Best Practices and Recommendations for Digital Harm Reduction Services

Guidance for community-based and community-led organisations

What is this publication about?

This publication aims to support the design, delivery and evaluation of digital harm reduction services and projects by community-based and community-led organisations. This is achieved through:

Exploring digital harm reduction and discussing topics of community, accessibility and security; Introducing best practices for digital harm reduction services; Providing recommendations to guide the design, delivery and evaluation of digital harm reduction projects and services; Encouraging innovation and creativity within the digital harm reduction space; Contributing to the overall discussion in developing quality standards for digital harm reduction services.

Who is this publication for?

This resource targets community-based and community-led organisations, more specifically:

Organisations who are setting up a new project that integrates digital technologies into harm reduction services; Existing harm reduction projects and services that utilise digital technologies; Existing offline/physical harm reduction projects that would like to implement digital technology within their service delivery.

Best practices and recommendations

The best practices can be considered as a set of goals for community-based and community-led organisations in achieving high quality, accessible and ethical digital harm reduction service delivery. The recommendations can be considered as practice steps that organisations can take to implement the best practices statement.

How were the best practices and recommendations developed?

 

These best practices and recommendations have been developed through a mixed methodology design, including: 

 

    • Comprehensive literature review; 
      A review of existing grey literature, guidelines and academic publications related to digital harm reduction services.

    • Quantitative and qualitative Delphi surveys;
      The systematic collection of professional and community opinions regarding the key components of effective community-based and community-led digital harm reduction services.

    • ‘Digital Expert’ meeting; 
      Further consultation with a ‘Digital Expert’ group to discuss how the best practices could be implemented and operationalised within community-based and community-led organisations.

The best practices and recommendations have been developed specifically with community-based and community-led organisations in mind, acknowledging that these organisations often may run in low-resource settings, as well as face legal and political constraints. Fulfilling these recommendations is not a prerequisite for piloting or running a digital harm reduction service. Rather, this guidance can be considered a ‘blueprint’ to support effective service delivery.

The best practices are summarised below, with the proceeding section exploring each statement in more detail as well as its accompanying recommendations 

1. The digital harm reduction service must have a clearly defined aim and ethical framework that considers the target community and specified service platform.

2. The digital harm reduction service design, implementation and evaluation must be evidence-informed.

3. The digital harm reduction service must meaningfully involve community members in the design, implementation and evaluation of the service.

4. The digital harm reduction service must make accessibility considerations within their user-experience (UX), user-interface (UI) and use of language.

5. The digital harm reduction service must protect the data of service participants and take active measures to ensure data security.

6. The organisation of the digital harm reduction service must promote an inclusive and considerate staff culture. Service providers and staff must be adequately trained, supported and understand their roles and responsibilities.

7. The digital harm reduction service must be informed about the legal and regulatory frameworks they operate and take appropriate precautions.

Introduction to Digital Harm Reduction Services

Defining ‘digital harm reduction’ from a community perspective

 

Defining a ‘digital harm reduction service’ has been difficult in practice given the diverse context and scope that the term suggests. The lack of a unified definition within literature, service provision and regulatory bodies means that it is difficult to assess the quality of these services and provide a structure for reporting and accounting.

We can build a working framework of ‘digital harm reduction services’ from a community perspective, relevant to the context of this publication, by breaking down the term to its constituent parts.

Harm reduction

C-EHRN has a working definition of harm reduction as, “humane, non-judgemental, people-centred, and evidence-informed policies and practices that aim to minimise the adverse health, social, economic, and legal consequences of drug use and related drug and health policies.”

Digital services

Many working definitions of ‘digital services’ within the health and social sector exist. The WHO has a set classification of digital interventions, services and applications, referring to technology functionality, software, and information and communication technology (ICT). This has been adapted by other organisations to refer to ‘services covering but not limited to, components such as e-health, mobile health, telehealth and the use of any digital technology for the provision of health and social services’.

Community perspective
    • Introducing a community perspective into our definition of a ‘digital harm reduction service’ accounts for community-based and community-led projects and services that may fall outside the scope of traditional understanding of service delivery.
    • Community-based harm reduction services are programs designed and delivered within a specific community to meet the unique needs of its members, often with input from, but not necessarily controlled by, the community itself.
    • Community-led harm reduction services are designed, implemented, and governed by members of the affected community (e.g., people who use drugs), ensuring their voices guide all aspects of the service and emphasising full participation, autonomy, and empowerment.
    • Terms like ‘e-health’, ‘telehealth',’ m-health’ can be quite rigid, whereas a community perspective provides greater flexibility within the working definition of a digital harm reduction service.

