outreach team, you’ve been working side by side with your wife. What’s that like?
(Laughs) Well, actually, it’s good and it’s bad, you know, to be honest. Because I, too, have to have an outlet. And, like I stated, I was drug dependent, and I attend a 12 Step program, and sometimes I have to talk about some of the things that go on with me working with my wife… And I’m grateful to be able to work with her, because I didn’t have the opportunity [before]. We were in the same field, but different areas, different times, so I didn’t get a chance to spend as much time like I do now.

She’s been in the outreach program [longer], and she knows more than I know in the outreach area, and so I’m humbly taking my stand. And sometimes it gets frustrating when she has to be stern, and then sometimes I don’t like it… But I understand that it’s for the best for the program and the organization, and I keep an open mind. And it’s actually good. We have our bad times, but it’s more good times than bad. I think that it could work. It’s life!

Prevention Works in Delaware

In case you missed it, this editorial ran Saturday in the News Journal. There are improving numbers on HIV/AIDS in Delaware, made possible by the work of organizations like BCI.

Some highlights:

• No babies born with HIV in 3 years
• New infections are down while the number of tests is up.
• Community support continues for the needle exchange and is helping it be successful.

This means we need to keep up the work we’re doing. It’s making a real impact.

Black Life Is Worth Saving. Get Educated! Get Tested! Get Involved! Get Treated!

National Black HIV/AIDS Awareness Day is Saturday, February 7, 2009. In Delaware and across the country, communities will be taking action and spreading the word to help prevent and treat HIV/AIDS. Nationwide, Blacks account for nearly half of all HIV/AIDS cases. Here in Delaware, this is even higher. 67% of our state’s residents with HIV/AIDS are Black.

NBHAAD is an annual initiative for HIV testing and treatment directed by a group of national organizations in partnership with the Centers for Disease Control and Prevention. The goal is to mobilize communities and address specific issues in regards to local epidemics and best practices that are science-based and will influence the course of HIV in Black communities across our country.

For more information on what you can do, including events taking place in Delaware, visit blackaidsday.org.

BCI LINK: A Social Networking Approach to HIV Prevention

One of our biggest challenges in meeting the goals of Delaware's Needle Exchange is how to reach those most at risk for HIV. With 12 positives found in two years, we know there are more yet to be discovered. As it was reported last summer, fewer minorities are enrolled in the Needle Exchange despite their disproportionately high risk. Typically, these injection drug users are mistrustful of law enforcement, have never been tested for HIV, and are not involved in any treatment program. As resourceful as our outreach workers are, we can never elicit everyone’s trust. So if someone won’t listen to an indigenous outreach worker, who will they listen to? We think the answer is their own peers who are already participating in the Needle Exchange.

Brandywine Counseling has launched a new recruitment strategy based on peer to peer networking, called BCI LINK. We will use existing social networks to promote HIV awareness, the Needle Exchange program, and drug treatment. Specifically, all participants in the Needle Exchange will be offered an incentive to recruit others in their social networks. The approach is evidence-based and has shown that that the incentives also increase adherence to the program.

The great thing is, we assume we already have people who collect and exchange used syringes from their peers. BCI LINK will train these individuals as “Connectors” to reach out and draw in their peers (“Crew Members”) who otherwise would not enroll. The effect will be that BCI reaches greater penetration levels within the community. Every Connector and Crew Member is required to be tested for HIV. We will also learn more about trends in needle-sharing, intravenous drug use, and HIV infection in Wilmington.

What’s more, because BCI LINK takes advantage of established patterns amongst Wilmington’s injection drug users, it has the potential to grow exponentially, reaching ever-larger groups of at-risk drug users. The graphic above shows the results of a similar program in Philadelphia that showed great success after a year and a half.

We began BCI LINK one week ago, and have already enrolled 6 Connectors and 5 Crew Members. We are truly excited to bring this approach to Wilmington. Stay tuned as we report on our progress and results.


Graphic c/o Howard Wasserman for Prevention Point Philadelphia.

How Much Would You Pay to Save a Life?

What can you do with a $1.00 donation to Brandywine Counseling? You might think, "not a whole lot," but you'd be wrong.

