Reducing harms through interactions: Workers orienting to unpredictable frames in a low-threshold project for people injecting drugs

Abstract

BackgroundPeople using injection drugs and living in complex, vulnerable and stigmatised life situations can face many kinds of barriers when accessing social and healthcare services. Thus, they are often encountered in easily reachable low-threshold services aimed at harm reduction. However, little is known about how clients’ multiple drug-related needs are actually encountered in the everyday practices of harm reduction work. MethodsThis ethnomethodologically oriented interaction analysis examines harm reduction work in a Finnish low-threshold project, the aim of which is to support clients broadly in their drug-related life situations. The data consist of 12 audio-recorded client-worker meetings observed in 2017 by utilising mobile ethnography. In this context, workers are expected to react to clients’ needs in situ; they must take different kinds of orientations within the interactional frames that the clients have set for the meetings. This study asks: 1) In what kinds of frames are client-worker conversations conducted in the project? 2) How do the workers orient to these frames? ResultsThe results point out that participants orient to various frames – practical, therapeutic, educational and casual – during the meetings. The workers respect the frames set by the clients and maintain them by taking variable interactional orientations. By doing so, they are able to respond to the clients’ individual and acute needs, and they conduct a client-centred harm reduction approach through interactions. ConclusionsThe study highlights that when workers utilise situationally reactive interactional approaches, they conduct client-centred harm reduction work through interactions. When people using injection drugs are given much interactional freedom, they can be powerful actors in institutional contexts. Thus, harm reduction is not merely about reducing the concrete risks of drug use; it is also about social interactions that show respect for the interests of the people visiting the service.