422 Final Paper SSP Jones Radcliffe and Nave 2016 Revised Ce Comments

Running head: Syringe Services Program 1
Assessment of and Recommendations for the Syringe Services Program
Amber Jones Radcliffe and Brittany Nave
Western Washington University
NURS 422 Organizational Change for Quality and Safety in Healthcare
December 1, 2016
Syringe Services Program 2
Assessment of and Recommendations for the Syringe Services Program
Injection drug use (IDU) is the most common risk factor for contracting hepatitis C virus
(HCV) due to sharing of needles and associated equipment (Linton, Goldoft, Syphard, &
Lindquist, 2016). Among the efforts to reduce transmission of HCV, syringe exchange programs
stand out as a frontline defense. Whatcom County Health Department (WCHD) joined this effort
in 1999 with the beginning of their own syringe exchange, known as the Syringe Services
Program (SSP) (Relyea, 2016). However, rates of HCV and other complications associated with
IDU continue to pose a significant public health challenge. Since 2007, there has been a dramatic
increase in the rate of hepatitis C reported in Whatcom County (Brockmann, Massanari, Newell,
Phillips, & Drewes, 2012). This is consistent with the increase since 2010 in the North Sound
Accountable Community of Health (NSACH)encompassing Whatcom, Island, Skagit, and
Snohomish Countiesin both acute hepatitis C cases reported and new diagnoses of chronic
hepatitis C (Linton et al., 2016). In Whatcom County alone, persons who inject drugs (PWIDs)
utilizing the SSP has increased 152% (Relyea, 2016).
Given this, the authorstwo Western Washington University nursing studentswere
tasked with assessing the health needs of this population and exploring ways to improve access
to and the efficacy of the SSP. To do this, the authors developed a written survey with the
guidance of mentors Jessica McAllister and Nancy Poulinboth public health nurses with
WCHD. Sixteen questions were presented to clients of the SSP, focusing on supplies, behaviors,
complications, and resource use (Appendices A and B). The authors also conducted one-on-one
interviews with focus questions to elicit the populations perceptions of the SSP and their
community (Appendix C). Cindy Hollinsworth, manager of Communicable Diseases and
Epidemiology at WCHD, assisted the authors in forming focus interview questions. A literature
review was also conducted to explore potential changes that could increase the accessibility or
efficacy of the SSP.
Change Theory
To assist in this endeavor, the authors looked to established change theories to guide their
efforts. Lippitts Phases of Change theory in particular reflects the stages of the nursing process
in a way that was meaningful to the authors and was clearly delineated in its own expectations
(Mitchell, 2013). It is also noted in the article by Mitchell (2013) that Lippitts theory pairs well
with a democratic leadership style, which may suit the needs of WCHD in moving change
forward to improve the SSP.
Assessment and Diagnosis
According to Mitchell (2013), assessment encompasses the first three phases of Lippitts
theory: diagnosing the problem (phase 1), assessing motivation or capacity for change (phase 2),
and assessing change agents motivation and resources (phase 3). Given the increase of HCV in
the county, the authors identified three potential questions to seek answers to: 1) Why do HCV
rates continue to increase?, 2) What are the unmet health needs of this population?, and 3) How
can the SSP grow? In identifying these questions, the authors distilled the issues down to
learning and health needs of PWIDs, as well as accessibility of the SSP to those who do not live
in the city of Bellingham, where the SSP is located.
In assessing WCHDs capacity and motivation to change, the authors developed a force-
field analysis (Appendix D), to visualize factors propelling and restraining organizational
change. This is further discussed in the Organizational Readiness for Change section.
The authors assessed their own motivation and resources to contribute to this change, as
both are residents of Whatcom County and both work as nurses in the community. Through their
mentors, the authors had access to literature offered by WCHD, as well as SSP statistics and
demographics. The authors reached out to other county and regional organizations, such as
Phoenix Recovery Services and the University of Washington Alcohol and Drug Abuse Institute
(UW ADAI). The authors also developed a survey that underwent Plan, Study, Do, Act (PDSA)
cycles with feedback from their mentors and compiled the results in Survey Monkey.
Planning
Both phases 4 and 5 of Lippetts theory fall under the planning stage of the nursing
process (Mitchell, 2013). Phase 4 suggests selecting a progressive change objective. The
authors created a logic model to help define actual outputs, as well as recommendations for short
and long-term goals for the WCHD (Appendix E). The authors also drafted a written survey and
verbal focus interview questions and developed a time-table set over 3 weeks to accomplish
these surveys (see Table 1). Plan, Study, Do, Act (PDSA) cycles were conducted in regards to
survey participation factors (Appendices F and G). Minor changes were made to questions and
formatting based on feedback from mentors after the first survey week (Appendices A and B).
Results are in Appendices H through K (Jones Radcliffe & Nave, 2016).
Table 1. PDSA Survey Timetable

