CHECKLIST
1. Review New Jersey’s new harm reduction law, regulations, and application for authorization.
The application for authorization is not a competitive process. To ensure widespread syringe access, New Jersey needs a wide range of authorized syringe services from smaller, volunteer-led initiatives to medical facilities that integrate syringe services into their existing health services There is no upper limit to the number of authorized syringe services that can be approved or operate.
Read this FAQ on New Jersey’s new syringe access law from NJHRC
Review NJDOH Regulations for Harm Reduction Centers
Review NJDOH Application for Authorization
● Important: The application for authorization is a distinct process from funding opportunities through NJDOH, but it will be a prerequisite to apply for funding Expect NJDOH to release a funding request for applications (RFA) in late summer or early fall 2023.
2. Familiarize yourself with the principles of harm reduction, leadership of people who inject drugs, and safer use materials.
The harm reduction movement is a powerful, generations-old community of practice, with local and national networks of support Familiarizing yourself with basic principles and practices of harm reduction will help your services thrive.
Review “Principles of Harm Reduction” from the National Harm Reduction Coalition
● To consider: The War on Drugs has reinforced the notion that drug use is a criminal issue and that the goal of policies and services should be the eradication of all substance use. In a harm reduction approach to drug use, our goal is an increase in individual and community quality-of-life and wellbeing.
Download and explore the one-pager on “Meaningful Involvement of People Who Use Drugs: Nothing About Us Without Us” from AIDS United
● To consider: Meaningful leadership of people who use drugs helps guarantee effective outreach strategies, non-stigmatized care, and trusted relationships to make your services successful
Review “Materials for Syringe Service Programs: A Guide for Staff & Volunteers” from NASTAD
● To consider: Safer use supplies are public health tools to prevent unwanted infection and overdose, and practical tools to offer people that lead to increased referrals and connections to care over time.
3. Develop and implement needs assessments.
Adding syringe services is a team effort, made for the common good of our local communities Determine what needs your community has, and develop a plan to meet those needs – talk to your local networks, staff and colleagues, clients at existing programs, community stakeholders, and more. Speak with other providers in your area to identify gaps in services Outline what partnerships you might require to offer harm reduction services.
Conducting a multifaceted, intensive needs assessment may not apply to drug user-led groups already poised to implement syringe services once authorized However, even for deeply community-based and drug user-led organizations ready to launch today, needs assessment tools are helpful for ongoing program planning, evaluation, adaptation, and improvement.
Read this module on planning and executing a needs assessment from the National Harm Reduction Coalition
Conduct an organizational needs assessment with current staff
● To consider: What unmet safer drug use needs are staff learning about from clients, patients, or members? What is your internal organizational awareness of, and competency or experience-level around, supporting people who use drugs using a drug user health framework?
Develop and distribute your own needs assessment for potential partners
● To consider: Are there existing syringe access services in your community that you could partner with? Where are people who use drugs already connecting to care and community support?
Develop and distribute your own needs assessment for clients, patients, or members
● To consider: No matter where you are in the planning or implementation process, client input and program development based on client needs are service provision best practices.
● Best practice: Compensate clients, or members for their time and accumulated expertise that is shared in a needs assessment, in a form that works for clients
4. Get to planning!
Using your needs assessment, design the syringe access program that works for you and your community
Review “Syringe Service Programs: A Technical Package of Effective Strategies and Approaches” from NASTAD and the CDC.
● To consider: Your Harm Reduction Center services should be aligned with national best practices This technical package from NASTAD and the CDC is an extraordinarily comprehensive overview of elements and considerations in syringe services development, and an invaluable resource for ongoing planning.
● Best practice: Needs-based syringe distribution and secondary distribution models are both best practices that should be included in your program design.
Determine your introductory offerings of services
● To consider: Syringe service programs evolve over time and based on need Introductory offerings of services are those you will start by providing. Start somewhere with ongoing evaluation and feedback, you can layer on more drug user health and wraparound services over time!
● Important: See the checklist appendix for a breakdown of core services and activities you must offer and expanding services and activities you can offer
Establish your service delivery method: on-site, mobile, delivery, or a combination of delivery methods
● Tip: Check out page 25 of the NASTAD/CDC toolkit for a chart outlining the pros and cons of different service delivery methods
● Tip: Learn more about peer-delivered syringe access from this National Harm Reduction Coalition toolkit and training guide
● For existing healthcare providers: For health centers, there are generally two ways to incorporate syringe services: (1) Add syringe services to your existing scope of practice or (2) partner with a community-based syringe service program to provide on-site services Learn more from National Healthcare for the Homeless’s issue brief “Health Centers and Syringe Service Programs.”.
Determine location(s) of services
Assess your intended service location(s) for municipal zoning information
● To consider: Read this explainer on assessing locations for proper zoning Knowledge is power: learn the municipal zoning process in your location(s). The New Jersey Legislature has designated some zoning authority to municipalities through the Municipal Land Use Act Zoning ordinances typically break up that municipality into “districts,” and zoning authority is constrained by the New Jersey and federal constitutions as well as local, state, and federal law.
