September 2013

What makes a good NSP?

The NSP was a nondescript shop front in a row of discount outlets. The street was off the main shopping strip but close to the train station and had seen better days. The main window signage said it was a health clinic, but there was a small sign, handwritten in blue texta, on the door which said: NSP.

A row of large, yellow wheelie bins was visible through the shop front’s milky glass, looking like industrial-grade sharps containers. Nothing outwardly indicated that this was one of the busiest NSPs in the state.

Inside was a standing-room-only reception area and a counter; a no-nonsense sort of a place. The boxes of injecting equipment open on the counter inside the serving area gave the only hint as to the place’s real function.

The counter attendant was welcoming and friendly. Her warm smile was disarming as she asked how she could help Robert.

“Just a five-pack,” he said.

“Do you need a spoon, water? How about cotton wool?” she asked, bagging up five 1-ml syringes.

“No, I use cigarette filters, always have. What’s the story with the cotton wool?” he asked, wanting to draw the worker out a little.

“We recommend cotton wool because there’s some danger that fibres from cigarette filters can be drawn up into the syringe and get into your veins. It’s thought that they can stick to the vein walls and mat up and actually block or collapse veins.”

“But I’ve been using cigarette filters for years.”

“And how are your veins?”

“Collapsed.”

“And do you ever get tingling in your fingers?”

“Yep, bad sometimes.”

“So you’d probably be better taking some of the cotton balls,” she added with a gentle smile.

After many mixed experiences with NSP workers, this was one of the best for Robert. The worker’s friendly and non-intrusive manner relaxed him and her warm and non-judgmental approach conveyed respect. Her obvious openness to further discussion without prdessing the issue made Robert feel confident he could return in the future and get sound advice for any other issues.

Finding the right balance between respecting a person’s privacy and right to determine their own health needs whilst trying to provide them with equipment, information and referrals isn’t always straightforward.

The interaction between an NSP worker and a client can be complex. Finding the right balance between respecting a person’s privacy and right to determine their own health needs whilst trying to provide them with equipment, information and referrals isn’t always straightforward.

Time pressures also need to be taken into account. Realistically, a client/staff interaction at an NSP can last 60 seconds and a client may be in a hurry or nervous, only wanting to get their equipment and leave. They may not be interested in referrals and may resent being questioned. On the other hand, an NSP staff member may be inexperienced or time-poor and not able to engage the client as much as they’d like.

Some of the ideal qualities for NSP workers are as follows:

• non-judgmental attitude;

• easy-going and friendly;

• tolerant;

• good communication skills with a wide range of people; and

• ability to remain calm in stressful situations.
Claire Hose, a peer educator with Noarlunga Primary Health Clean Needle Program in South Australia, believes taking a non-judgmental and open approach is key. She concedes, though, that it is not always easy.

“Just because we’re users doesn’t mean we’re not judgmental. As an opiate user, I might have some judgment around amphetamine or steroid users.

“We’ve all developed our views and values over our lifetime, and you can’t just put that aside, you really have to work at it. Even if you’re trying hard, you can let it [your views] out by using the wrong language. It’s a constant process of people reminding themselves and going over it, otherwise things will slip out.”

In terms of referrals, Claire very much believes in following the client’s lead and that the client should determine how the interaction unfolds. But she also points out that everyone is an individual and every interaction is different.

“It’s up to the person to decide what they want to do with themselves. For me to push one treatment over the other is unethical. It’s up to the client to tell me what they want and for me to work out how to help them get it.

“The first few times someone comes in, we might not say anything aside from ‘hi’ and ‘how’s the weather?’ Very general stuff. It’s about building the rapport so that if something does happen, they feel confident they can talk to me or someone else in the service.

“We have a stat sheet where we tick off every time we give someone information or peer education. It’s a hard one because if we talk about the weather it’s not peer education, but it’s building up a rapport. It might seem like a waste of time talking about the weather for twenty minutes, but it pays off and you build the relationship.”

In a previous role, Claire was a volunteer coordinator. When speaking to new volunteers, she emphasised the importance of not telling people what to do.

“I always told them the one thing you never say is ‘No, don’t do that!’ You might say ‘Oh, don’t you understand this might happen’, or ‘Do you realise this?’ You provide them with the information so they can make the informed decision themselves. Don’t make them feel bad about what they are doing.”

Jason Savo is a community support worker with Alcohol, Tobacco and Other Drug Services at the Innisfail Hospital in north Queensland.

He says the NSP has two staff for a three-person operation covering a big area from Tully 60km to the south and Babinda 40km north. Clients come in to the triage staff at the hospital’s front desk and an NSP worker is called if required. His advice for newcomers to NSPs is to thoroughly know and understand the injecting equipment.

“You’ve got to know the different kinds of needles used for different drugs so when the clients ask for a certain kit you know what drugs they’re doing.

“But if you put on a happy face every day and provide good, clean equipment, it’ll keep the clients happy.”

Jason says confidentiality is an issue at times. He was brought up in Innisfail and sometimes people come in who know him and are worried their drug use may become the subject of town gossip. He takes great pains to let them know whatever happens in the NSP stays in the NSP.

“We have to keep confidentiality because all they want to do is pick up the packs.”

Jason says they can provide any other help they need, beyond the routine supply of injecting equipment.

However the extent to which he is able to offer other assistance depends on the rapport he has built with clients.

“We do have a duty of care and we can say: ‘Hey you aren’t looking so well’. But you have to build up a rapport so when they come in they know you. Our service is a voluntary service so if they want help we can provide it for them when they’re ready. We don’t force anyone. A lot of clients have got issues in their lives that they don’t want to talk about. But the first interaction, that general conversation to see how they’re going – ‘How’s the family? How have you been?’ – is important.

“A lot don’t have that conversation with anyone because they isolate themselves so I just try and spark up that conversation,” Jason says.

He says that over the years he has seen regular clients’ health deteriorate but they have to ask for help first.

“Some have high needs but they’ve gotta make that first move. Except sometimes they don’t know how to, so unless you start that conversation you’ll never know.”