Appendix 1.0 (wip)

University of Ottawa – Algonquin College Collaborative B.Sc.N

NSG3323: Community Health Nursing Practicum

Final Nursing Report

Project Title: Harm Reduction

Host Organization: Algonquin College

Name of School and Course: Algonquin College NSG3323P and DEN4450

Date of Placement: Fall 2015

Team Members: Nursing: Rachael Moutoussidis, Nimo Osman, Luz Arcena, Jessica Vena, Chantal Charron, Delaney Bernhardt, Aira Buenviaje, Candace Bachmann

Dental Hygiene: Naomi Hurtubise, Kendall Paolino, Marie Smith, Freya Potter

Clinical Preceptors: Polly Leonard, Amanda Neilson

Clinical Professor: Sherry Poirier

Purpose:

The purpose of this community group project is harm reduction and community engagement. Harm reduction is the use of strategic tools and techniques in order to minimize the harm to self. The use of harm reduction in this project is geared towards minimizing harm when using drugs and other substances. This project focuses on marijuana, and MDMA. The team collaborated with the Algonquin College Umbrella Project in order to promote harm reduction in the Algonquin College student community. The goal of the Umbrella Project is to raise awareness to students of the increased risks when using substances and to educate them on how to minimize these risks if they do choose to use.

Assessment:

The following includes secondary data that the students researched in preparation for planning the interventions.

• UBC Healthy Mind Healthy Campus Initiative

  An initiative implemented by the University of British Columbia to promote campus mental and physical health, in addition to promoting harm reduction strategies. There are four pillars of action that increase students overall health outcomes. The pillars are: healthy school policy, social and physical environment, partnership and services, and teaching and learning.

• Centre for Addiction and Mental Health: Treatment

  Mental health centre in Toronto that offers services for clients struggling with addictions. Some of the any services include: Addiction assessment services, Medical withdrawal unit, Metro Addiction Referral Service, and Metro Addiction Assessment Referral Service

• Changing the Culture of Substance Use – Phase II Project Update

  A harm reduction initiative for postsecondary campuses across British Columbia. The goal is not to stop drug use, but to implement harm reduction strategies. The article refers not only to alcohol, however it does focus on it. “Dinner Basket” conversations are an initiative whose goal is to follow up with students regarding interventions. The Campus hub allows students to consume alcohol in a safe, secure environment.

• UVIC Harm Reduction Activity

  At the University of Victoria, there are students creating organizations to introduce the topic of drug use and how to reduce harm. At parties and raves on campus, volunteers are available to help participants make informed decisions about substance use.

• Portugal – Harm reduction/ legalization strategy

  Portugal decriminalised the possession of all drugs for personal use in 2001, which means that while it is no longer a criminal offence to possess drugs for personal use, it is still an administrative violation, and is punishable by penalties such as fines or community service. Portugal added to its policy of decriminalisation by expanding and improving prevention, treatment, harm reduction and social reintegration programmes. Portugal’s shift towards a more health-centred approach to drugs, as well as wider health and social policy changes, are equally responsible for the positive changes observed since 2001.

• Harm Reduction on International Campuses

  Many campuses around the world have initiated harm reduction strategies. University of Oxford provided Counselling and self-help, in addition to the addiction workbook, which is a step-bystep guide to quitting alcohol and drugs. Night line is an intervention run by students where one can talk about anything via Skype, mobile, or drop in for “coffee and a chat”. The Little Green Safety Book’ incorporates a “Broad range of guidance documents that you may need to refer to during your time at Cambridge.” The Australian National University has an online interactive program called The Desk, which is a free online program providing Australian post-secondary students with strategies and skills for successful wellbeing.

• Safer Use of Cannabis

  Cannabis is the most commonly used illicit substance in Canadian youth (ages 15-24). People use cannabis for a variety of reasons such as: to relax and decrease anxiety, relieve stress, have fun, as a coping strategy, for spiritual purposes, or to reach an altered state of consciousness. Although it is unrealistic to stop all youth from using cannabis, education can be provided about safer ways to use and therefore prevent some of the negative outcomes. Some harm reduction strategies include: using only one substance at a time, ensuring a safe way home, a safe environment, and take shallow puffy instead of deep inhalations.