Survey Week 1 Survey Week 2 Survey Week 3
w = 39 w=3 w = 18
v=1 v=0 v=6
Authors recruited participants Authors were not present. Authors were present and
in person without material Treatment counselor was encouraged participation, as
incentives. Clipboards with present to encourage well as incentivized focus
surveys and pens were placed participation. interviews with food and
on waiting room chairs. beverage.
w = written surveys v = verbal focus interviews
Phase 5 includes definition of the change agents role in the change process (Mitchell,
2013). The authors roles were limited to data collection and consultation. Being outsiders to the
WCHD, the authors lack social clout and other knowledge of moving change forward through
the WCHD. But as outsiders, the authors were also free to explore avenues that might not have
occurred to WCHD staff or were limited by work hours and logistics.
Implementation and Evaluation
Phase 6 describes the implementation of the proposed changes, with special consideration
given to communication, feedback, and motivation. While the authors will not be present to see
through any implementation of recommendations made to WCHD, they still had the opportunity
to seek and implement feedback using brief PDSA cycles to improve the nature of both the
written survey and focus interviews. Phase 7 includes evaluation and withdrawal of the change
agent (Mitchell, 2013, p. 37) at a time set forth at the beginning of the consulting relationship.
This date was November 17th for the authors and also included a feedback session with WCHD
staff and colleagues to further develop the recommendations set forth in this paper.
Organizational Readiness for Change
To visualize supporting and restraining components of WCHDs readiness for change, a
force-field analysis was modeled (Appendix D) after the example provided by Mitchell (2013).
Developed by Lewin, a predecessor of Lippett, the force-field analysis illustrates factors
propelling or restraining change. It is suggested that the organization considering change look for
ways to bolster propelling factors, while attempting to minimize restraining factors (Mitchell,
2013). One of the main driving forces for change is the increase of HCV rates in Whatcom
County. While not necessarily a positive factor, it is still one that necessitates change and may be
supported by increased public awareness of both opiate addiction and HCV. WCHD itself has
also initiated new quality improvement processes that will aid in reevaluating the effectiveness
and areas to improve the SSP.
Another encouraging factor is that prior to this project, the WCHD had already begun
laying the groundwork for a partnership with the East Whatcom County Council. This council
includes the area of Kendall, which lies at the intersection of major roadways in the east part of
Whatcom County. The authors findings support this plan, as three of six focus interview
participants also cited Kendall as an area in need of outreach services or a satellite syringe
exchange. Collaboration with other counties and institutions outside of Whatcom County is
another promising route, but the authors did encounter resistance to forming these relationships
on their own.
Other restraining factors include budgetary concerns, as well as the logistics of a potential
secondary location. Per Cindy Hollinsworth, the budget for WCHD has been submitted, so
additional improvements were require requesting more funding or seeking grants elsewhere.
Transportation or storage of supplies at a secondary site would have to be considered, as well as
recruiting additional volunteers if current volunteers are unable to travel to a secondary location.
Staff within the WCHD will also have to discuss whether a satellite location would suit the needs
of PWIDs better than a mobile syringe exchange.
Acceptance of the local community is another vital factor in the success of a SSP
(NASTAD & UCHAPS, 2012). While Bellingham largely seems to tolerate and support the SSP
located downtown, the perceptions of other communities in the county such as Kendall should be
assessed thoroughly. As one focus interview participant noted, the public may view a SSP as
enabling drug use, therefore creative and collaborative approaches in outlying communities
will be essential.
Recommendations
User-Driven Model
With 87% of written survey respondents indicating they could use more syringes and
68% indicating that they reuse syringes, WCHD may also consider increasing the number of
syringes exchanged on a one-to-one basis or entertaining an entirely different model altogether
the User-Driven model. WCHD currently has a one-to-one exchange with a maximum of 100
syringes per week, per person. A User-Drive model allows the participant to determine the
number of syringes they need without having to exchange an exact number in return. A multi-
city study noted that limits on syringes exchanged may contribute to a scarcity effect that
encourages reusing of syringes (Bluthenthal et al., 2004). Chicago and Oakland were cited in
particular as having more open syringe exchange policies, and consequently PWIDs reported less
reuse of syringes (7% and 11%) compared to Hartford, Connecticut where there is a limit (26%).
Allowing PWIDs to determine how many syringes they need may reduce this scarcity effect and
in turn, encourage use of a clean syringe every injection.
However, it may be financially burdensome to a smaller health department such as
WCHD to allow distribution of syringes independent of used syringes exchanged. But if it is
feasible, perhaps removing the limit of 100 syringes per person, per week may have a similar
effect. It may also reduce hoarding of used syringes, thus increasing safe syringe disposal.
Mobile Exchange
Phoenix Recovery Services operates a mobile syringe exchange in the Skagit Valley
under a contract with the Skagit County Public Health Department and presents a flexible and
effective distribution model well-suited to rural areas (National Alliance of State and Territorial
AIDS Directors (NASTAD) & Urban Coalition for HIV/AIDS Prevention Services (UCHAPS),
2012). Though the authors made multiple unsuccessful attempts to contact this agency, further
efforts might be beneficial to exploring a mobile-based service in rural parts of Whatcom
County.
Satellite Location
Continuing to build upon the work WCHD has already done in regards to a satellite
location in Kendall seems most promising and is supported by data gathered from key informants
in focus interviews. To ensure community support, WCHD should continue to build relationships
with members of the East Whatcom County Council and assess the perceptions and knowledge
of both the greater community, as well as PWIDs that live in that area in regards to the SSP.
Future Surveys
While the survey conducted by the authors elicited potentially useful information, it
would behoove WCHD to continue to seek information on the using behaviors of PWIDs. More
focused questions surrounding the using behaviors in regards to sharing and cleaning of
equipment could reveal potential learning needs regarding transmission of HCV. Assessing the
needs of rural clients would also elicit useful information in targeting that specific population,
whose access to the SSP in Bellingham may be limited.
Conclusion
In light of increased HCV rates, continual assessment of using behaviors of PWIDs is
essential to monitor both unmet learning and health needs in this population. While growth of the
SSP may be restricted by seemingly immovable forces such as finances, creative community
solutions may elicit positive changes for this population that results in a healthier community and
decreased HCV rates in the long-term.

References
Bluthenthal, R. N., Malik, M. R., Grau, L. E., Singer, M., Marshall, P., Heimer, R., & Diffusion
of Benefit through Syringe Exchange Study Team. (2004). Sterile syringe access
conditions and variations in HIV risk among drug injectors in three cities. Addiction
(Abingdon, England), 99(9), 11361146. https://doi.org/10.1111/j.1360-
0443.2004.00694.x
Brockmann, L., Massanari, M., Newell, A., Phillips, C., & Drewes, B. (2012). Whatcom County
Community Health Assessment (pp. 1136). Whatcom County Health Department and
PeaceHealth St. Joseph Medical Center. Retrieved from
http://www.doh.wa.gov/Portals/1/Documents/1200/WhatcomCHA2012.pdf
Jones Radcliffe, A., & Nave, B. (2016). Syringe Services Program Data Report. Western
Washington University.
Linton, N., Goldoft, M., Syphard, L., & Lindquist, S. (2016). Viral Hepatitis C in Washington
State (No. 420159) (pp. 197). Washington State Department of Health. Retrieved from
http://www.
doh.wa.gov/DataandStatisticalReports/DiseasesandChronicConditions/ChronicHepatitisS
urveillance
Mitchell, G. (2013). Selecting the best theory to implement planned change. Nursing
Management, 10(1), 3237.
National Alliance of State and Territorial AIDS Directors (NASTAD) and Urban Coalition for
HIV/AIDS Prevention Services (UCHAPS). (2012). Syringe Services Program (SSP)
Development and Implementation Guidelines for State and Local Health Departments.
Retrieved from https://www.nastad.org/sites/default/files/055419_NASTAD-SSP-
Guidelines-August-2012_0.pdf
Relyea, K. (2016, August 14). As opioid epidemic worsens, demand jumps for clean needles in
Whatcom County. Retrieved November 12, 2016, from
http://www.bellinghamherald.com/news/local/article95404832.html
Appendix A
Syringe Services Program Survey Week 1

Appendix B
Syringe Services Program Survey Weeks 2 and 3

Appendix C
Focus Questions for Interviews
1. How did you hear about the syringe exchange program?
2. Outside of Bellingham, which areas do you think need syringe exchange services the
most?
3. Do you wish the exchange was open more days of the week?
a. How many days would be helpful?
b. What days of the week would be helpful?
c. What time of day would be helpful?
4. Some cities have safe injection siteswhat are your ideas about this?
5. Do you have any suggestions for how the program could be easier to access?
6. Tell me about your strengths.
7. Tell me about your struggles.
8. Tell me about your community strengths.
9. Tell me about your community struggles.