● To consider: If your mobile or delivery services are not conducted at any one fixed location, they may not be subject to municipal zoning laws. For fixed sites, consider where other intersecting health and social services are offered. Check out “Advancing Harm Reduction Services in the United States: The Untapped Role of the Americans with Disabilities Act.”
Develop a disposal plan
● All sites must develop a plan for the handling and disposal of used syringes and needles
Determine a staffing and/or or volunteer plan and training schedule
● All staff and volunteers must be trained in harm reduction best practices and how to facilitate appropriate referrals to medical, substance use disorder, and social service providers, and offer information to consumers on HIV, bloodborne pathogens, and STDs, as well as safe injection practices and overdose prevention
● Tip: Check out Workforce Development Hacks for SSPs on the Harm Reduction Hacks microsite.
Establish protocols for client intake, assessment, and referral to additional services
● Tip: Check out Hacks for Harm Reduction Policies, Procedures, and Programs on the Harm Reduction Hacks microsite.
● Best practice: Include a policy for secondary distribution in your program design that makes it easy and straightforward for people to get and distribute supplies for their networks on a self-direct, needs-based basis.
Develop an outreach strategy to get out the word about your services
● To consider: Develop this strategy with people with lived experience of drug use in your area to ensure that your efforts to reach people who use drugs will be effective.
Ensure that your plans are equity-minded, allowing for client input and feedback
● Tip: Revisit “Meaningful Involvement of People Who Use Drugs: Nothing About Us Without Us” from AIDS United
● Tip: Utilize the free e-course “Taking Action on Racial Equity in Drug User Health Programs” from Reframe Health & Justice and In the Works.
5. Create a community of collaboration
Harm reduction services build crucial trust with people who are targeted by exclusionary and discriminatory drug policies. A key part of your programming will be building relationships with service providers and providing trusted referrals and other support so that clients can get the care they need.
Identify and establish partnerships with service providers that can support people who use drugs in your area
● To consider: Possible partners include providers of healthcare, medication-assisted treatment, detox and other substance treatment, shelters, employment services, reentry services, advocacy organizations, case management, HIV, Hepatitis C, and STI testing, neighborhood food pantries, and advocacy organizations advancing racial, economic, and social justice.
6. Develop Data Collection and Evaluation Processes
NJDOH requires all harm reduction service providers to develop and implement data collection systems to determine the satisfaction with and success of individual programs. Collecting and keeping good data will also support you as you seek funding for these programs from the state and private philanthropy sources. And, if designed thoughtfully, data and evaluation can also be tools for accountability and change as you learn what changes or tweaks your program would benefit from.
Review NJDOH data reporting requirements for Harm Reduction Centers
● The regulations say that each Harm Reduction Center should collect and record, to the extent practicable and with the consumer’s consent, at least the following information: (1) the consumer’s age, race, ethnicity, sex at birth, and current gender identity; (2) the substances the consumer uses and the modes of use; (3) the dates on which the harm reduction center delivers authorized harm reduction services to the consumer; and (4) a list of the authorized harm reduction services and referrals, if any, that the harm reduction center provides during each encounter with a consumer.
● Tip: Data reporting should be minimal and not ever prevent someone from receiving core syringe services like sterile syringes and safer use supplies, disposal, or information and referrals Confidentiality of consumer information should be protected to the fullest extent possible
● To consider: Each authorized Harm Reduction Center has to submit a quarterly report based on the data and evaluation
, Check out the Harm Reduction Hacks overview of data and reporting for syringe service programs
Choose and implement a data collection system for quantitative (numeric) data
Develop a plan for client needs and feedback, as client needs will guide your work, and regular mechanisms for qualitative (open-ended) evaluation
7. Think About Funding and Sustainability
NJDOH funding for Harm Reduction Centers is separate from, and distinct from, the application for authorization. NJDOH will be announcing new funding for Harm Reduction Centers later this summer, and authorized programs can seek NJDOH funding and/or fund their operations through a wide variety of options.
Prepare a program budget for your harm reduction services, including staffing, software, necessities, and indirect expenses
Slowly but surely develop your financial and organizational foundation
● To consider: You may be launching a syringe service program while you also develop a new organizational structure to serve an unmet need in your community. Developing the foundation for funding streams with high administrative burdens is work in and of itself Ask for support from trusted partners, and check out the Harm Reduction Hacks microsite for crowdsourced tips on building organizational infrastructure.
Speak to your current funders about their plans and your plans to offer harm reduction services. Ask for their support or introductions.
● To consider: Organizations and healthcare entities that already receive funding for services adjacent to harm reduction services (ex: overdose prevention and response, medication for opioid use disorder, HIV testing/treatment, HCV testing/treatment, wound care, case management for unhoused populations) may be able to add some harm reduction supplies and services. Many federal funding sources
(eg , SAMHSA, CDC) encourage and allow grantees to utilize funds for harm reduction service delivery by supporting staff salaries and other costs, though they will not pay for safer use supplies themselves This would enable you to integrate syringe services at a lower fundraising point as the only new costs might be supplies not allowable through federal funds.