• Molly

  Molly is a nickname for MDMA, a synthetic compound. MDMA is pure crystal powder but is commonly sold as pills. Ecstasy refers to pills containing MDMA and other additives including amphetamines, caffeine, ketamine and ephedrine. Harm reduction strategies with molly include: staying hydrated while using, staying in one location and using with familiar people, taking supplements post trip to restore serotonin levels, c hew gum to help with jaw clenching, and allow time between trips to allow brain to restore serotonin levels

• ACHA-NCHA

  The NCHA is a national survey conducted periodically in order to better understand students’ health and wellness. Some of the topics included in this survey are the general health of college students, disease and injury prevention, academic impacts, violence, abusive relationships and personal safety, alcohol, tobacco and other drug use, sexual behaviour, nutrition and exercise, mental Health, sleep and marijuana use. The statistics for marijuana use found that:
  Never Used: 60.1%
  Male: 57.5 %
  Female: 61.3 %
  Used in the last 30 days: 16.0 %
  – Male: 19.3 %
  – Female: 14.5 %

• Canadian Centre on Substance Abuse

  This is organization based in Ottawa that provides guidance on addiction and substance use. Over the past decade there has been an increase in alcohol and drug use in Canada. From 1994 to 2004, current use went from 72% to 79% for alcohol use, from 7% to 14% for marijuana, from less than 1% to almost 2% for cocaine/crack use and from 1.1% to 1.3% for LSD/speed/heroin. About 25% of Canadians occasionally or frequently use alcohol in a way that can increase complications. Youth alcohol consumption which is ages 15-24 is at 83% which higher than the general population. Of that 83%, 37% reported binge drinking. Canada is aiming to create environments that promote health in individuals, families and communities to help prevent substance abuse and reduce the harms associated with substance abuse across Canada. The areas of priority for this organization includes increasing awareness and understanding of problematic substance abuse through public education, sending a message that substance abuse can be linked to mental illness and other health issues, promoting a general agreement around common terms such as misuse, abuse and addiction, getting the people who are most affected involved in making the message and providing education for Health professionals and public on harms connected with problematic use of pharmaceuticals

• The Acadia Strang Report

  Acadia University released a summary of best practices and recommendations for alcohol use. The report discusses the harms associated with binge drinking, mixing caffeinated beverages with alcohol, the incidence of assault, motor vehicle collision, sexual assault, and unprotected sex. The report presents a framework that can be used to create programs and policies that may help to decrease harm focusing on three interventions. These include individual to decrease the demand for alcohol and harms that result from over drinking. The second intervention is environmental, which is to decrease the supply of alcohol (on/near campus). The third intervention is systems, which is to broaden community support at a higher level such as provincial or federal that regulate alcohol policies.

• Toking and Driving

  There was an exploratory pilot study conducted to investigate the characteristics of Canadian university students who drive after cannabis use. This study revealed that the number of university students who drive after using cannabis has dramatically increased over the past decade. The highest use prevalence levels (29–47%) are concentrated in the age group of 15–24 years, including secondary and post-secondary student populations. Interventions need to aim at shaping awareness and decision making in these particular sociocultural contexts.

Analysis:

The Umbrella Project is a two year campaign that is being run at Algonquin College. The Nursing and Dental Health students’ project is part of the first quarter of this project. The students only conducted secondary data and based on the data collected, the group decided to hold two campaign days in order to raise awareness about harm reduction strategies for drug use. It was found that one of the most effective ways to engage college students is to use games, bright colours, prizes and giveaways. This is how the students decided to design our campaign days in attempt to get as much participation as possible, while spreading our message to as many people as possible. As a result, a four-part poster series, and two pamphlets regarding safer use of MDMA and cocaine were created. Following the work done by the nursing and dental health students, The Umbrella Project will be continued on and primary data will be conducted in January through the implementation of a survey at the college.

Interventions:

Four interventions were implemented: two booths (one for safe partying, and one for stress management) a four part poster series, and pamphlets on safer use of cocaine and MDMDA

• Intervention 1: Booth Day #1: October 20, 2015

  On this day, the nursing students and dental hygiene students help two campaign booths (one in the Student Commons and one in the B-building). The purpose of these campaign booths were to raise awareness about harm reduction strategies for drug use. The focus of the teaching at theses booths were on drugs related to partying (marijuana and MDMA) because it was a week before Halloween when many people go to parties. The games that were made to encourage participation included harm reduction strategies focused on doing drugs at parties (Ex. Find a safe ride home). In order to engage people to come to the booths, the students decorated the tables with Halloween decorations, used bright colours on the posters and worse Halloween costumes. Also, the students handed every person a loot bag with Halloween candy, an Umbrella Project pin or lip balm, and a Handout with 5 Tips to Harm Reductions and Addiction Resources on it. In addition, as an incentive to play the game at the booths, if the guest participated in the game, they were entered in a draw for one of the many prizes (2 T-shirts, 2 one-month gym memberships and 2 water bottles).