Appendix D
Force-field Analysis
Factors Propelling and Restraining Change within the WCHD SSP
Factors Propelling Change Factors Restraining Change
Increased public awareness of

opiate addiction
Limited contact with other agencies
Evidence showing increase in

hepatitis C rates Budgetary concerns
Groundwork in progress for 2 location

Logistics and staffing of
2 location
Community partnership with

East Whatcom County Council
Public misconceptions of SSPs
New quality improvement

initiatives within WCHD
Conflicting internal goals
Appendix E
Logic Model
Statement of Need: Reduce hepatitis C rates in Whatcom County by improving and expanding the SSP.
Inputs Strategies/Activities Outputs Short-term Long-term Outcomes

Outcomes
WCHD staff Conduct written survey Number of Identify and Increase access to
(nurses, to collect information on filled out address internal SSP, either by
administrative, SSP areas for surveys and areas of increasing days/ hours
epidemiologist), improvement, barriers to data compiled improvement of operation or number
substance use access, and experiences in Survey of locations where
Identify client
counselor of clients Monkey, as SSP is offered
learning needs
well as own
Syringe Services Host one-on-one based on Provide focused client
data report
Program (SSP) interviews to elicit discrepancies in education to address
volunteers clients perceived Qualitative data and discrepancies in best
strengths and struggles data from focus address with practice vs. actual
Paper, clipboards,
interviews with education practice of client
and pens for survey Advertise survey within
comments on substance use
waiting area of SSP and Recommend
Computer with trends and behaviors
encourage participation ways to
Internet access to insight
with verbal reminders improve Make suggestions for
compile and
Generate a accessibility to services offered, based
disseminate results Assess surrounding
community SSP on client feedback
community and
Incentives to get health
resources available to Supply
participation in assessment
clients tabulated
focus interviews based on data
results of
Literature review to gathered from
Time for windshield survey
inform activities related windshield
survey, to conduct participation to
to survey survey and
surveys and focus inform whether
clients
interviews, and Request input from incentives are
other activities industry experts Comparison of necessary
survey
Building/facilities Supply graphs
participation
designated for to show trends
with incentives
exchange in data from
and without
survey
Appendix F
Run Chart of Written Survey

Appendix G
Run Chart of Focus Interviews

Appendix H
Syringe Services Program Data Report
Summary of Findings
Response rates for written survey questions were generally favorable and those questions
with relatively few respondents are noted in the data analysis. Respondents indicated a high need
for more syringes and a moderate need for more alcohol wipes and Narcan. It was noted that
cookers were viewed as something over half of respondents could use less of, which may
correlate with most respondents saying they reuse cookers. Cotton fever and abscesses were the
most commonly reported health issue related to their injection drug use (IDU). Accessibility
issues appear to revolve around fear of identification and lack of transportation. Regarding
information services, most respondents indicated they had at least taken brochures home and
nearly half indicated they had used those services. Over half of respondents had accessed
hepatitis C or HIV testing specifically at the exchange and if they had not, the top reason cited
was that they had already been tested by their primary care provider.
Background and Methods
The data collected is the summarization of 3 separate written surveys conducted during
the Syringe Services Program (SSP) at Whatcom County Health Department (WCHD). The first
survey had 39 respondents, the second had 3, and the third had 18, for a total of 60 surveys
compiled into this summary. The survey consists of 16 questions, which when compiled into
Survey Monkey, resulted in a total of 19 distinct questions across all 3 surveys. Respondents
were asked only to fill surveys out if they had not before. No immediate incentives were offered
for completing the written survey, though potential respondents were counselled that the survey
could lead to improvements in accessibility and efficacy of the SSP. The following data analysis
is organized by question and correlates with the question numbers listed in the Survey Monkey
data summary (located after the appendices).
Verbal focus interviews were also conducted on the first and third survey days. The
initial plan was to hold actual focus groups, but a one-on-one approach seemed less daunting to
participants. On the first day, no incentive was offered for participation in a focus interview and
they were held after a Narcan class. There were 9 questions. This yielded one participant. On the
third day, incentives were offered (Cliff bars and hot beverages) and interviews were conducted
immediately after clients exchanged. There were 12 questions. This yielded five participants. All
participants were informed that their answers would be used to improve identify problems in
accessing the SSP, as well as other needs of the community. All questions asked were prefaced
as optional. Sample surveys are presented in Appendices A and B. Open-ended and focus
interview answers are located in Appendices I and J. Survey results are located in Appendix K.
Data Analysis and Key Findings
Written Survey
1. Most respondents (87%) indicated that they could use more syringes, with moderate
interest in more alcohol wipes (52%), Narcan (50%), and water (45%), with 57
responding.
2. Cookers (65%), cottons (43%), bandaids (52%), and ties (50%) were indicated as
supplies respondents thought they could use less of (44 responding).
3. Of items respondents share, cookers (62%), cottons (56%), water (56%), alcohol (43%),
and ties (62%) were indicated (37 responding). While the word share is subject to
multiple interpretations, this may imply that cookers are being shared in a way that could
expose persons to communicable disease. But this is not a certainty.
4. The item most traded was syringes (92%), followed by cookers and cottons (both 23%),
but only 13 responded to this question.
5. Regarding items most reused, respondents noted cookers (73%) and syringes (68%) most
significantly, followed by ties (46%) and cottons (37%). This could indicate a need for
more syringes, as well as education on the cleaning of cookers to ensure safe and clean
equipment.
6. When asked to identify the number of items used each week, responses varied from as
little as 1 syringe per week to over 100. Other items had similar variability in range of
answers, with outliers potentially skewing the provided averages of supplies used each
week.
7. When asked how many times per day they injected, 70% of respondents indicated they
inject 3 to 5 times per day. 16% responded 0 to 2 times per day and 14% responded 6 or
more (50 responding).
8. Respondents were asked how many times per week they injected. Only 27 respondents
answered, with 37% indicating they inject 21 to 25 times per week, 22% at more than 30,
and 18% at 11 to 15 times per week. This question only appeared on the first survey, as it
appeared somewhat redundant given Q7 and seemed to imply math was a prerequisite to
answering.
9. On the second and third surveys, Q8 was changed to How many days a week?. Only 14
respondents answered, but indicated that 7 days a week was the most common frequency
of use (92%).
10. Regarding health problems related to IV drug use, 38 respondents identified cotton fever
(81%) and abscesses (63%) as the most commonly experienced complications. While the
perception of what constitutes cotton fever may vary (symptom-wise), the percentages of
respondents indicating a history of abscesses combined with high interest in receiving
more syringes and moderate interest in receiving more alcohol wipes could indicate that
clients are aware of how to prevent abscesses, but may just lack the resources to use
cleanly and safely every time.
11. When asked what other services clients would use if offered, only 22 respondents
answered. 36% were unsure of services they would like to see offered, but 27% were
interested in either suboxone or methadone as an alternative to IDU. While WCHD may
not be able to provide this service, the data still shows a potential demand.
12. Most respondents indicated their transportation method as a car (58%) (51 respondents).
There was significant overlap of answers in this question, as clients indicated they did not
always have rides or a vehicle available to them. Buses were the second-most used
transportation at 39%.
13. Average travel time indicated by respondents was 23 minutes, however there was
variability in mode of transportation, as well as outliers (one client indicated they travel
120 minutes one way, another wrote 5 minutes), so the absolute average may not be a
useful data point.
14. Respondents indicated that they do tell other users about the exchange, with 53
respondents all (100%) saying so.

