Egan recommends that professional development initiatives related to harm reduction include analyses of power relationships between the “harm reduction worker” and “client”. Anne Docherty, a community educator and researcher in Hazelton, BC, echoes this advice. She argues that it is important for practitioners to "take time to articulate their values, principles and approach to their work and to recognize that they have an agenda when entering a relationship with learners." (Docherty, 2006: 5).

Sarah’s response: This is a crucial part of staff development, and often under-funded.

The Women’s Options for Risk Reduction through Knowledge of Self (WORKS) is a harm reduction intervention described in two studies looking at harm reduction programs with women Injection Drug Users (L. M. Brown & Gilligan, 1992; N. L. Brown, Luna, Ramirez, Vail, & Williams, 2005). This intervention enacts a philosophy that sees Harm Reduction as an empowerment tool for patients — providing HIV prevention workshops, counselling and testing to female injection drug users (IDUs) or their partners. The goals were to teach women to recognize their own HIV risk, use HIV-prevention strategies and access local health services, but not to stop using drugs. The paper by Brown and Gilligan looks more specifically at how community-based organizations (CBOs) can collaborate to provide effective interventions and services for clients at risk of HIV, as well as the barriers to collaboration, and how these can be overcome. Researchers identified the following four issues as important in collaborative interventions. They would all be important considerations in a literacy context:

• trusting relationships between staff and program participants;
• clear, easy to follow information on how to help participants gain access to services;
• support services such as child care and
• adequate time and resources to meet participants’ needs.

These researchers, along with several others (Garcia, 1999; Marlatt, 1998; Murray & Ferguson, 2003; Tatarsky, 1998), describe the journey of a drug-user ’s life as non-linear and incremental. Murray and Ferguson note that users cycle back and forth, in and out, between stages. In the San Francisco Treatment Guidelines, B. Garcia says:

Relapse or periods of return to use should not be equated with or conceptualized as "failures of treatment." As substance abuse treatment providers have always understood, the "road to recovery" is paved with many twists and turns (and) total abstinence is difficult to achieve… Harm reduction approaches can also decrease the emotional and physical damage associated with these episodes. (Garcia, 1999)