We know in these economic times, it's more and more difficult to support your favorite charitable causes. "Microdonations" of 1, 5, or 10 dollars are becoming a popular option. So with that in mind, I asked some of our BCI program directors what we could do with one dollar, five dollars, or ten dollars. This is what they came up with:

$1.00 will buy 14 condoms to protect someone from HIV.
$1.00 will also buy:
… 4 First Aid Kits
… 1 Wound Care Kit
… 1.3 Dignity (Hygiene) Kits (contraception, instructions, and resource guide)
… 10 Sterile Water Vials for use with bleach to clean syringes
… 12 Sterile Syringes

$5.00 will provide a hot meal for someone who comes to us hungry.
$5.00 will also provide:
… one group counseling session
… a gift card incentive for someone doing “well” in treatment for continued motivation.
… 70 condoms
… 21 First Aid Kits
… 5 Wound Care Kits
… 6.5 Dignity (Hygiene) Kits
… 50 Sterile Water Vials
… 60 Sterile Syringes

$10.00 will buy a DART bus pass for someone without a car to get to treatment and search for a job.
$10.00 will also:
… assist someone in obtaining an evaluation for addiction treatment.
… pay for 2.5 days worth of daily medication for a methadone patient.
… pay for 1 day of daily medication for a Suboxone patient.
… provide someone with 10 minutes of face to face contact with a counselor. Dollars buy minutes, and time saves lives.

So you can believe me when I say, one dollar can indeed save a life. As one of my co-workers put it, “Treatment works!! Not all clients can get treatment paid by Dr. Phil. How much would you pay to save a life?”

Brandywine Counseling offers convenient, secure online donations, including one time or recurring donations with your American Express card. Microdonations welcome. Thank you so much!

World AIDS Day: Unite to Raise Awareness and Reduce Stigma

Today is World AIDS Day. Worldwide, an estimated 33 million people are living with HIV. In the United States, an estimated one million Americans are living with HIV. HIV is still an incurable but preventable virus that is spreading faster than we can influence it among those who have unprotected sex. People still think it won't happen to them

Brandywine Counseling’s goal today is to remind you that HIV/AIDS is still a critical issue in the U.S. and around the world, and to promote HIV testing. We are taking part in Bloggers Unite on World AIDS Day 2008, a collaboration of AIDS.gov, the National Institute on Drug Abuse (NIDA), and Blog Catalog.

So here are some ways you can further the cause and elevate the voice of HIV/AIDS awareness online:

Learn the link about HIV/AIDS and drug abuse by viewing NIDA’s online Webisodes, a video series about how non-injection drug use can lead to increased risk behavior, and can change lives forever. Once you learn the link, be sure to send the link to friends and family.

Join the AIDS.gov Facing AIDS World AIDS Day Campaign. It’s simple - take a photo of yourself wearing a red ribbon and put the photo on your social networking site (such as Facebook or MySpace), blog, Twitter page, or Web site. The goal is to help eliminate stigma and recognize World AIDS Day online. They also have Web badges that you can share with your friends and colleagues and add a to your Web site or blog.

Use your wall, status, tweets or Web site to encourage HIV testing. BCI provides free and confidential rapid testing, with results given in 20 minutes. Testing is available at every Needle Exchange Site, or call 302-655-9880, ext. 21 for an appointment. Picture ID is required. If you’re outside the Wilmington, Delaware area, find an HIV testing site near you (in the U.S.) by sending a text message with your ZIP code to “KNOWIT” (566948) or visit: http://www.hivtest.org/. Encourage your friends to do the same and to promote HIV testing!

A Network of Partnerships and Technology Makes "Safety Net" Work for Delaware's Severely Ill

One year ago, Brandywine Counseling began an ambitious, multifaceted project targeting Delawareans with some of the most severe needs for substance abuse, mental health, and HIV risk reduction services. Never before in the state had all of these services been connected under one umbrella. Safety Net Services has changed that, and the results so far indicate this approach is working.

We started this program last October with a 5 year grant from CSAT, and admitted our first clients in January. Many of them enter the program through Christiana Care’s Wilmington Hospital. They come to the hospital for emergency care, OB/GYN care, or other services, but also have substance abuse and/or mental health needs which the hospital system is not equipped to treat. Through Safety Net Services, we’ve established a partnership with Christiana Care and other agencies so we can link these patients to appropriate care, whether it’s medication management; HIV outreach, education and risk reduction counseling; or substance abuse treatment.

We are reaching people who could otherwise get “lost in the cracks.” On one occasion, a woman we encountered during street outreach tested positive for HIV on our mobile van. She was ready to be linked to medical care and other services, and also was ready to enter substance abuse treatment. We got her admitted to our program that day, enrolled her in our on-site HIV medical clinic so her health could be monitored, and also connected her with our HIV case management program (NSAFE). She now has easy access to all these services under one roof, increasing the likelihood that she can adhere to medical care and be successful in treatment.