15. Of respondents (40) who know individuals who do not come to the exchange, 37%
indicated a fear of being identified, 25% cited a lack of transportation, and 15% perceived
others as being too lazy to access the exchange.
16. Regarding brochures taken home (52 respondents), 92% indicated that they had taken
brochures from the exchange.
17. Of the same number of respondents (52), 42% indicated they had used services from
those brochures. It should be noted however (and was by one client) that not all of the
brochures offer services, but do offer valuable information that may be useful to
respondents.
18. Regarding testing (52 respondents), 57% indicated they had received hepatitis C or HIV
testing at the exchange.
19. When asked if they had not been tested (21 respondents22 had indicated in Q18 that
they had not received testing), 28% noted they had already been tested by their primary
care provider and 14% indicated a perceived lack of time to wait for testing.
Focus Interviews
Syringe Services Improvement. Trends across the focus interview answers were found
to correlate with trends in the written survey data. All six focus interviewees identified that they
heard about the exchange from another client. Half of respondents indicated Kendall would be an
ideal location for a secondary SSP, which may account for some of the individual transportation
times exceeding the average of 23 minutes. All interviewees indicated that 2 to 3 days per week
would be ideal, but the days of the week were varied. Most participants seemed to agree that the
current time of day is adequate. Regarding safe injection sites, interviewees were positive and
cited safety as the primary benefit. To improve accessibility, answers varied but reflected the
concerns of written survey respondents: more syringes, more privacy, additional sites, and
outreach to those hesitant to come to the exchange.
Self and Community Assessment. Participants were also asked to comment on personal
strengths and struggles. Participants readily called up positive characteristics of themselves,
ranging from being a safe user to simply being a nice person. Struggles typically revolved
around familial conflict or circumstances that contribute to their use. Participants were also asked
to describe what they perceive their community strengths and struggles to be. Most participants
saw their community (identified as other users) as mostly safe and one where No ones
selfish. Regarding struggles, one participant stated, Mental health issues its hard to
decipher if its that or if someones just high. Some people get discarded as a drug addict. They
say Oh, just stop using and your life will get better. Well, hes using because his life hasnt
gotten better.
Recommendations
User-Driven Model
With 87% of written survey respondents indicating they could use more syringes and
68% indicating that they reuse syringes, WCHD may also consider increasing the number of
syringes exchanged on a one-to-one basis or entertaining an entirely different model altogether
the User-Driven model. WCHD currently has a one-to-one exchange with a maximum of 100
syringes per week, per person. A User-Drive model allows the participant to determine the
number of syringes they need without having to exchange an exact number in return. A multi-
city study noted that limits on syringes exchanged may contribute to a scarcity effect that
encourages reusing of syringes (Bluthenthal et al., 2004). Chicago and Oakland were cited in
particular as having more open syringe exchange policies, and consequently PWIDs reported less
reuse of syringes (7% and 11%) compared to Hartford, Connecticut where there is a limit (26%).
Allowing PWIDs to determine how many syringes they need may reduce this scarcity effect and
in turn, encourage use of a clean syringe every injection.
However, it may be financially burdensome to a smaller health department such as
WCHD to allow distribution of syringes independent of used syringes exchanged. But if it is
feasible, perhaps removing the limit of 100 syringes per person, per week may have a similar
effect. It may also reduce hoarding of used syringes, thus increasing safe syringe disposal.
Future Surveys
While the survey conducted by the authors elicited potentially useful information, it
would behoove WCHD to continue to seek information on the using behaviors of PWIDs. More
focused questions surrounding the using behaviors in regards to sharing and cleaning of
equipment could reveal potential learning needs regarding transmission of HCV. Assessing the
needs of rural clients would also elicit useful information in targeting that specific population,
whose access to the SSP in Bellingham may be limited.
In future surveys, exact language may also elicit more useful information. Some words
such as share in Q3 have multiple interpretations and may not provide useful data. There was
also significant overlap in answers to Q12 and Q13 regarding transportation mode and travel
time. Future surveys may consider a more direct way of assessing accessibility barriers of
participants.
Appendix I
Open-Ended Written Survey Responses
Open-Ended Written Survey Responses

Answered Skipped
What other items or services would you use if the exchange offered them? 22 38
Don't Know 8
Treatment services 6
suboxone 2
methadone 2
Unlimited exchange 2
More Narcan 2
Proper injection technique 1
Safe Injection Site 1
Safe Injection Education 1
Testing 1
Psychological Assistance 1
lancets 1
Answered Skipped
Do you know other IV drug users who don't come to the exchange? 40 20
No 7
Yes 33
If yes, why?
Fear of identity being exposed 15
No ride 10
"lazy" 6
Uses mine 4
No time 3
Don't know 2
kids 1
Forgetful 1
Buy them 1
Dealer 1
Don't want to 1
Syringe Services
Open-Ended ProgramSurvey Responses (continued)
Written 26
Answered Skipped
If you haven't test, why not? 21 39
Done by PCP or other practitioner 6
Already have 2
No time 3
"Lazy" 1
Already tested positive for diseases 2
Don't know why not 2
Don't think they have the disease 1
Just started Injection Drugs 1
Fear of identity being exposed 1
Unclear response 1
Fear 1
Appendix J
Focus Interview Responses
Focus Interview Responses

1. How did you hear o Word of mouth.
about the syringe o Word of mouthIve lived in 7 different states with
exchange similar things and been using for 40 years.
program? o From a friend.
o Parents were addicts and always used it.
o The grapevine this is my fourth week coming.
o Word of mouth, been going about 10 years on and off.
2. Outside of o Kendall.
Bellingham, which o Samish Way
areas do you think o Maple Falls or Kendall.
need syringe o Kendall or Paradise area from what I hear from
exchange services people.
the most? o I dunno, Ferndale?
o One is enough.
3. Do you wish the o Yes.

exchange was open o Used to be two days a week. Two days.
more days of the o Two times a week.
week? How many o Two to three days a week.
days would be o At least two days.
helpful? o Three times a week.
4. What days of the o Monday, Wednesday, Fridaylike the food bank.