Digital transition, challenges and opportunities

 

Digitalisation and technological innovation has provided harm reduction services:

Opportunity → adapt existing services to tackle existing challenges through digitalisation
Transformation → introduce new services on new and existing platforms, targeting new and existing communities

Mainly, the increased efficiency and adaptability of digital services help to alleviate some of the challenges that are faced by traditional harm reduction services. These include:

    • Restrictive regulatory and legal frameworks;
      Legal frameworks and prohibitionist drug policies can limit the availability and capability of harm reduction services by outlawing certain services and support that are seen to promote or enable the use of drugs. This can include regulation and terms of service on third-party platforms. Punitive policies can also act as a barrier for people accessing harm reduction services out of fear of criminalisation.
    • Stigma, discrimination and marginalisation;
      Stigma within society and institutions acts as a major barrier for people accessing harm reduction services, out of fear of judgement, mistreatment and discrimination. This includes institutionalised stigma within healthcare and other services, social stigma associated with accessing physical services as well as discrimination by individual health providers.
    • Geographical and time barriers;
      Examples of geographic and time dependent barriers include the limited service availability for rural and remote populations and limited opening hours of physical services.
    • Funding and resource limitations;
    • Service gaps within service delivery;
    • Paperwork, registration, documentation.

In response to these challenges of traditional, physical harm reduction services, digital harm reduction services may be able to:

    • Overcome geographical and time barriers by offering 24/7, remote services;
    • Provide anonymous, discrete and low threshold services;
    • (Often) require less funding, resources and infrastructure;
    • Automate portions of service delivery;
    • Operate in legal grey areas;
    • Provide autonomy and leverage online social networks.

In addition to overcoming some of the challenges that arise with traditional harm reduction service delivery, digital harm reduction services are adaptive to the way that digitalisation has changed the way that people access, purchase and use drugs. Digital harm reduction services are able to operate in the virtual space, interacting with communities that have been built and exist online. These new, updated or adapted digital harm reduction services face a new set of challenges regarding service delivery. These include: 

    • Exacerbating the ‘digital divide’, specifically with reference to digital access, digital literacy and digital inclusion (see section: “digital rights and the digital divide”); 
    • Digital security, privacy and data concerns; 
    • Lack of regulatory and legal framework as well as standards and guidelines; 
    • Greater difficulty in developing trust and relationships between service participants and providers; 
    • Greater risk of burnout and potential breach of personal and professional boundaries;
    • Required additional training, education and support about digital tools and technologies for service providers and staff. 

Community and digital harm reduction

 

Online and digital communities can have different characteristics to offline communities. For harm reduction services and projects, this can change the approach to trust building within service delivery as well as approaches to harm reduction. A notable distinction of online communities compared to offline communities is the social organisation of risk and information. Online communities are able to form a sense of community that may be unachieveable offline and develop the basis for collective support necessary for empowerment.  Digital communities also tend to decentralise authority, as information can be easily exchanged by peers. This can allow participants to reconstruct their own narrative and resist stigma that exists within traditional health services.

Digital rights and the digital divide

 

Digitalisation and technological innovation has provided harm reduction services:

Digital rights → Human rights surrounding the use of digital tools, technologies and the internet. This can include the right to privacy, freedom of expression, access to information and protection from harm.
Digital divide → Inequalities in accessing digital tools and technologies, as well as the benefits they bring.
Digital access → Ability to utilise digital tools, technologies and the internet. This includes having access to devices like computers and smartphones, as well as the necessary infrastructure like internet connections.
Digital literacy → Skills and knowledge to effectively and safely utilise digital tools, technologies and the internet.
Digital inclusion → Equality of access and effective use of digital tools, technologies and the internet.

Digital harm reduction services have the potential to exacerbate inequalities in service delivery, by excluding community members with limited digital access and digital literacy. As a result, digital tools that are meant to increase accessibility, support communities and push back against stigma, may instead contribute to additional barriers in accessing harm reduction services.

Additionally, digital harm reduction services have a responsibility to respect and uphold people’s digital rights. This helps to ensure that people can access digital tools and technologies safely, privately and fairly.

Alongside their purpose, digital harm reduction services should attempt to promote digital inclusion to help mitigate some of the risks of digitalisation.

Supporting digital inclusion includes addressing: 

    • Access to digital equipment (eg. computer, smartphone, internet connection, battery);
    • Digital skills/digital literacy; 
    • Confidence and motivation to use digital technologies. 

Many of the recommendations in this guidance document are suggested to address these points. Specifically,

    • Mitigating the risks associated with digital harm reduction services and the digital divide,
    • Protecting and promoting digital rights. 

Brief introduction to digital harm reduction services

Areas of digital harm reduction
    • Outreach and engagement;
    • Education and information dissemination;
    • Counselling and peer support;
    • Crisis response;
    • Trip-sitting;
  • Community forum;
  • Offline service referrals;
Platforms for digital harm reduction service delivery

A platform acts as a digital space or system that allows participants to interact, share, create or access content or services.Platforms mediate the delivery of digital harm reduction, some examples include:

Messengers and chatbots
  • Messenger platform examples include  telegram, whatsapp, viber, facebook messenger, signal, instagram DM.
  • Specialised chatbots. 

