Injection drug use is an ongoing and growing concern in Canada.
The rising rates of HIV and Hepatitis C in this group are
staggering. As well, overdoses and other opportunistic infections
historically plague people who use injection drugs. The difficulty
has always been in how to work with this group. They are
often viewed as chaotic and non-compliant. Natural Helpers,
a community development initiative based on harm reduction
philosophies, is a concept that creates avenues to allow
the injection drug use community to work with service providers.
Not only do service providers gain information, injection
drug users have the opportunity to express their needs, and
contribute in the creation of a safer and healthier community.
Boyle Street Community Services Co-operative is an agency
that attempts to fill many of the gaps experienced by people
living in poverty in the inner city of Edmonton. Services
include but are not limited to adult outreach, adult literacy,
a drop-in, and Streetworks (Edmonton’s needle exchange
program). Through thirty years of experience, the staff
recognized that there were people in the community who
had a natural
inclination to help their friends and family. Some of these
people were leaders in the community, but there was a large
segment that received little or no recognition for the
work that they did. To acknowledge the important role these
played in the community, the term Natural Helpers was coined.
Streetworks has been in operation for over ten years. Its
services are based on a harm reduction model, with a focus
on relationship-based programming. Streetworks focuses on
community development and building on the strengths of individuals,
therefore, the concept of Natural Helpers was a perfect fit.
The staff began to identify people in the injection drug
using community who felt a need to help their friends and
Streetworks’ definition of the Natural Helpers project
is to provide and/or enhance the skills, knowledge, resources
and support that they need to be able to do their “job” better.
It was soon recognized that more needed to be done. Streetworks
began to explore funding sources that would enable the
staff to acknowledge and expand the roles of Natural Helpers
Funding was obtained through Health Canada. A nurse was hired
to bring together a group of Natural Helpers to explore what
they would see as being most helpful to them in their role.
After the initial challenges of bringing a slightly chaotic
group together and trying to capture all the ideas, a wealth
of information, ideas, and dreams arose. It was decided within
the group to compile the knowledge and experiences that they
shared to develop a booklet on safer injecting. As a result
the Vein Care Handbook was born.
The novelty of having a group of injection drug users in
one room who were stable enough and willing to talk, quickly
gained attention. There were many requests from various
sectors to meet with the group to gain some firsthand knowledge
people who had “been there”, not just those
who worked with them. These requests were brought to the
and they had the final say as to whether they would meet
with the interested parties. The Streetworks staff encouraged
those who wanted to speak with the group to consider a
consultation fee as part of the process.
Streetworks was able to confer with this small segment of
the community about changes to the program and resource development.
The group gave input and approval to resources that were
developed in the program before distribution to the wider
The initial project was extremely successful and opened
the doors for additional funding. The new funding (granted
the Edmonton Community Lottery Board) allowed the group
to continue, adding new members as needed. The next project
took over a year, and resulted in the Street First Aid: ‘Cause
You Just Never Know booklet. This was an expansion beyond
issues directly related to injection drug use and showed
the growth of the group. The Natural Helpers group quickly
took up a new project, and has just completed work on a
germ book, focusing on infectious diseases.
There has been widespread interest not only in the resources
developed, but also in the group development. This has created
various opportunities for presentations by the group facilitators,
as well as the group members.
FORMING THE GROUP
Streetworks hired a nurse and appointed another staff member
to be facilitators of the Natural Helpers project. The
facilitators observed the community members closely and
who took care of others in their community. They asked
questions like “how many people do you exchange for”, “why
do you exchange for others”, “how do you take
care of others”, and “what would you need to
help you do what you are doing better”. One community
member who had developed a strong relationship with Streetworks
was included in the group. Once people were identified,
a meeting place and time was set and they were asked to
Group size was limited to 10 members initially, although
it grew to about 14. The group was representative of the
drug using community that accesses Streetworks with respect
to gender, race, type of drug use, and age. Natural Helpers
were treated as consultants and were provided $10 per hour.
A. GROUP STRUCTURE
Meetings were held once to twice per month. An environment
where community members felt safe and comfortable
The Natural Helpers project, a community development initiative
based on harm reduction concepts, has many benefits. It is
a strength-building project where information and expertise
is shared mutually between the facilitators and the community
members. Community members involved in injection drug use
participate in harm reduction strategies and also learn to
advocate for themselves. Natural Helpers access a hidden
portion of the injection drug use population. There is potential
to improve the health of the entire community.
Building on Strengths
Developing a Natural Helpers Group builds on the strengths
of people who are typically viewed as weak, and sometimes
scorned by the mainstream. Living with a 20 year addiction
affords one a wealth of knowledge from experience - imagine
the skill it takes to survive a 20-year addiction and remain
relatively healthy. The facilitators must genuinely acknowledge
and respect the strengths of injection drug users (IDU’S).
The facilitators should respect the group members as people
on equal ground with themselves. Both the group members and
facilitators possess knowledge that can be shared. The facilitators
should expect to learn as much as they teach.
Natural Helpers Group members advocate for their community
both directly and indirectly. The NH group can speak on
behalf of IDU’s to professional groups who want to access
the drug using population. The facilitators will gain insight
into the lives of IDU’s. This insight is invaluable
and allows the facilitators to advocate more effectively
on behalf of IDU’s.
Community Involvement in Harm Reduction
NH members will be honing their prior skills and adopting
new harm reduction strategies. They carry them into the broader
IDU community. The NH members may not identify their new
knowledge base as harm reduction.
Reach a Hidden Population
Programs aimed at the injection drug use population should
anticipate that they do not see every person that they target.
NH members access a portion of the hidden drug use population.