week would be o Tuesdays and Thursdays.
helpful? o A weekend day would be good.
o Open Monday, Wednesday, Friday like the food bank.
o Mondays and Thursdays. I know a lot of people who
run out on the weekend, so Mondays would be good.
o Monday, Wednesday, Friday.
5. What time of day o Noon to 4PM.

would be helpful? o Earlier9AM to 12PM.
o Afternoons are fine.
o 1PM to 4PMjust a little earlier.
o Afternoon like now is good.

o 2PM to 5PM.
6. Some cities have o Absolutely. Society needs to be more accepting of drug

safe injection users.
siteswould you o Good idea. Its safer and cleaner and theres people on
use one if it was hand to help with ODs.
available in o I dont know. Maybe good for new users, but what
Bellingham? about privacy?
o Cool, but some people think its enabling. But at least
its safe.
o Kind of weird, but some people dont know what
theyre doing. Some kids do way too much and we have
to stop them.
o Good idea.
7. Do you have any o More needles and ask name less.

suggestions for how o Mobile pick-up site, better advertisement.
the program could o Reach out to embarrassed userstheres a lot of
be easier to access? shame.
o Word of mouth seems best.
o No, you guys have it slam dunked.
o More days a week.
8. Tell me about your o My educationI have my high school diploma, some

strengths? college.
o Safe user, always use clean needles. I pick up needles
on Pillsbury Road, where people throw them in ditches.
Dont want kids finding them.
o Im transgender so I dont let what people think affect
me.
o Im a nice person, try to treat people respectfully, never
know what theyre going through. I used to be a
degenerate, but I had to look at my actionshurt is hurt
and I dont want to put that on people.
o Im trustworthy and loyal.
9. Tell me about your o Depressed, frustratedbeen married 3 times and trying

struggles? to get SSI. Spent 20 years in prison, but I still paid into
it. Im antisocial and too old.
o Divorced 10 to 15 years ago. Started with Vicodin for

sports injuries and I was just a normal person. Last time
I quit, my girlfriend had drug court and we just had to 5
years ago. I went to meetings every day, but my sponsor
hung himself and I relapsed.
o My family history of addiction.
o My ex is pregnant with my kid and wont have any
contact with me.
o Lack of motivation to change. Court and jail helped me
stop, not having money helped me stop. Its more
extreme.
10. Tell me about your o Not much.

community o Tight-knit group. Sharing food, taking care of people
strengths? when theyre sick. I dont use heroin, but I always carry
some in case a friend is sick from withdrawal. No ones
selfish.
o People are safe and advocate for others.
o Give me food or cigarettes. When Im sleeping on the
street, Ill wake up because someones covering me up.
They care about me for some reason.
o Theyre friendly, young, and creative.
11. Tell me about your o Used to look after peoplenot much comradery now.
community o No comments.
struggles? o No comments.
o The people who dont have struggles dont care and the
people who do care have struggles of their own.
o Mental health issues its hard to decipher if its that
or if someones just high. Some people get discarded as
a drug addict. They say Oh, just stop using and your
life will get better. Well, hes using because his life
hasnt gotten better.
12. Other comments? o I believe IV meth is safestit bypasses the lungs,

mouth, and gets right to your heart.
Appendix K
Survey Monkey Results and Bar Graphs
(see next page)

Syringe Exchange Survey (combined) SurveyMonkey
Q1 What could you use more of?

Answered: 57 Skipped: 3
Syringes
Alcohol
Narcan
Water
Cottons
Ties
Bleach
Bandaids
Cookers
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Answer Choices Responses
Syringes 87.72% 50
Alcohol 52.63% 30
Narcan 50.88% 29
Water 45.61% 26
Cottons 28.07% 16
Ties 24.56% 14
Bleach 24.56% 14
Bandaids 22.81% 13
Cookers 15.79% 9
Total Respondents: 57
1 / 26
Q2 What do you need less of?

Cookers
Bandaids
Ties
Cottons
Bleach
Alcohol
Water
Narcan
Syringes
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Cookers 65.91% 29
Bandaids 52.27% 23
Ties 50.00% 22
Cottons 43.18% 19
Bleach 29.55% 13
Alcohol 22.73% 10
Water 6.82% 3
Narcan 6.82% 3
Syringes 0.00% 0
2 / 26
Q3 If any, what do you share?

Cookers
Ties
Cottons
Water
Alcohol
Syringes
Bandaids
Bleach
Narcan
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Cookers 62.16% 23
Ties 62.16% 23
Cottons 56.76% 21
Water 56.76% 21
Alcohol 43.24% 16
Syringes 35.14% 13
Bandaids 27.03% 10
Bleach 21.62% 8
Narcan 13.51% 5
3 / 26
Q4 If any, what do you trade?

Syringes
Cookers
Cottons
Water
Alcohol
Ties
Bandaids
Bleach
Narcan
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Syringes 92.31% 12
Cookers 23.08% 3
Cottons 23.08% 3
Water 7.69% 1
Alcohol 7.69% 1
Ties 7.69% 1
Bandaids 0.00% 0
Bleach 0.00% 0
Narcan 0.00% 0
4 / 26
Q5 If any, what do you reuse?

Cookers
Syringes
Ties
Cottons
Water
Bleach
Alcohol
Bandaids
Narcan
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Cookers 73.33% 33
Syringes 68.89% 31
Ties 46.67% 21
Cottons 37.78% 17
Water 22.22% 10
Bleach 8.89% 4
Alcohol 0.00% 0
Bandaids 0.00% 0
Narcan 0.00% 0
5 / 26
Q6 How many of each item do you use