Telegram Chatbots: Overdose Prevention @OverdoseHelpBot (Ukrainian) Drugstore Project

On Telegram, it is possible to create bots that automatically respond to messages from prewritten code. One example is the bot, @OverdoseHelpBot created by Drugstore Project, that can provide information on what the symptoms of an overdose looks like and how to provide first aid in overdose situations. 

Social media
  • Social media examples include tiktok, instagram, facebook, snapchat, youtube.

Social media: PrEP Facts Facebook group PrEP Facts: Rethinking HIV Prevention and SexA closed community group for discussions, debates, questions and concerns about PrEP, promoting fact-based information and compassion. Social media can provide both private and public spaces to engage with community members. On Facebook, it’s possible to create private groups for a specific topic or community. Admins are able to set community guidelines, monitor posts and control memberships. On other platforms including Instagram and Tiktok, public accounts can provide information and answer questions through posts, videos and comments.

Specialised forums and servers
  • Individual forums;
  • Forum and server platforms;
    Examples include Reddit, Discord.

Forum: Swiss drug forum for risk-conscious drug use (German)eve&rave Switzerland

The forum run by eve&rave aims to facilitate the exchange of information regarding harm reduction and the use of substances, with specific subtopics for different substances.

Newsletters and email/mailing lists
Smartphone applications
  • Chat-enabled games, dating apps,
  • Dedicated harm reduction apps.

Dating app: Cibereducadores (Spanish) ONG Stop

Stop’s ‘cyber educators’ have an online presence across messenger services (Whatsapp, Telegram) as well as on dating apps (Grindr, Wapo, Hornet, u4bear, Scruff, Growlr, MachoBB). Their volunteers are there to privately answer questions about sexual health and provide emotional support. 

Websites and web-based applications
Website: TripSit.me

TripSit

Tripsit.me features various pages, linking people to live trip-sitters (Discord), ways to compare drug combinations and doses (web app and web calculator) and other educational resources. Websites can help to direct and link service participants to various resources and other platforms. 

Audio streaming platforms
  • Examples include Spotify, Apple Music, soundcloud. 

Podcast: Nachtschatten Reloaded (German)

SONAR and Safer Nightlife Berlin

A podcast that focused on substance use in the context of nightlife and partying in Berlin, offering safer use tips, commentary and discussion of trends in party culture.

Depending on your area of digital harm reduction, the most effective platform for service delivery will differ. For example, social media can be an effective tool for outreach and engagement, whereas websites or web-based applications would be more applicable for counselling and peer support services.

Best practices for harm reduction services

1. Aim and ethical framework

The digital harm reduction service must have a clearly defined aim and ethical framework that considers the target community and specified service platform

Defining the aim by setting goals

 

Clearly defining the aim of your digital harm reduction service can help to create a structured framework for its design, delivery and evaluation. 

 

Recommendation: Define your digital harm reduction service by a specific goal that you are trying to achieve rather than a specific method. As platforms develop and communities transform, dynamics of service delivery and purpose can change rapidly, the best way of reaching your target community may shift. By defining your project/service aim in this way, you can support long-term sustainability and the space for innovation in your project/service.

 

New contributions

 

When determining your aim, it is also important that your project/service is able to stay relevant.

 

Recommendation: Consider how your project/service can contribute something new and meaningful within the digital harm reduction community. As the digital space is fast-paced, it can become more difficult to stay up-to-date. Without a long-term outlook on service delivery, it’s possible that the project/service may struggle even before it has been piloted.

 

Aim and target community

 

Recommendation: Clearly define your target community and their community-specific needs, wants and expectations, both in general and relating to your project/service. As communities differ in their characteristics and dynamics, what is important to take into consideration will differ from community to community.

 

Centering sex workers in harm reduction services
Sex workers face a series of additional challenges when it comes to accessing harm reduction services. Local legal conditions, stigmatisation of sex work and violence prevention are additional considerations, specific to people who engage in sex work, that can change the priorities of harm reduction service delivery.

 

When moving online and utilising digital services, it is also important to consider how your target community’s digital access and digital literacy can impact service delivery.

 

Digital inclusion for people in homelessness
People in homelessness face additional challenges that can make it more difficult to be digitally included. These barriers can include limited wifi availability, inability to charge devices and concerns over privacy.


 While having a clearly defined target community can help to ensure appropriate considerations are made to meet the needs of your community, it is also important to allow flexibility within your service definition given the porous nature of digital communities.

 

Aim and platform choice

 

In some cases, by identifying the aim and the target community of your project/service, the most suitable platform will be clear. This highlights well the notion of “building where the people are.” If your project/service specifically focuses on delivering harm reduction online to a community that already exists online, the most suitable platform would be where the community already exists.