Safety Net Services owes much of its success to technology. Staff have the ability to do “mobile intakes” out in the community, which creates a path of least resistance for clients to enter treatment. We use laptops with wireless air-cards for Internet access to remotely dial into the Brandywine Counseling servers. We also depend on cell phones to keep our team in constant communication with one another, whether it be for a new referral or to contact a client who has been absent for treatment. Constant communication among our staff from various programs lets us assist each client with managing their time and responsibilities, such as keeping appointments.

In the past year, we’ve seamlessly transitioned 75 clients to co-occurring treatment, in which substance abuse and mental health disorders are treated simultaneously. Our average client is 40 years old and female. About half the population is minority. Of the 75, 42 clients had medical problems in addition to HIV that required medication management at our “one stop shop” clinic, with an average of four medical problems per participant. Most (83%) of the clients also have a mental health diagnosis, most commonly major depression. They are also seeking greater stability in regards to living situation, employment and income.

Six months after admission, we measure several indicators of recovery and stability. Our clients show good progress on all measures. None had dropped out of treatment after six months. Two-thirds reported no drug use, half reported no alcohol use, and 40% reported no alcohol or drug use.

Overall, Safety Net Services is making recovery and stability possible for many Delawareans with severe substance abuse and mental health issues. This program has allowed us to focus on some of the most needy individuals in this community, simultaneously addressing multiple critical issues. The interagency partnerships with organizations like Christiana Care, and the new technology available to us, make it possible to reach people who would otherwise have no contact with treatment providers.

The Dedication of The Linda DeShields Outreach Center

Brandywine Counseling's Outreach Center, located at 2814 Lancaster Avenue, Wilmington, has been renamed in honor of Linda DeShields, our first Director of Outreach Services. The dedication coincides with the near-completion of renovations to the facility to accommodate our outreach staff and human resources. The following proclamation was made October 21 by our Board of Directors:

Proclamation

Board of Directors
Brandywine Counseling, Inc.

Whereas, Brandywine Counseling, Inc., a non-profit organization, has announced a Building Dedication in establishing The Linda DeShields Outreach Center;

Whereas, Linda DeShields Outreach Center will establish a focus towards "intervention and outreach to addicts;"

Whereas, Brandywine Counseling, Inc., has a mission to intervene and provide outreach;

Whereas, All outreach and intervention in the Disease of Addiction is the key to prevention;

Whereas, Outreach and intervention begins with hope, self acceptance and forgiveness;

Whereas, Linda DeShields believed that with tolerance and compassion we embrace diversity;

Whereas, Linda DeShields believed that Together we make a difference through outreach,

Whereas, Brandywine Counseling, Inc. invites all to declare October 21, 2008 as the dedication of its outreach center, as the Linda DeShields Outreach Center and this Center will act as a model for all of us to follow, each and every day;

NOW, THEREFORE, The Board of Brandywine Counseling, Inc. hereby dedicate and proclaim October 21, 2008 as the dedication of its annex building as The Linda DeShields Outreach Center and invite all to observe and honor her memory.

IN WITNESS WHEREOF, I have here unto set my hand and caused the Great Seal of Brandywine Counseling, Inc. to be affixed this 21 day of October 2008.

David Oppold, President

ATTEST: Lisa Sherwood, Interim Secretary

Volunteer Spotlight: Felecia Doyle, Outreach Support

My name is Felecia Doyle. I am doing my internship at BCI HIV/AIDS Outreach Program. I first learned about the program from seeing the sign on Lancaster Avenue. I started researching what programs they offered and was interested in how much the staff helps the community. Being a Delaware Tech student in the Drug and Alcohol Degree program we are required to complete 200 hours of unpaid internship. Not only am I learning from my experience here, I am helping the staff achieve their goals by offering my support.

Before I started at BCI, I figured the staff had to have a heart in working with the community that is at risk for HIV. Once I started, the staff welcomed me with open arms. Since the facility is under renovations, the staff is working out of one room. Even though the space is tight, they all work together like one family.

I am currently working on data entry for the NEP, Needle Exchange Program. This program manages the clients who are new to NEP and who have utilized NEP as repeat clients. These clients are given numbers to use as their identification. Another program I am helping with is the CSAT GPRA, Center for Substance Abuse Treatment Government Performance and Results Act. This is through SAMHSA, which funds grants to provide substance abuse and mental health services to states and communities. This program monitors clients for a year.

I have learned a lot with the needle exchange program. I believe that this is a great program to help the community. The outreach workers go out into the community to promote the program, give out safe sex kits, bleach kits and let clients know about the rapid free HIV testing.

What I would take away with me from the experience is to have had the pleasure of meeting such great people who work at the HIV Outreach. All of the staff have hearts of gold and give so much to the community. I like to help people and bring smiles to their faces. If more people would open up their hearts it would make such a big difference.