every week?
Syringes
Cottons
Alcohol
Water
Bandaids
Cookers
Ties
Bleach
Narcan
0 10 20 30 40 50 60 70 80 90 100
Answer Choices Average Number Total Number Responses
Syringes 59 2,107 36
Cottons 45 950 21
Alcohol 18 280 16
Water 7 106 16
Bandaids 5 97 18
Cookers 5 108 24
Ties 2 44 20
Bleach 2 32 15
Narcan 0 2 9
# Syringes Date
1 50 11/12/2016 7:39 PM
6 / 26
2 60 11/12/2016 7:37 PM
3 75 11/12/2016 7:35 PM
4 100 11/12/2016 7:25 PM
5 1 11/12/2016 7:24 PM
6 100 11/12/2016 7:24 PM
7 100 11/12/2016 7:20 PM
8 12 11/12/2016 7:19 PM
9 100 11/12/2016 7:15 PM
10 30 11/12/2016 7:15 PM
11 100 11/12/2016 7:14 PM
12 7 11/12/2016 7:06 PM
13 10 11/12/2016 7:05 PM
14 40 11/12/2016 7:03 PM
15 75 11/12/2016 7:02 PM
16 150 11/12/2016 6:55 PM
17 8 11/12/2016 6:54 PM
18 12 11/12/2016 6:52 PM
19 120 11/12/2016 6:50 PM
20 50 11/12/2016 6:48 PM
21 14 11/12/2016 6:44 PM
22 40 11/12/2016 6:33 PM
23 100 11/12/2016 6:32 PM
24 35 11/12/2016 5:54 PM
25 21 11/12/2016 5:54 PM
26 50 11/12/2016 5:53 PM
27 80 11/12/2016 5:51 PM
28 100 11/12/2016 5:45 PM
29 100 11/12/2016 5:44 PM
30 100 11/12/2016 5:42 PM
31 75 11/12/2016 5:41 PM
32 10 11/12/2016 5:38 PM
33 100 11/12/2016 5:36 PM
34 40 11/12/2016 5:35 PM
35 21 11/12/2016 5:34 PM
36 21 11/12/2016 5:33 PM
# Cookers Date
1 8 11/12/2016 7:37 PM
2 3 11/12/2016 7:35 PM
3 2 11/12/2016 7:24 PM
4 0 11/12/2016 7:20 PM
5 3 11/12/2016 7:19 PM
7 / 26
6 5 11/12/2016 7:15 PM
7 3 11/12/2016 7:14 PM
8 1 11/12/2016 7:05 PM
9 2 11/12/2016 7:03 PM
10 20 11/12/2016 6:55 PM
11 3 11/12/2016 6:48 PM
12 0 11/12/2016 6:46 PM
13 1 11/12/2016 6:33 PM
14 15 11/12/2016 6:32 PM
15 1 11/12/2016 5:54 PM
16 1 11/12/2016 5:53 PM
17 2 11/12/2016 5:51 PM
18 3 11/12/2016 5:44 PM
19 2 11/12/2016 5:42 PM
20 2 11/12/2016 5:41 PM
21 2 11/12/2016 5:38 PM
22 5 11/12/2016 5:36 PM
23 3 11/12/2016 5:35 PM
24 21 11/12/2016 5:33 PM
# Cottons Date
1 30 11/12/2016 7:37 PM
2 50 11/12/2016 7:35 PM
3 100 11/12/2016 7:24 PM
4 100 11/12/2016 7:20 PM
5 12 11/12/2016 7:19 PM
6 1 11/12/2016 7:05 PM
7 20 11/12/2016 7:03 PM
8 10 11/12/2016 7:02 PM
9 20 11/12/2016 6:48 PM
10 25 11/12/2016 6:44 PM
11 20 11/12/2016 6:33 PM
12 40 11/12/2016 6:32 PM
13 21 11/12/2016 5:54 PM
14 50 11/12/2016 5:53 PM
15 80 11/12/2016 5:51 PM
16 100 11/12/2016 5:44 PM
17 100 11/12/2016 5:42 PM
18 100 11/12/2016 5:41 PM
19 20 11/12/2016 5:38 PM
20 30 11/12/2016 5:36 PM
21 21 11/12/2016 5:33 PM
8 / 26
# Water Date
1 1 11/12/2016 7:24 PM
2 4 11/12/2016 7:20 PM
3 1 11/12/2016 7:19 PM
4 1 11/12/2016 7:03 PM
5 6 11/12/2016 6:55 PM
6 1 11/12/2016 6:48 PM
7 4 11/12/2016 6:33 PM
8 5 11/12/2016 6:32 PM
9 7 11/12/2016 5:54 PM
10 1 11/12/2016 5:53 PM
11 4 11/12/2016 5:51 PM
12 3 11/12/2016 5:44 PM
13 3 11/12/2016 5:42 PM
14 40 11/12/2016 5:38 PM
15 4 11/12/2016 5:36 PM
16 21 11/12/2016 5:33 PM
# Alcohol Date
1 20 11/12/2016 7:24 PM
2 0 11/12/2016 7:20 PM
3 12 11/12/2016 7:19 PM
4 5 11/12/2016 7:03 PM
5 5 11/12/2016 7:02 PM
6 50 11/12/2016 6:48 PM
7 18 11/12/2016 6:44 PM
8 5 11/12/2016 6:33 PM
9 50 11/12/2016 6:32 PM
10 21 11/12/2016 5:54 PM
11 2 11/12/2016 5:53 PM
12 60 11/12/2016 5:51 PM
13 10 11/12/2016 5:42 PM
14 7 11/12/2016 5:38 PM
15 5 11/12/2016 5:36 PM
16 10 11/12/2016 5:33 PM
# Bandaids Date
1 15 11/12/2016 7:37 PM
2 5 11/12/2016 7:24 PM
3 0 11/12/2016 7:20 PM
4 12 11/12/2016 7:19 PM
5 5 11/12/2016 7:03 PM
6 0 11/12/2016 7:02 PM
9 / 26
7 0 11/12/2016 6:55 PM
8 5 11/12/2016 6:48 PM
9 7 11/12/2016 6:44 PM
10 5 11/12/2016 6:33 PM
11 2 11/12/2016 6:32 PM
12 21 11/12/2016 5:54 PM
13 0 11/12/2016 5:53 PM
14 4 11/12/2016 5:51 PM
15 2 11/12/2016 5:42 PM
16 10 11/12/2016 5:38 PM
17 4 11/12/2016 5:36 PM
18 0 11/12/2016 5:33 PM
# Ties Date
1 3 11/12/2016 7:37 PM
2 2 11/12/2016 7:35 PM
3 1 11/12/2016 7:24 PM
4 2 11/12/2016 7:20 PM
5 1 11/12/2016 7:19 PM
6 2 11/12/2016 7:03 PM
7 1 11/12/2016 7:02 PM
8 10 11/12/2016 6:55 PM
9 1 11/12/2016 6:48 PM
10 1 11/12/2016 6:44 PM
11 2 11/12/2016 6:33 PM
12 2 11/12/2016 6:32 PM
13 7 11/12/2016 5:54 PM
14 1 11/12/2016 5:53 PM
15 1 11/12/2016 5:51 PM
16 0 11/12/2016 5:42 PM
17 1 11/12/2016 5:38 PM
18 3 11/12/2016 5:36 PM
19 3 11/12/2016 5:35 PM
20 0 11/12/2016 5:33 PM
# Bleach Date
1 2 11/12/2016 7:37 PM
2 0 11/12/2016 7:20 PM
3 1 11/12/2016 7:19 PM
4 1 11/12/2016 7:03 PM
5 6 11/12/2016 6:55 PM
6 1 11/12/2016 6:48 PM
7 1 11/12/2016 6:33 PM
10 / 26
8 5 11/12/2016 6:32 PM
9 7 11/12/2016 5:54 PM
10 0 11/12/2016 5:53 PM
11 1 11/12/2016 5:51 PM
12 1 11/12/2016 5:42 PM
13 1 11/12/2016 5:38 PM
14 2 11/12/2016 5:36 PM
15 3 11/12/2016 5:33 PM
# Narcan Date
1 0 11/12/2016 7:20 PM
2 1 11/12/2016 7:03 PM
3 1 11/12/2016 6:33 PM
4 0 11/12/2016 5:54 PM
5 0 11/12/2016 5:53 PM
6 0 11/12/2016 5:51 PM
7 0 11/12/2016 5:42 PM
8 0 11/12/2016 5:38 PM
9 0 11/12/2016 5:33 PM
11 / 26
Q7 How many times per day do you inject?