  • Student Commons Booth Game
  • At this booth, the students had a matching game as a teaching aid when speaking with people about harm reduction. There were 10 pairs of matches with statements about harm reduction strategies and information about The Umbrella Project. To play this game, the guest would have to attempt to match as many pairs as possible.
  • B-Building Booth Game
  • At this booth, the students had a Jeopardy-style game, where on the poster, there were questions about harm reduction strategies and The Umbrella Project.
• Intervention 2: Booth Day #2: November 17, 2015

  On this day, the nursing and dental health students held two campaign booths (one in the
  Student Commons and one in the B-building). The purpose of these campaign booths were to raise awareness about harm reduction strategies for drug use. The focus of the teaching at these booths were on drugs related to stress relief (caffeine, stimulants, marijuana) because at this time of year many students have midterms and upcoming final exams. The games that were made to encourage participation included harm reduction strategies focused on doing drugs in order to study or relieve stress (Ex. Don’t pull ‘all-nighters’). In order to engage people to come to the booths, the students decorated the tables with calming decorations such as candles and neutral colours. Also, the students handed every person a loot bag with an herbal tea bag, cookies, an Umbrella Project lip balm, and a handout with Safe Study Tips and Addiction Resources on it. In addition, as an incentive to play the game at the booths, if the guest participated in the game, they were entered in a draw for one of the many prizes (2 canisters of tea and 2 massage gift certificates). The teaching methodology at both of these campaign days was through conversations with the guests; during the games if they got anything correct or incorrect, the students would explain to them the meaning of each question/match, and also, the students welcomed any questions that the guests had.

  • Student Commons Booth Game:

    At this booth, the students had a matching game as a teaching aid when speaking with people about harm reduction. There were 12 pairs of matches with statements about harm reduction strategies and information about The Umbrella Project. There were matches included in this game that focused on exam stress and drug use. To play this game, the guest would have to attempt to match as many pairs as possible.

  • B-Building Booth Game:

    At this booth, the students had a Jeopardy-style game, where on the poster, there were questions about harm reduction strategies and The Umbrella Project. There were also questions included in this game that focused on stress relief and drug use.

• Intervention 3: Four Part Poster Series

  The purpose of this intervention was to provide the preceptors with a deliverable that can be used for future portions of The Umbrella Project. The function of the posters was to act as a way to communicate small health promotion acts with regards to the use of alcohol and drugs. Additionally, the purpose of the posters are to spread awareness about The Umbrella Project. Each poster focuses on one of the four main slogans of The Umbrella Project which are: pick one, don’t hold your breath, mind your mental health, and not too much not too often. During the planning process for designs, observations of posters already present on The Algonquin Students’ Boards were examined. The writers concluded that a simple design and straight forward messages on posters were most effective. Each poster will be individually described below.

  • Pick One

    The premise of this poster was aimed to touch upon the use of multiple drugs simultaneously. The design of the poster is meant to lead the viewer to understand that if an individual were to use drugs, to only pick one rather than use two drugs together; hence the split road sign depicting one way is to choose marijuana and the other is alcohol. A short message was provided on the poster to include some teaching, “Things that don’t go good together: alcohol and any other drug including caffeine”.

  • Don’t Hold Your Breath

    The basis behind this slogan is to teach students to not hold their breath when they smoke THC. Marijuana is absorbed instantly when inhaled and if the user were to continue to hold their breath, based on the assumption that one gets “higher” when holding their breath, they damage their lung tissue. When one holds their breath it allows the toxins to sit and stay longer in the lungs. On the image of the poster, the Umbrella logo is used to represent the lungs. This combination is aimed at incorporating the Umbrella projects harm reduction ideals along with the basis of protecting the lungs in this specific example. The respective message depicted is, “You’re not going to get any higher! THC only takes a few seconds to absorb into your system”.

  • Mind Your Mental Health

    The information that this posters intends to convey is around the basis of mental illnesses following the use and abuse of alcohol and drugs. To support this information the poster focuses on the mental wellness of college students. The image of this poster depicts the Umbrella project logo acting as a reminder to protect ones mental health. A small message added onto this poster is, “Take notice of how you are feeling before, during and after using alcohol or other drugs”.