● Tip: Check out the “Harm Reduction is Healthcare: Sustainable Funding for Harm Reduction Programs” toolkit from Vital Strategies, National Harm Reduction Coalition, Anka Consulting LLC, and In The Works Not all (but some!) harm reduction services may be billable to insurance.
Review public funding opportunities
● SAMSA
● Grantsgov
● New Jersey State Agencies - While Grants.gov compiles federal funding opportunities, state-level funding opportunities are announced and managed by each state agency.
● Sign up for grant updates in your municipality and county
Review private foundations who fund nationally or in New Jersey
● AIDS United Harm Reduction Futures Fund
● Comer Foundation
● Emergent Fund
● NACCHO
● NASTAD
● Vital Strategies
● New Jersey Center for Nonprofits grant list
Pursue in-kind supply donations
● Tip: Apply to the New Jersey Department of Human Services (NJDHS) naloxone portal Intranasal naloxone is one of if not the most expensive harm reduction supplies offered as part of safer use supplies at harm reduction services NJDHS distributes naloxone to community organizations and Harm Reduction Centers are eligible entities. It is also worth taking the time to learn about Intramuscular naloxone, which has benefits for some people who use drugs, is approved for community distribution, and is available at a much lower price point Check out this very comprehensive explanation of intramuscular naloxone from Remedy Alliance
● Tip: Consider joining Direct Relief network for in-kind donations of medical supplies
● Tip: Are safer use supplies your main programmatic costs? If so, can you partner with a more established harm reduction service for shared purchasing or in-kind supplies to distribute? Can you discuss with NJDOH whether any supplies will be made available on an in-kind basis? Are you in an overdose hotspot and able to receive supplies through NJDOH’s Overdose Hotspot Initiative?
Support increased investment in harm reduction services
● Tip: Every year, New Jersey lawmakers include syringe services in the state budget, but this investment pales in comparison to money spent on drug treatment and a criminal approach to drug use. Check out “For The People, By The People: State Budget 101” from New Jersey Policy Perspective and help grow public investment in harm reduction services
● Tip: Advocate for investment in harm reduction services using stateand county-level opioid settlement advisory funds Check out this overview on New Jersey’s Opioid Settlement Funds from Vital Strategies
8. Be proactive with public education
While the evidence for harm reduction services is overwhelming, decades of exclusionary policies and misinformation about the facts underlying drug use mean that using criminalized substances is still highly stigmatized in our state It is important to cultivate local partners who can advocate for your services, and be proactive with educating neighbors and community members on the importance of harm reduction Here are some materials you can use for this purpose:
● CDC: Syringe Service Programs Fact Sheet
● Changing the Narrative
● The New York Times: Politics are Tricky, but the Science is Clear: Syringe Exchange Programs Work
● Pew: Syringe Distribution Programs can Improve Public Health During the Overdose Crisis
● Peer-reviewed research about syringe service programs
9. Submit Your Application for Authorization!
Congratulations, you’ve done the difficult and often unglamourous work of planning work that will make your proposed program as impactful as possible NJDOH will respond to all applications within 30 business days of receipt.
Complete the Harm Reduction Center Registration Application and submit it to HRC@doh.nj.gov
● Tip: Be mindful that your submitted application will become part of the open public record and available publicly by request.
● Tip: You do not by any means have to have the answers to all of the questions posed by this checklist before submitting your application. This checklist gives more in-depth food for thought than the initial application requires You are also able to ask questions and have an iterative conversation about the application for authorization. The NJDOH harm reduction team encourages questions at HRC@doh njgov
APPENDIX
Core services and activities for authorized Harm Reduction Centers, which must be provided for free to the person receiving them, must include:
➢ Provide syringes, needles, safer use supplies, naloxone, and safe syringe disposal to consumers 18 years of age or older
➢ All clients and staff must be given a uniform membership card
➢ Provide a schedule of the HRC operating hours and locations
➢ Provide spoken education about HIV, viral hepatitis, overdose prevention, harm reduction services, and substance use disorder treatment services. (HRCs also have the option of adding written and electronically available materials )
➢ Educate all consumers about safe and proper disposal of needles and syringes.
➢ Encourage consumers to receive HIV, viral hepatitis, and sexually transmitted infection tests.
➢ Provide overdose prevention information to consumers, family members and friends of consumers, and members of the public.
➢ Please note: While safer injection supplies are a nonnegotiable component of harm reduction services, many New Jerseyans who would benefit from expanded harm reduction services are interested in safer smoking and snorting supplies, and these supplies are also essential public health tools.
Expanded services and activities for authorized Harm Reduction Centers, which must be provided for free to the person receiving them, may include:
➢ Drug user health education including education about safer injecting and safer consumption techniques, overdose prevention and response, viral hepatitis, HIV, and other issues relevant to the health of people who use drugs
➢ On-site access, referral, or linkage to care for intersecting health and social services including substance use disorder (SUD) treatment, wound care, counseling, mental and physical healthcare, harm reduction support groups, shelter and housing, public benefits, employment services, legal services, HIV, viral hepatitis, and STI testing, care and treatment, HIV PrEP (Pre-Exposure Prophylaxis), and reentry services
Updated July 6, 2023 njharmreductioncoalition.org
@njharmreduction