Ten Thousand Needles Off Delaware's Streets Through Exchange

Delaware's needle exchange program passed another huge milestone recently when we exchanged our 10,000th syringe. What an accomplishment for a program now entering its twentieth month of operation. Six months ago, our total was at 3,500.

Every syringe has been exchanged for a clean one, meaning ten thousand dirty ones are no longer on the streets of Wilmington. Because it's a one-for-one exchange, there is incentive for participants to bring every clean one back after it’s been used. So although we’ve given out ten thousand syringes, they are being returned. The effect is not needle litter, but the opposite.

Here’s some more impressive numbers:

• We’ve enrolled a total of 353 participants.
• A total of 1697 exchanges have taken place.
• 132 participants were referred by another needle exchange participant.
• 17 participants have entered drug treatment.
• Since November 2007, 621 rapid HIV tests have been done on our van. 7 positives have been identified.

Live United! United Way Kicks Off 2008 Campaign

United Way of Delaware kicked off its 2008 campaign September 4. The state's largest charitable campaign raises over $20 million a year for more than 100 member agencies including BCI.

The slogan for this year's campaign is, "Live United." As you can see in this video, the message is that we all have the power to make a difference, by giving, advocating, and volunteering.



At BCI, United Way funds support our HIV Prevention and Outreach Services. Your donation means we can continue to send our dedicated and caring staff like Dee and Claudette out on the streets every day to educate, test for HIV, and make referrals. If you believe we need to stop the spread of HIV in Wilmington, please support our work with a donation.

If your workplace has never run a United Way campaign, it’s easy to start! Contact United Way at (302) 573-3700 and they will set you up with everything you need. You can request guest speakers from BCI or other member agencies for your campaign rally.

There is no wrong way to give. Select the Community Impact Fund, and your gift will be distributed among all member agencies. Select a Strategic Focus Area, like Healthy and Independent Communities, to direct your gift toward a specific issue. You can also designate your gift to Brandywine by selecting code 165, or to another agency of your choice.

So get involved and Live United! As the video says, it’s our state, our community, let’s build it up together.

5 Questions for James Harrison, Site Director

5 Questions is our ongoing feature where we introduce you to the people who make Brandywine Counseling run, spotlighting a different staff member every two weeks.

Name: James Harrison
Job: Site Director, Lancaster Avenue
Time with BCI: 20 years

1. How did you get started working in the addiction treatment field?
I think mine was a unique situation. I was actually finishing up a three [year] mandatory prison term, and Kay Malone and Linda DeShields came to the Plummer Center in 1988, and at the time, the American Red Cross was providing HIV education in the prison. They had a gentleman that came in, and none of the inmates would respond to him. They were rowdy, they were disruptive. And so, the warden asked me if I would co-facilitate the group. And I agreed to it. And after his first presentation, I actually took control of the presentation.

All the inmates were extremely receptive. It was like hearing it from one of their peers. And this was a time when HIV and AIDS was at truly epidemic proportion in our city, and folks were dying within five years. And so I hollered out, “Listen up, people! I have some life-saving information!” And people were quiet. People listened. And that kind of opened the door for me to start doing some prevention education, after I was released. Of course, Kay and Linda DeShields agreed to hire me after I was released, waited five months for my release, and I’ve been here ever since.

Many people would be surprised to know that I’ve actually had a 30 year history with Brandywine. So, many folks, especially newcomers, oftentimes will not realize that I’ve spent ten years on the other side of the fence. And so, I’ve seen the changes we’ve made as an agency, particularly around process improvement and access, and just being kinder and gentler to the addict. I think what folks will not realize is that ten years as a consumer embedded an advocacy in me that will never leave. And so I carry with me, day to day, having to straddle both fences. I’m still in recovery, I will say that. I can always see the client’s view clearer in my head as I’m also trying to move our agenda, and move the agency to the next level. So when you first look at me, you don’t see the old James, and so that’s the piece that I carry with my job that many folks don’t know about.

2. What changes have you seen in your 30 years with BCI?
Part of what I’ve seen is a growing trend, that we’re seeing a younger, sicker population. And I look at all of the old-timers, for loss of a better analogy. They are the dying breed. I recall one consumer I saw yesterday, who has been with Brandywine [for] a 30 year history, is actually wheelchair bound, and blind. And that same person, I used drugs with, I hustled with, I participated in drug addict behavior with. And now this person is barely struggling to survive.