3-5
0-2
6 or more
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
3-5 70.00% 35
0-2 16.00% 8
6 or more 14.00% 7
Total 50
12 / 26
Q8 How many times per week?

21-25
more than 30
11-15
16-20
26-30
0-5
5-10
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
21-25 37.04% 10
more than 30 22.22% 6
11-15 18.52% 5
16-20 11.11% 3
26-30 7.41% 2
0-5 3.70% 1
5-10 0.00% 0
Total 27
13 / 26
Q9 How many days a week?

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
7 92.86% 13
2 7.14% 1
0 0.00% 0
1 0.00% 0
3 0.00% 0
4 0.00% 0
5 0.00% 0
6 0.00% 0
Total 14
14 / 26
Q10 Have you had any health problems

related to your IV drug use? If yes, circle all
that apply:
cotton fever
abscesses
infection
overdose
sepsis
endocarditis
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
cotton fever 81.58% 31
abscesses 63.16% 24
infection 36.84% 14
overdose 28.95% 11
sepsis 10.53% 4
endocarditis 5.26% 2
15 / 26
Q11 What other items or services would you

use if the exchange offered them?
# Responses Date
1 Don't know. 11/12/2016 7:39 PM
2 Methadone. 11/12/2016 7:37 PM
3 Proper injection technique. 11/12/2016 7:37 PM
4 ? 11/12/2016 7:35 PM
5 More narcan. 11/12/2016 7:34 PM
6 Safe using spot with medical personnel. 11/12/2016 7:32 PM
7 ? 11/12/2016 7:26 PM
8 Testing/psychological assistance. 11/12/2016 7:19 PM
9 ? 11/12/2016 7:03 PM
10 Any. 11/12/2016 6:54 PM
11 Short tip needle. 11/12/2016 6:50 PM
12 [Needle] points. 11/12/2016 6:48 PM
13 Use of narcan. 11/12/2016 6:32 PM
14 Lancets. 11/12/2016 6:31 PM
15 More than 100 exchange. 11/12/2016 5:51 PM
16 ? 11/12/2016 5:42 PM
17 Methadone. 11/12/2016 5:41 PM
18 Treatment or any. 11/12/2016 5:39 PM
19 All. 11/12/2016 5:38 PM
20 Suboxone 11/12/2016 5:36 PM
21 Suboxone 11/12/2016 5:35 PM
22 3 cc 1.5 in syringe 11/12/2016 5:33 PM
16 / 26
Q12 How do you usually get to the

exchange?
Car
Bus
Walk
Ride from
another person
Bike
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Car 58.82% 30
Bus 39.22% 20
Walk 31.37% 16
Ride from another person 27.45% 14
Bike 7.84% 4
17 / 26
Q13 How long does it take to get to the

exchange (in minutes)?
Minutes:
0 10 20 30 40 50
Answer Choices Average Number Total Number Responses
Minutes: 23 1,155 50
# Minutes: Date
1 10 11/12/2016 7:39 PM
2 25 11/12/2016 7:37 PM
3 10 11/12/2016 7:35 PM
4 10 11/12/2016 7:34 PM
5 20 11/12/2016 7:32 PM
6 25 11/12/2016 7:30 PM
7 45 11/12/2016 7:26 PM
8 5 11/12/2016 7:25 PM
9 120 11/12/2016 7:24 PM
10 15 11/12/2016 7:24 PM
11 10 11/12/2016 7:20 PM
12 20 11/12/2016 7:19 PM
13 5 11/12/2016 7:15 PM
14 15 11/12/2016 7:15 PM
15 75 11/12/2016 7:14 PM
16 10 11/12/2016 7:06 PM
17 10 11/12/2016 7:05 PM
18 10 11/12/2016 7:03 PM
19 15 11/12/2016 7:02 PM
20 35 11/12/2016 6:55 PM
21 5 11/12/2016 6:54 PM
18 / 26
22 5 11/12/2016 6:53 PM
23 45 11/12/2016 6:52 PM
24 20 11/12/2016 6:51 PM
25 10 11/12/2016 6:50 PM
26 15 11/12/2016 6:46 PM
27 10 11/12/2016 6:45 PM
28 35 11/12/2016 6:44 PM
29 10 11/12/2016 6:33 PM
30 10 11/12/2016 6:32 PM
31 30 11/12/2016 6:31 PM
32 20 11/12/2016 6:30 PM
33 60 11/12/2016 6:29 PM
34 15 11/12/2016 6:28 PM
35 5 11/12/2016 5:57 PM
36 15 11/12/2016 5:54 PM
37 45 11/12/2016 5:53 PM
38 50 11/12/2016 5:51 PM
39 15 11/12/2016 5:45 PM
40 60 11/12/2016 5:44 PM
41 5 11/12/2016 5:42 PM
42 10 11/12/2016 5:41 PM
43 30 11/12/2016 5:40 PM
44 30 11/12/2016 5:39 PM
45 30 11/12/2016 5:38 PM
46 3 11/12/2016 5:36 PM
47 10 11/12/2016 5:36 PM
48 15 11/12/2016 5:35 PM
49 45 11/12/2016 5:34 PM
50 7 11/12/2016 5:33 PM
19 / 26
Q14 Do you tell other IV drug users about

the exchange?
Yes
No
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Yes 100.00% 53
No 0.00% 0
Total 53
20 / 26
Q15 Do you know other IV drug users who