The NH project is an opportunity to spread harm reduction
strategies to this group.
Improves the Health of the Entire Community
There is potential to improve the health of the entire community.
Harm reduction meets people where they are at and provides
skills, knowledge, resources, and support necessary to live
safer and healthier lives. Improved health of the community
is anticipated if more of the population is practicing harm
ORGANIZING A GROUP
The first step in creating a group is to find community
members who are “natural helpers”. Ask the staff to observe
the service users closely and to identify those who seem
to be caring for others in their community. Ask the service
users questions such as “How many people do you exchange
for?”; “Why do you exchange for others?”; “How
do you take care of others?”; and “What would
you need to help you do what you’re doing better?”.
Identify and include 1 or 2 regular service users who have
developed strong relationships with your agency. Limit
the group size to about 8 to 10 members. Ensure the group
representative of the population you are trying to reach
with respect to gender, race, type of drug use and age.
NH members should be treated as consultants, provide some
of reimbursement for their participation. Ask those who
have been identified if they would like to be involved
project. Ask people when is a good time of day to have
meetings (maybe afternoons). Set up a time and place for
Be aware of how much time you have and what resources are
available. Explore funding options. Set start and finish
dates for the project. Let the group know how long the
project will last. Limit group meetings to about 2 hours
with 2 fifteen-minute
breaks. Understand that NH group members may have limited
experience with group work. Avoid trying to make individuals
fit in. Go with the flow. Have a couple staff take notes.
Let the process take shape naturally. The group process
will eventually evolve into its own unique format. Find
safe place big enough for everyone to fit. Be sensitive
to individuals’ lifestyles. If people smoke, allow
for breaks. Provide both nutritious food and sweets. People
use injection drugs may struggle when discussing drug use.
It can be a trigger for some to feel the need to use. Let
the group members know that they can leave anytime or stop
the discussion if necessary. Understand that people may
not be straight when they attend meetings. Decide with
at what point people will be asked to leave (this group
made a rule that if someone comes high, they must be productive
and not nodding out).
Try to have at least one or two staff as facilitators. Initially,
the facilitators may need to take the reigns. They should
ease off as the group naturally progresses. Keeping a diary
of the meetings helps the facilitators reflect and watch
the group grow. It also acts as a reminder to back off so
the group can own itself. A diary or log is essential for
evaluation. The facilitators must be non-judgmental and approachable.
Let the group know that everyone has expertise to share.
The facilitators should not be afraid to ask questions. They
should be honest and genuine. Respect each other. The group
members should be treated as consultants with expertise.
At the first meeting, let everyone know what the group
is all about. Start a discussion about trends and issues
the street. Brainstorm ideas and write EVERYTHING down.
It might be necessary for the facilitators to narrow
With group involvement, review the overall themes and
decide on a realistic goal. If there is more than one
Foster group involvement as much as possible.
Evaluation should be ongoing. The facilitators should
be constantly evaluating the process. Ask questions like “Are
we maintaining the focus?”, “Are we on schedule?”, “Is
the group progressing?”, “Do we need more group
members?”, “Are group members taking ownership?”, “Do
group members feel listened to?”, etc. Evaluate the
outcomes of the process. “Did the group complete the
project?”, “What unexpected outcomes occurred?”, “Did
the group accomplish what you expected it to?”, “What
the group expected it to?”, “What could have
been done different?”, etc.
The goal of the NH project is not therapeutic support.
Although it may naturally occur, it should not be the
focus of the
group meetings. Nor is it peer education. These people
are already involved in actions, which contribute to
The facilitators should back off as the group takes ownership.
If the facilitators think they can empower someone, they
assume that they have all the power. Empowerment is a
process of individuals/groups who discover their own
power and act
Try not to underestimate group members. Listen to what
people have to say.
STREETWORKS’ NATURAL HELPERS
Streetworks’ Natural Helpers group has been operating
off and on since 1997. Accomplishments include a Vein Care
Handbook, Street First Aid: Cause you just never know,
The Germ Book, Clean Points; Tips on Hepatitis C video
STD handbook. There has been interest in the first aid
and germ books from across Canada and the United States.
have consulted on a number of other resources. The group
has acted as speakers, advocates, and consultants to a
variety of professionals. This Natural Helpers group also
a poster presentation at the 1st Annual Alberta Harm Reduction
Some community members involved with Streetworks’ Natural
Helpers made some positive changes in their lives. Four members
are dealing with their addictions and taking steps to quit.
One member bought a first aid kit and cruises around Edmonton’s
inner city to help out where he can. He also frequents inner
city hotels and collects used needles to exchange. Some community
members know they can visit this fellow for supplies if they
can’t access the needle exchange sites. Three members
have taken steps to attend education programs. One member
has recently started a new job as a parking attendant.
The group members over time bonded and act as a support
other outside of meetings. Group members will often start
the meeting by asking everyone around the table how things
are going. As people discover that they have skills and
expertise, their ability to take control over their lives
will increase, and positive personal changes can occur.
The Natural Helpers’ focus to this point has been mainly
on resource development. This was due to many factors; especially
the groups’ need to have something very tangible to
focus upon, and various funders’ requirements. As
the group grew together, other possibilities began to emerge.
These potential areas included mutual support, consultation
to the community at large, and creating a political voice
for a seldom heard segment of the population. Any of these
areas could be expanded on with potentially powerful results.
The benefits that the group members and the organization
experienced could easily be transferred to other marginalized
groups in society. Some potential groups might include:
injection drug using youth, sex trade, street-involved
women whose partners are injection drug users, and so
on. The potential for positive health impacts on marginalized
populations are enormous.