And I see on the other spectrum, young white females and young black males chronically addicted to opiates, but now struggling with HIV, mental illness, and addictions. And I think the most obvious change has been the severity of folks’ addictions and their problems, coupled with the social ills as well: increased gas prices, food, housing shortage. All those other issues, where I think years ago, folks could make it off of a year’s income of about $12,000, but now, that’s starving. And so, couple that with addiction that’s more severe in its nature, we’re seeing sicker and more violent individuals as well.

3. BCI was in the news last week because of the challenge of reaching black drug users with the needle exchange. What do you think it will take for this population to access these services?
There was a workshop I went to, years ago, that addressed this very issue. The name of it was, “Beyond Tuskegee.” And if you remember the Tuskegee experiments, blacks historically had a fear of public health systems, and the whole notion that, “This is suspect, in terms of, the government has its hands on it, and that law enforcement may use this as a vehicle to further disenfranchise us.” So getting beyond Tuskegee would say that, “No, this is not true. There’s not a great conspiracy theory around accessing needle exchange, or providing services in an outreach effort.”

I think we have to build a comfort zone for African Americans. It’s like, if they see me drink the water, then the water’s okay. But until they see it and watch me be okay, many times they won’t access. So I think the most valuable tool we’re going to have is our African American peers who currently work on the [needle exchange] van. For [drug users] to see, again for loss of a better analogy, that they too have drunk the water and the water’s okay. So there’s got to be a comfort level in saying, “You know what? Needle exchange is a good thing. It saves lives, it’s not connected to law enforcement, it’s not some sort of drug inside the syringes.” The belief that it is a good thing has to be kind of penetrated throughout the community.

And accessibility -- going into what we call the “red light district” of the city of Wilmington is challenging, especially with all the shootings. I don’t know if African Americans are truly the population who are now injecting at an alarming rate. Certainly we do have some folks injecting, but I also believe that this is a dying population as well. And more people, because of drugs being purer, are smoking and sniffing. And so, there may not be as great a need for syringes as we first thought. So I think a collective kind of effort with our Senator Margaret Rose Henry, who’s birthed this project, our community leaders, our naysayers, our people who advocate for this population, we all have to collectively come up with a strategy to keep pushing the message that the water’s okay.

4. You can tell a lot about a person from their office. Tell us what you have in your office.
My office is very eclectic. I sometimes am embarrassed about it! But I have jazz artwork here. I have New Orleans. The Nanticoke Indians, which never really got recognized during Mardi Gras, but they too decorated, and had the same kind of celebration, but never recognized. But then I also have one section that’s dedicated to family. I have pictures of my son who graduated from Villanova. I also have a collection of articles of the work we’ve done here at Brandywine, the projects where I grew up in as a kid, and articles saying, “A $10 bag of heroin approximate to the 95 exit [for] sale,” “Fewer resources spent on prevention,” and then one of Basha [Silverman] and a syringe-filled shooting gallery, which reminds me of the work that we do. And that’s in addition to the Comprehensive Accreditation Manual from Joint Commission, books around licensure, and policy and procedure manuals.

But I also have a snake to unclog many of the restrooms, and a quart of oil for some of our vehicles. And so, you can find anything from a light bulb to the 2007-2008 Delaware Psychiatric Residency program’s pictures, of which I’m also a part, doing some training with the residency. So I like to think of it as eclectic. I think there’s times when it’s more orderly than others, especially when visitors are around, but for the most part, it really depicts my work here at Brandywine. One minute I might be the janitor, one minute I am the clinical supervisor, the next minute I’m an administrative person, the next minute I am a client advocate. So it really depicts the changing roles I play.

I just recently described my job here at Brandywine to someone, and I said, “I can’t call it work, because it’s something I like to do.” Now, it just so happens I get paid for it, but even [in] absence of money, I would still be doing this type of work. So while the paycheck helps with the mortgage and the car payment and travel, absent of that I would still be doing the same thing I’m doing. So I’m fortunate and blessed that I can come and do something I was going to do anyway for the rest of my life, but get a paycheck for it.

5. If you had $30,000 to donate to BCI what would you do with it?
I think I would go to a learning institution and ask that we start a program specifically for addictions counselors to grow the work field. The major challenge is a workforce that’s declining. [BCI senior staff] will be leaving in a few years. We have a younger workforce, that I think for the most part, is not prepared for the challenges of a more sophisticated system, in terms of licensure, accreditation, and just maintaining a quality level of services.

So I would go to a Lincoln University, a Del State, or University of Delaware, and say, let’s have a name for a program specifically to grow the field. So I think that’s what I would do. While another clinic would be nice, a transitional house for recovering people would be nice, but I think if we don’t grow the field, we’re going to miss the opportunity to help people get better.