don't come to the exchange? If yes, why?
# Responses Date
1 Yes, not sure why they don't. 11/12/2016 7:39 PM
2 Yes, no transportation or fear of being watched. 11/12/2016 7:37 PM
3 Stay anonymous. 11/12/2016 7:35 PM
4 Lazy. 11/12/2016 7:34 PM
5 Yes, pride or don't want to see people. 11/12/2016 7:32 PM
6 Scared (ask too much info). 11/12/2016 7:30 PM
7 No ride. 11/12/2016 7:26 PM
8 Yes, lazy or embarrassed. 11/12/2016 7:25 PM
9 No transportation. 11/12/2016 7:24 PM
10 Forgetfulness. 11/12/2016 7:20 PM
11 No. 11/12/2016 7:19 PM
12 Cops. 11/12/2016 7:14 PM
13 No. 11/12/2016 7:05 PM
14 No. 11/12/2016 7:03 PM
15 Yes, no ride. 11/12/2016 7:02 PM
16 Yes, no ride. 11/12/2016 6:55 PM
17 Yes, help stay clean as possible. 11/12/2016 6:54 PM
18 Yes, embarrassed or lazy. 11/12/2016 6:52 PM
19 No. 11/12/2016 6:51 PM
20 They are dealers, they just buy them, don't take time to come down. 11/12/2016 6:50 PM
21 Yes, "I have kids". 11/12/2016 6:48 PM
22 Yes, lazy or no ride. 11/12/2016 6:46 PM
23 Scared (don't like leaving [illegible]). 11/12/2016 6:44 PM
24 Yes, CPS. 11/12/2016 6:33 PM
25 Yes, embarrassed, think someone will find out. 11/12/2016 6:32 PM
26 Don't want face shown. 11/12/2016 6:31 PM
27 Want to be anonymous. 11/12/2016 6:29 PM
28 No. 11/12/2016 6:28 PM
29 No. 11/12/2016 5:57 PM
30 No. 11/12/2016 5:54 PM
31 The usually don't have time or a way to come. 11/12/2016 5:53 PM
32 Yes, no ride. 11/12/2016 5:51 PM
33 Yes, don't want to be ID'd. 11/12/2016 5:44 PM
34 Yes, don't know, lazy, transportation depends on me. 11/12/2016 5:42 PM
21 / 26
35 Yes, no car or no ride. 11/12/2016 5:41 PM
36 Privacy. 11/12/2016 5:40 PM
37 Yes, they are scared of police contact. 11/12/2016 5:39 PM
38 Yes, they don't want to. 11/12/2016 5:38 PM
39 Busy 11/12/2016 5:36 PM
40 They are lazy and don't mind mooching off me 11/12/2016 5:33 PM
22 / 26
Q16 Have you ever taken brochures home?

Yes
No
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Yes 92.31% 48
No 7.69% 4
Total 52
23 / 26
Q17 Have you ever used services from

those brochures?
No
Yes
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
No 57.69% 30
Yes 42.31% 22
Total 52
24 / 26
Q18 Have you ever done hepatitis C or HIV

testing here?
Yes
No
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Yes 57.69% 30
No 42.31% 22
Total 52
25 / 26
Q19 If you haven't been tested, why not?

# Responses Date
1 I have. 11/12/2016 7:35 PM
2 Lazy. 11/12/2016 7:34 PM
3 Too late. 11/12/2016 7:32 PM
4 Always on a time. 11/12/2016 7:31 PM
5 ? 11/12/2016 7:26 PM
6 Already was. 11/12/2016 7:24 PM
7 Time. 11/12/2016 7:15 PM
8 Tested at doctor's. 11/12/2016 7:14 PM
9 Went to family planning. 11/12/2016 7:06 PM
10 Got tested in prison. 11/12/2016 7:05 PM
11 Tested at doctor's. 11/12/2016 6:53 PM
12 Regular doctor. 11/12/2016 6:52 PM
13 No reason. 11/12/2016 6:46 PM
14 Don't have it! 11/12/2016 5:57 PM
15 Just started to use. 11/12/2016 5:54 PM
16 Yes. 11/12/2016 5:54 PM
17 Testing by personal doctor. 11/12/2016 5:41 PM
18 Yes, I'm positive HIV and hep C. 11/12/2016 5:40 PM
19 No time. 11/12/2016 5:34 PM
20 anonymous 11/12/2016 5:33 PM
21 Fear of the inevitable. 11/12/2016 5:33 PM
26 / 26

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Running head: Syringe Services Program 1

Assessment of and Recommendations for the Syringe Services Program

Amber Jones Radcliffe and Brittany Nave

Western Washington University

NURS 422 Organizational Change for Quality and Safety in Healthcare

Assessment of and Recommendations for the Syringe Services Program

Accountable Community of Health (NSACH)encompassing Whatcom, Island, Skagit, and

utilizing the SSP has increased 152% (Relyea, 2016).

Given this, the authorstwo Western Washington University nursing studentswere

community (Appendix C). Cindy Hollinsworth, manager of Communicable Diseases and

efficacy of the SSP.

forward to improve the SSP.

Assessment and Diagnosis

in the city of Bellingham, where the SSP is located.

Results are in Appendices H through K (Jones Radcliffe & Nave, 2016).

Table 1. PDSA Survey Timetable

occurred to WCHD staff or were limited by work hours and logistics.

Implementation and Evaluation

Organizational Readiness for Change

To visualize supporting and restraining components of WCHDs readiness for change, a

Developed by Lewin, a predecessor of Lippett, the force-field analysis illustrates factors

and areas to improve the SSP.

Transportation or storage of supplies at a secondary site would have to be considered, as well as

of PWIDs better than a mobile syringe exchange.

syringes exchanged on a one-to-one basis or entertaining an entirely different model altogether

in turn, encourage use of a clean syringe every injection.

However, it may be financially burdensome to a smaller health department such as

WCHD to allow distribution of syringes independent of used syringes exchanged. But if it is

efforts might be beneficial to exploring a mobile-based service in rural parts of Whatcom

whose access to the SSP in Bellingham may be limited.

In light of increased HCV rates, continual assessment of using behaviors of PWIDs is

decreased HCV rates in the long-term.

(Abingdon, England), 99(9), 11361146. https://doi.org/10.1111/j.1360-

PeaceHealth St. Joseph Medical Center. Retrieved from

Management, 10(1), 3237.

HIV/AIDS Prevention Services (UCHAPS). (2012). Syringe Services Program (SSP)

Retrieved from https://www.nastad.org/sites/default/files/055419_NASTAD-SSP-

Whatcom County. Retrieved November 12, 2016, from

Syringe Services Program Survey Week 1

Syringe Services Program Survey Weeks 2 and 3

Focus Questions for Interviews

1. How did you hear about the syringe exchange program?

a. How many days would be helpful?

b. What days of the week would be helpful?

c. What time of day would be helpful?

6. Tell me about your strengths.

7. Tell me about your struggles.

8. Tell me about your community strengths.

9. Tell me about your community struggles.

Factors Propelling and Restraining Change within the WCHD SSP

Factors Propelling Change Factors Restraining Change

Increased public awareness of

Evidence showing increase in

Groundwork in progress for 2 location

Community partnership with

Public misconceptions of SSPs

New quality improvement

Inputs Strategies/Activities Outputs Short-term Long-term Outcomes

Run Chart of Written Survey

Run Chart of Focus Interviews

Syringe Services Program Data Report

Background and Methods

data summary (located after the appendices).