  • Not Too Much Not Too Often

    This message describes the importance of moderation when using alcohol or drugs. Constantly consuming alcohol or using drugs impacts the body in many negative ways. The image of the poster embodies the aspect of constantly consuming alcohol and its negative effects on the liver. The Umbrella logo is placed in the general area of the liver, but can also be interpreted as protecting the body in general. The message chosen for this poster is, “Consuming less alcohol and using less of a drug reduces the chances of you trending on social media for all the wrong reasons”.

• Intervention 4: Pamphlets on Cocaine and MDMA

  The information for the cocaine pamphlet was obtained from several evidence-based web sources. The MDMA information was chosen from a variety of evidence-based sources on the web as well as obtained from the Molly power point information provided by Jess Vena. The content selected for the pamphlets was chosen because it was felt that the most important information to provide in terms of the Umbrella Project’s harm reduction strategy. It was attempted to keep the content clear, understandable and directed at our target audience of college students. The team followed the layout of the other current pamphlets in circulation so that the Umbrella Project would have a cohesive set of handouts.

Evaluation:

• Intervention 1: Booth Day #1: October 20, 2015

  This Halloween-themed booth day which ran on October 20th, was a huge success. The main substances that were focused on were MDMA and marijuana. These drugs were chosen as the topic of focus at this time since they are considered party drugs. At the student commons booth 137 candy bags, 100 condoms and 300 pamphlets were distributed to the students. In regards to raffle prizes, 51 ballots were submitted and 3 winners were chosen. The raffle prizes consisted of a one month membership, water bottle and t shirt for the Algonquin gym. The team members at this booth quickly found that sticking the matching cards onto the poster board was not very effective. Instead, matching the sets on the table where the cards could easily be manipulated worked much better. It was also discovered that simply playing one game at a time was not adequate for the amount of participants that were interested in playing the game. A journalism student approached Jess, Rachael and Delaney to take their picture for the Algonquin Times, which was printed on October 29/2015. The team decided to split up the matching sets so that two games could be played at a time instead of one. Therefore, there were five matching sets per game instead of ten for one game. The booth set up in the B cafeteria distributed 150 candy bags, 134 condoms and 300 pamphlets. The same raffle prizes as listed above were distributed to 3 winners from the 85 ballots submitted. A few of the questions for the jeopardy game seemed to be misunderstood by the students, so they ended up being removed from the game. In the debrief both groups agreed that the easiest way to engage students was to approach them and ask, “Do you want to play a game about drugs?” Incorporating Halloween costumes and decorations into our booth displays attracted the target population. Providing students with goodie bags including candy was an effective way of attracting the clients. Students approached the booths in interest as to what was being done as many people would ask “What are you guys doing?” Some comments the groups received regarding the games were that they were informative and fun. The team decided for the next booth day that it would be beneficial to keep a log of comments and feedback from the students.

• Intervention 2: Booth Day #2: November 17, 2015

  This booth day ran on November 17th and was themed around coping skills during the exam period. The tone was much different than the first booth day. The goal was to promote a more relaxed and calming atmosphere as opposed to one of partying. The students achieved this through decorating the booths with candles, having neutral coloured table cloths and dressing in professional clothing. This time on the ballots, the guests were asked to rate on a scale from 1-5 how beneficial the booth was to them and provide a comment. The student commons booth counted 65 ballots: 38 people rated a 5, 13 rated a 4, 9 rated a 3, 1 rated a 2 and 0 rated a 1. The B cafeteria booth counted 90 ballots: 44 rated a 5, 16 rated a 4, 12 rated a 3, 1 rated a 2 and 0 rated a 1. In the debrief, the team discussed that advertising the opportunity to win a massage was effective. The groups found that many students did not want the goodie bags when we said we had cookies and tea. Therefore it was discovered that giving out candy is a more effective way of attracting students. Various comments the team had heard from the students included “refreshing” “love the initiative” “good job” “I smoke pot every day, is that bad?” “Great info”. The booth in the student commons had a different population this day due to an entrepreneur fair occurring behind the booth. Therefore there were many middle aged adults approaching as opposed to just students. This group of individuals was interested in what the group was teaching as well as playing the games. There was not found to be any judgement or discrimination regarding harm reduction strategies.

• The posters and pamphlets regarding safer cocaine and MDMA use have not been distributed to the public and therefore cannot be evaluated.

Recommendations:

There are a few recommendations that would make the remaining 75% of the project more effective. The recommendations will be split into two categories: one for the safe partying booth, and the second for stress management; following the recommendations the authors will discuss measures to ensure project continuity.