Photos From the Keepin' It Real Block Party

On Saturday August 9, 2008, the BCI Outreach Team created a fun and enjoyable block party atmosphere to motivate our community members to consider the importance of their health and their individual HIV status. Free rapid HIV testing was provided along with information tables, a DJ, educational games, free food and give-a-ways.

Click here to view our album of photos from a fun event for a good cause.

The Most At Risk Are The Hardest To Reach

The News Journal details the extent of our challenge in reaching a hidden and mistrustful population with the needle exchange. Though blacks remain hesitant to access the services, it's important to note our successes and how far we've come.

Before Wilmington got a needle-exchange program of its own, some addicts went to Philadelphia to get clean syringes from the exchange program there. In addition to needles, they brought back stories about police harassment near the vans that distribute them.

Those experiences make it hard to trust the Wilmington program, even though the relationship between its workers and police here has gone better than anyone could have expected, officials say.

...

"It's a fact that a needle-exchange program cannot reach the people it's trying to if there is not cooperation from the police department," Silverman said. "The cooperation we've had here has been outstanding. They're not using our vans as a mouse trap. No one has been arrested near the vans and no one has been followed and arrested down the block."

...

The program has exceeded its goals for clients and getting people into drug treatment centers.

And we have new strategies to reach those most at risk.

Silverman said she is formulating a plan, which she hopes to implement in the fall, that would get the program's current clients to go to shooting galleries and drug houses to recruit new members.

"Our team of workers are former addicts, former sex workers or have some connection to the communities we serve, but there are still places we can't go," she said.

Volunteer Spotlight: Walter Frazier, Outreach Support

Walter Frazier came to Brandywine Counseling as a volunteer with the Outreach Department in July 2008, and quickly became someone we could depend on to help out. In the first of a series of volunteer spotlights, Walter tells us about his experience in his own words:

I relocated to Wilmington a few months ago and decided that while I am seeking full-time employment I would volunteer at a non-profit agency. I learned about BCI by word of mouth and called to see if my skills might be needed.

In the past 10 years I have served on Boards and committees and even worked for the American Red Cross for 3 years as a program director in Bloomington, Indiana. These experiences have given me the opportunity to learn how important the work of non-profits is to a community.

Just based on the name, I assumed this organization most likely provided substance abuse counseling. Although this counseling is part of Brandywine’s activities, I had no clue there was an outreach department that provides free HIV testing and treatment if necessary, nor did I know of the methadone program for heroin users.

I have spent my time raising funds for the annual HIV Testing Event, which is held this year on August 9. I have found this project to be very fulfilling and relevant to me since I have lost 3 close friends to this wretched disease.

I have been surprised by how BCI approaches its endeavors. BCI provides its professional services without prejudice and blame. I have seen how quickly BCI drops everything when a client walks through the door for help. It has been inspiring.

What I have done while volunteering is very small compared to the activities of the whole organization. I feel gratified thinking one person might be tested for HIV, receive early intervention and live a longer life as a result of my efforts.

Outreach Workers Become Visible

From delawareonline.com, some video of our outreach team in action as they prepared for last Saturday's educational block party.

This Saturday - 1st Annual Keepin' It Real Block Party

1st Annual Keepin' It Real Block Party
Saturday, August 9, 2008
3 PM - 7 PM
L.A.C.C. (Latin American Community Center) Parking Lot
4th and Van Buren Streets, Wilmington

This Saturday is our 1st Annual Keepin' It Real Block Party event! We invite you to join us and have a good time.

The purpose of this event is to raise awareness, educate, and motivate people to get screened for HIV. We are targeting the adult community members who reside in the Hilltop/Westside neighborhoods in the 19805 zip code. We will be providing Free and Rapid HIV testing, Free Food, Games, Prizes, Gifts, and activities for the kids. Please consider joining us to spread an important message and create a fun and enjoyable atmosphere that will motivate our community members to consider the importance of their health and their individual HIV status.

Don't forget, this HIV Awareness event will feature information tables, a DJ, educational games, free food and give-a-ways! This is an excellent opportunity for your agency to promote its mission and services. Be sure to invite your co-workers, clients, family and friends!

New AIDS Infection Estimate Is A "Wake-Up Call"

About 55,000 Americans are infected with HIV each year, according to the Centers for Disease Control and Prevention. This number had been thought to be 40,000 a year, until a new, more accurate blood test was introduced. The new test can tell how long ago an infection occurred.

The CDC report also found that HIV infections are falling among injection drug users. Some experts are giving the credit to prevention efforts including syringe exchange, while at the same time calling for additional funding to expand them. Many populations continue to be at high risk, including gay and bisexual men, those under 30, and African Americans.

