The Homeless Health Care Los Angeles Center for Harm Reduction (HHCLA-HRC)

A comprehensive program model, including harm reduction and treatment, that focuses on a chronically homeless population that is disproportionately affected by opioid use disorder

Homeless Health Care Los Angeles (HHLCA) is a comprehensive service center for the homeless in Los Angeles. It focuses on providing substance use disorder treatment that also addresses mental health issues, takes a harm reduction approach, and is in conjunction with stable housing.

The Center for Harm Reduction, a part of HHCLA, is a community-based organization providing injection drug users with a syringe service program, overdose prevention training, medical care with a disease prevention approach, case management, and linkage to treatment. Most of the clients live in and around Skid Row, a part of Los Angeles that has one of the largest stable populations of homeless people in the United States.

One of their programs, overdose prevention training, has been described and evaluated in a peer-reviewed article.  The training included strategies to prevent an opioid overdose, how to recognize an opioid overdose, the mechanism of an opioid overdose, and recommended response techniques.

97% of the program's clients still have housing 12 months after placement and 400 lives are saved from overdose. 

Continuum of Care
Treatment
Harm Reduction
Type of Evidence
Peer-reviewed
Response Approach
Comprehensive services
Educational
Housing, Education, and Employment
Overdose prevention
Syringe service program / Needle exchange
Peer-reviewed Article

Evidence of Program Effectiveness

"Participants were 21% female, 42% White, 29% African American, and 18% Latino. Most were homeless and reported living predominantly in the street (44%), temporary housing such as hotels or motels (15%), or shelters (14%). Significant increases were found in overdose knowledge, driven largely by increase in knowledge about the appropriate use of naloxone. Twenty-two participants witnessed and responded to 35 overdoses during the follow-up period. Twenty-six overdose victims were reported to have recovered, four died, and the outcome of five cases was unknown. The most commonly reported response techniques included: staying with the victim (85%), administering naloxone (80%), providing rescue breathing (66%), and calling emergency services (60%). The average number of appropriate response techniques used by participants increased significantly from baseline to follow-up (p<0.05). Half (53%) of programme participants reported that their drug use decreased at follow-up… Results suggest that overdose prevention and response training programmes may be associated with improvements in knowledge and overdose response behaviour among IDUs, with few adverse consequences and some unforeseen benefits, such as reductions in drug use.” (Wagner et al., 2010)

Every year, the HHCLA reports that they place 200 clients in housing and 97% of their clients still have housing 12 months after placement, they serve 21,000 individuals through their services, 400 lives are saved from overdose, 900,000 syringes are collected, and 1675 individuals are trained.