• Safe Partying Booth

  Students running the booth were dressed up in cat costumes to promote Halloween spirit. While they did entice an audience (70% of which were male) it could be argued that they were oversexualized. Going forward, the authors would recommend all black business casual attire instead, in addition to having male students help run the booths as well. Also, pre-emptively training students how to effectively deal with sexual harassment would made the students feel more prepared. Continue to decorate the booth festively, as it was aesthetically pleasing and helped draw a crowd in. Continue to keep the mood light and fun, meet the booth goers where they are in terms of use, and address harm reduction tips specifically for partying (i.e.: finding a ride, going out with friends)

• Stress Management Booth

  The students were dressed in professional, business casual attire and were still harassed. Again, training students how to deal with sexual harassment before the booths would have made them feel more prepared. Provide more education about “hidden drugs” for example some students were surprised to hear that energy drinks were actually drugs because they are so often consumed. Open the dialogue about abusing prescription drugs because although statistics show that they are misused as study aids, no one admitted to their use.

• Project Continuity

  To ensure continuity of the AC Umbrella Project, the project was passed onto Social Work students. Rachael Moutoussidis met with the students and taught them how to use the posters, set up the booths, and use the games; the students were provided with written instructions in case of further questions. Rachael also attended the AC Umbrella Project Student Advisory Committee in order to engage other students. The students at the advisory committee agreed that if they could: engage the community, receive and document positive feedback, spread awareness of the project and ensure that students were aware of the safe spaces on campus and resources available, that the committee would be meeting the projects expectations of being “for the students, by the students” and hopefully be able to implement the project permanently.

Appendix A
Booth Day 1 – Matching Game

• The Umbrella Project – Algonquin College’s drug harm reduction campaign
• Student Support Services – Algonquin College Counselling
• Signs that you’ve taken too much – nausea, vomiting, difficulty breathing and confusion
• Additives in Drugs – Ketamine, ephedrine and amphetamines
• Holding your breath gets you higher – False
• Pick One Substance – The more drugs you mix, the more unpredictable your trip
• Harm Reduction – A way of staying safe
• Find a Ride – Drugs decrease reaction time, impair vision and impair judgement
• Don’t hold your breath – THC is absorbed within seconds
• Drinking water – Can prevent dehydration

Appendix B
Booth Day 1 – Jeopardy Game

Appendix C
Booth Day 2 – Matching Game

• The Umbrella Project – Algonquin College’s drug harm reduction campaign
• Student Support Services – Algonquin College Counselling
• Signs that you’ve taken too much – nausea, vomiting, difficulty breathing and confusion
• Additives in Drugs – Ketamine, ephedrine and amphetamines
• Holding your breath gets you higher – False
• Pick One Substance – The more drugs you mix, the more unpredictable your trip
• Harm Reduction – A way of staying safe
• Find a Ride – Drugs decrease reaction time, impair vision and impair judgement
• Don’t hold your breath – THC is absorbed within seconds
• Drinking water – Can prevent dehydration
• Don’t pull “all-nighters” – Sleeping after studying helps your brain retain information
• Stay off campus if you choose to use – Suspicious behaviours on campus can be reported

Appendix D
Booth Day 2 – Jeopardy Game

Appendix E
Mind Your Mental Health Poster

[image here]

Appendix F
Don’t Hold Your Breath Poster

[image here]

Appendix G
Not Too Much, Not Too Often Poster

[image here]

Appendix H
Pick One Poster

[image here]

Appendix I
Evaluation of Booth Day 1

Halloween Candy Giveaway – focused on partying and drug use.

Appendix J
Evaluation of Booth Day 2

Halloween Candy Giveaway – focused on partying and drug use.

BALLOT STATS:

Appendix K
Qualitative Statements

Verbal Statements:

• “I smoke pot every day! Is that bad?”
• “That’s interesting to know” (regarding ‘don’t hold your breath’)
• “That’s unique to do that. You’re brave!”
• “I work for the AC Hub. I was in the meeting where we came up with the name ‘Umbrella Project’”
• “I like that you guys are doing this. I like seeing this here”
• “Great concept! Fantastic!”
• “It’s really great what you’re doing”
• “Very forward thinking”
• “Awesome service. Keep the good job!”
• “Love the initiative”

Written Comments on Ballots:

• “Refreshing!”
• “Great!”
• “Rushing!!!”
• “Great info and stuff!”
• “Good job guys!”
• “Well done!”
• “Thanks”
• “Good”
• “Meh”
• “Great game!”
• “Cool!”
• “Great enthusiasm!”
• “Great awareness!”
• “Fun!”
• “Keep going!”
• “Very informative pamphlets”