Whether more funding comes or not, the revised estimate clearly is a "wake-up call to scale things up," said Dr. Kevin Fenton, who oversees CDC's prevention efforts for HIV/AIDS.

For more information, see:
The full article
CDC HIV Fact Sheets

5 Questions for Dianna Dorsey, Outreach Worker

5 Questions is our ongoing feature where we introduce you to the people who make Brandywine Counseling run, spotlighting a different staff member every two weeks.

Name: Dianna Dorsey
Job: Outreach Worker, HIV Prevention and Needle Exchange
Time with BCI: 5 years

1. What is your job at BCI?
I work in the Outreach Department as an HIV Prevention Specialist, and the NEP program. And what we do is, we go out in the community, and pass out condoms, educate individuals on the street about HIV, the spread of HIV and Hep C, and different STDs. We also try to get them to come and do an HIV test, and let them know how important it is to learn their status. A typical workday is being out on the streets, going all across town, educating them, just letting them know how important HIV is, and how important it is to not to be sharing your works.

And the needle exchange, we have the van, and the clients come out and exchange their dirty syringes for clean ones to prevent the spread of HIV and prevent sharing. So when we’re in the community and we’re doing our outreach, that’s another target. We go and hand out flyers, and let them know we have the needle exchange, and we’re also doing HIV testing out on the street at this location and this time, and different locations that we have throughout the week.

2. What got you interested in doing this kind of work?
I actually had family members who went through the struggle of addiction. And just seeing them inspired me to understand addiction, to find out the triggers, and everything that comes along with that. So that was my main reason. As far as working with HIV, I just wanted to be more educated about it. And once I got the proper education, I just fell in love with it, and that’s my goal. I love what I do.

3. What is your biggest challenge in doing your job?
My biggest challenge is not having [clients] come through, as far as getting tested. Or, on the streets, trying to really really really educate these people out there, and they’re still saying no. So, we have to come from different angles at times, and that’s a challenge. Because you have some people that are out there that say, “Well, I don’t want to get tested.”

“Well, have you ever been tested?”

“No.”

“Tell us the reason you don’t want to be tested.”

“I don’t.”

“Do you understand the importance of being tested?”

So, when they tell us no, they don’t want to be tested, that’s a very big challenge to me, because I’m not accomplishing what I’m out here to do.

4. What would people be surprised to know about your work?
I think they would be surprised to know that I really care. And caring for the individuals on the streets, that’s a plus. That’s number one. Because if you’re in this addiction - and you have individuals that are out there that don’t have loved ones – [and] you really show them that you’re there, and that you’re supporting them regardless of what decisions they make, I think that surprises them a lot also. Because if you just go out and say, “Here, take this condom,” or, “Come to the exchange,” they’re going to feel some type of way about that, because they’re not feeling the love at all from us. So in order for us to engage with these clients, we have to show them that we care. We have to show them that we love them, and I think that surprises a lot of them.

5. What advice do you have for someone who would like to do the job you do?
Come with it with your heart. Don’t just do it for a paycheck, have it in your heart that this is what you want to do.

5 Questions for Jeremy Zane, Therapeutic Supervisor

5 Questions is our ongoing feature where we introduce you to the people who make Brandywine Counseling run, spotlighting a different staff member every two weeks.

Name: Jeremy Zane
Job: Therapeutic Supervisor, Lancaster Center
Time with BCI: 4 years

1. Safety Net Services is one of the BCI programs you’re involved in. How are you addressing an unmet need for substance abuse treatment and HIV/AIDS services in Wilmington?
Our main focus is getting people into treatment. The [Christiana Care] infectious disease clinic, who is the largest HIV treatment provider in the city, was referring a lot of people to Brandywine, and a lot of people weren’t making it. The first thing that we’re doing is the seamless transition. A lot of times we get referrals from the infectious disease clinic the day people find out they’re HIV positive. In fact, in the first five months, there’s already been 4 or 5 where we were at the infectious disease clinic the moment they found out that they were positive. So from day one, we’re linking up these two services. We want people to understand that HIV is treatable, that it’s not a death sentence anymore, as long as a person takes care of their body, and takes their medication. Also, substance abuse treatment can coincide with HIV.

We’re talking about a population that is probably taking the bus everywhere, or needing to get rides. Transportation can be a very significant barrier in itself. We’re talking about a person who could be going, in one day, from substance abuse counseling, get on the bus, go downtown, go out to the infectious disease clinic, sit all day out there, get the things that they need to get done, and then go back into the middle of town to Connections or Community Mental Health for their mental health services. That’s a lot of running around. And if the person is in a lot of need, and needs services every week, the chances they will get those services consistently, decreases greatly, having to run around town that much.

