When you walk into your favorite barbershop or hair salon to get a shape-up, a trim, or a new look, what happens? Likely you’re greeted with smiles and welcoming words. If it’s a bit fancy, maybe an assistant offers you something to drink. Somebody takes your coat, offers you a seat. There is a sense of community here. Maybe you’re ushered into the chair immediately. Looking into the mirror, you see a trusted confidant and guide hovering above your head. You know this is someone who wants you to look your best for the world.
You know that no matter how often or how rarely you come to this chair to see this person, they will offer unconditional warmth and an attentive ear. You know that if you suggest a new style for yourself, they will give you an honest and considered opinion. You know that if you insist on a look they believe won’t flatter you, they will gently encourage you not to go there, even offering scenarios for how it might play out – whether it’s that platinum color you’ve been coveting, or the comb-over you insist will hide the growing bald patch on your crown. You respect the opinion they offer, so you listen and contemplate your decision carefully. Past experience has shown you that they have a good sense of what works for you, and what doesn’t. And even when you’ve been gone for a while, and show up with the remains of a bad cut from someone else, they don’t harangue you for your bad decisions, or turn you away. So you keep returning to this chair because your partnership with this person has helped you to feel good in the past, consistently, and their wisdom, when it comes to your hair, has taught you things about yourself.
A person-centered approach is common in so many areas of our lives. It shapes our neighborhood relationships, our community involvement, and even our daily social interactions. We take for granted that this is what we expect to encounter in our transactions with others. But we’ve been slow to adapt it to our response to substance use disorders, despite the strength and value of this approach in mental health.
At Services for the Underserved (S:US), we have recently embarked on a transformational process to renovate and strengthen the ways in which we deliver substance use services. Many of the people we serve, with histories of homelessness, criminal justice involvement, intimate partner violence, and other traumas, struggle with substance use. Now more than ever, in the face of a growing overdose epidemic, we are obligated to integrate a focus on substance use throughout our system. With this sense of urgency, we are exploring the ways we can leverage the opportunities of a rehabilitation model to design a continuum of engagement and tailor a range of services to offer the most meaningful, effective response to our participants.
The barbershop-hair salon metaphor was among several analogies proposed by our program leadership during a recent ideating session we held, as we worked to articulate the aspects of a person-centered approach we want to create. We know that we need to reach people no matter how they are managing substance use in their lives right now. We need to accommodate all levels of participation in substance use services, from those who are frequently involved in services to those whose participation is intermittent and even rare. How do we ensure we have made our services easily accessible to our participants? How do we ensure they have gotten a useful minimum set of services, if we only have this one opportunity to engage them?
It is critical for us that we consistently support a harm reduction lens to substance use services at S:US. We recognize the structural vulnerability our participants experience, and the imperative of our role for mitigating the potential harms in their lives, including related to substance use. Our services must be flexible and engaging, taking into account the individual paths that people are taking, and maximize a person-centered approach by embracing harm reduction as a wide-angle view for approaching self-defined recovery. The four pillars of recovery – health, home, purpose, and community – describe a framework for this approach, ensuring we account for the many dimensions of our participants’ lives in the ways that we work with them. Recognizing the social determinants of our participants’ health, we can integrate a focus on substance use across our services.
We look forward to implementing the transformative approach we are developing at S:US in the coming months, and to showcasing it in action next year. We are optimistic that our attention to the principles of person-centered care and harm reduction will yield positive results. A responsive approach to substance use is one that accommodates everybody, without judgment, neither in the moment nor for the long haul.