Having Christiana Care’s remote site here, a person can come in, get their substance abuse treatment, see the nurse practitioner, get their HIV meds, and they’re able to do it all under one roof. The mental health component also can be contained here. A person with mental health issues can have their evaluation done here, can have their medication management done here, can get their prescription through here. Everything that person needs is contained under one roof.

2. You also helped start Recovery Counts for people who weren’t succeeding in the usual track of treatment. What is this program and how did it come about?
I remember the day, there was a particular client who came over and said, “They’re discharging me off the clinic, but right now, I’m clean. I can give a clean urine right now, but I’m being discharged.” And from that moment, Basha [Silverman] and I kind of looked at each other and thought, “I wonder how many other people there are like that, who are being told they’re discharged, and now, this is when they’re going to decide to make that change?” And after looking at it, we found it to be quite common. So what we wanted to do was to come up with a program that, we say in a very concrete way: This is your last chance at treatment. If you do not demonstrate changes now, you’re going to be referred to a higher level of care, and you’re going to be discharged from the opioid treatment program.

We started a pilot program of about a dozen people. And what we were able to do was, really offer them more intensive services. We’re going to have a couple of groups a week, we’re going to be meeting for an individual session every single week, until we get through this and over this hump. And from that point, it started to grow. And then what we started to realize was that, maybe we should start working with people at the beginning. Anybody who’s on contract at all is then going to go into this program.

The reason they’re not succeeding in treatment is because, maybe we’re not offering intensive enough services. This person needs to be seen more than once a month, and they need a case manager, they need to be coming to group. And the same person running the group needs to be running their individual counseling sessions, so they can incorporate what’s going on in group back in the individual session, in a seamless way.

We also look at an outcome questionnaire. By decreasing incarceration risk, housing need, [and increasing] interpersonal relationship skills, education and employment, it has a correlation with their urine screens. As negative urine screens go up, these factors improve.

3. Recovery Counts and Safety Net Services could both be described as harm reduction approaches to addiction treatment. Do you have an opinion of whether harm reduction or traditional treatment is more effective for clients?
I personally believe that a harm reduction model is more effective. Now, you have to really define what harm reduction means, because it means different things to different people. Some people who are on the liberal side of the harm reduction model say that no one should ever be penalized for urine screens, ever. That a person should never have negative consequences, should never have hard holds. I’m certainly much more on the conservative side than that. I believe that a person needs time to change. They’re going to be positive while they’re in treatment, and the day they walk in the door, you can’t possibly expect them to just, all of a sudden, start submitting negative urine screens. So where is that point? Is it two months into treatment, eight months into treatment? And from my point of view, that’s going to be different for everybody. That toleration, that acceptance that a person’s going to be positive while they’re beginning treatment here, in my opinion, is still part of the harm reduction model.

I also believe, however, that there’s also some point where, if we’re not demonstrating changes at this level of care, and allowing the person to continue their behaviors at this level of care, it’s more detrimental than it is helpful. And we need to make efforts to get a person into a higher level of care, which can be perceived as punishment. If we’re discharging a person because we believe they can’t succeed at this level of care, and they don’t want to go inpatient, then that person’s probably going to perceive what we’re doing as punishment, and I think some of the purest harm reduction model thinkers would also think that that’s punishment as well.

4. How did you get into the field of addiction treatment?
I got introduced to Brandywine when I was at Wilmington College with my undergrad degree. Basha had come in and was doing a presentation about the outreach services that Brandywine had to offer. And at that point, I really didn’t know what I was going to do with an undergraduate degree in psychology. And that was the first time that I became interested in outreach in general, and in getting into the substance abuse field. So I came in for an interview, and there was a project they had just gotten some funding for, and I just kind of fell into it that way.

And once I’d gotten involved and started working with the population… you grow into it. It became something that was very interesting to me. The substance abusing population has mental health issues, they have medical issues, and counseling people with substance use disorders, you get a little piece of everything. So, as opposed to just working with people with depression, or just working with people with post-traumatic stress, you get all that here, but the common thread is, everybody’s also abusing substances. So you get a more complete package, and a more dynamic caseload, in my opinion.

5. What is rewarding about your work at BCI?
I think everybody says that they’ve got a couple of clients who’ve really made changes, and with some of the clients that I’ve had now for 2-3 years, you see them struggle and struggle and struggle, and then finally get to this ultimate goal. The first time a particular client gets travel bottles. When somebody is detoxed successfully who was about to be kicked off the clinic a year ago. Everybody’s got those two or three clients that they’re always going to keep with them. That type of satisfaction, that type of reward and internal satisfaction that you get, I don’t see how you could possibly get that at any other job.