 

Recommendation:

 “If you want to build a community, start where the people are.”

With reference to the target community, there are a few other factors that can influence the most suitable platform for your project/service:

Funding
    • Most of the time, platform choice can be restricted by the amount of funding and other resources that are available to your organisation. Developing new technologies and applications can require large amounts of money and time. With many community-based and community-led organisations, resources are finite and there is great opportunity to utilise already existing platforms, third-party applications and open-source resources.
    • In other cases where funding is not a barrier for service design and delivery, it is still important to consider the community and other relevant dynamics before choosing your platform.
    • Developing an app can take a lot of time and effort, yet it can easily become outdated and it can be difficult to maintain a harm reduction application on the app store and google play store given their own regulations.
Donor reporting

In cases where your project/service is funded by an external donor organisation, there can be clear expectations of deliverables.

Regulations:
    • Regulations of a third-party platform:
      In other cases, where your target community does not already exist online, and therefore ‘build where the people are’ cannot apply or a case where, ‘where the people are’ is not a suitable platform for your aim, third-party regulations can impact your platform choice, these can include a platform’s code of conduct, terms of service and content moderation.
Sensitivity of information

Engaging with communities and service participants

 

It can be helpful to identify how your target community interacts with the virtual environment. Generally, two types of engagement can occur. First, you may engage with a community that already exists online, connecting with people who are already using digital spaces to interact and share information. Alternatively, you may engage with a community that primarily exists offline but reach them through digital means, such as social media, messaging platforms, or other online tools. Understanding which type of engagement applies to your service will help shape your outreach strategies and communication approaches.

 

Cross-platform engagement

 

Once you have a clear understanding of your target community’s digital habits, you can tailor your presence across multiple online spaces to effectively reach them. One of the benefits of digital harm reduction is the ability to maintain a presence in several virtual environments at once, increasing visibility and accessibility. A major part of this work involves both connecting directly with service participants and raising awareness that your project or service exists.

 

Recommendation: Consider how different platforms can be used to reach and engage your community. Having a presence on social media (e.g., TikTok, Instagram) and in digital spaces where your target audience already spends time (e.g., forums, dating apps, online games, classified ad sites) can help introduce your project and make referrals easier.

 

2. Evidence-informed practices

The digital harm reduction service design, implementation and evaluation must be evidence-informed

Evidence-based vs. evidence-informed

 

While the two phrases, ‘evidence-based’ and ‘evidence-informed’ are extremely similar, they can have widely different connotations when working with service design, delivery and evaluation. By definition:

Evidence-based practices → reliance on research evidence and quantitative studies to guide interventions. Generally, this is a standardised and replicable approach
Evidence-informed practices → integration of various types of evidence beyond research and clinical expertise, including client feedback, contextual factors and lived experience. Generally, this approach is more adaptive and flexible to individual circumstances

Digital and online harm reduction should be evidence-informed, allowing for new innovation and the flexibility to explore and experiment within the digital space.

 

Digital harm reduction methods are still relatively new and under-explored within a clinical or research setting. Dynamics of community, trust, accessibility (the list can go on) that exist within the digital space differ greatly from those that exist within traditional or offline harm reduction services, where the majority of current research investigates. Consequently, the ‘evidence’ that is available might not be representative of the practices and outcomes that are possible with a technological approach to harm reduction. Implementing an evidence-informed perspective allows the space for new innovation and the flexibility to experiment within service design, delivery and evaluation.

 

Prioritising evidence-informed practices also provides greater flexibility within service design, as anecdotal and lived experiences are just as relevant as scientific methods of research. This approach is therefore more adaptive for community-based and community-led organisations where limited resources might limit the possibility to run multiple trials and collect evidence before piloting the project/service. With this in mind, evidence-informed becomes more appropriate as to not discourage small community-based and community-led organisations from piloting or starting a new project/service because ‘there’s not enough evidence.’

 

Existing and open-source resources

 

Another element that comes with evidence-informed practices, is utilising work, research and resources that already exist — or put differently, ‘not trying to reinvent the wheel.’ Make the most of guides, recommendations, templates, checklists, layouts, programmes, papers, networks that are accessible to your organisation. There is a lot of open-source material and existing resources available online.

 

Some existing guides in setting up digital harm reduction services include: 

Open-source resources → are tools (such as software, code, data, educational material, etc.) that are made freely available and publicly accessible for anyone to use, modify or share. They are generally collaborative and developed by the community. As a result, open-source content can be a cost-effective solution in resource limited settings. While what is available through open-source might not perfectly meet the specific needs of your project/service, these materials can provide a great foundation to build off of, so you do not have to start from scratch.

Some examples where open-source resources can be useful within service design, delivery and evaluation:

    • translation services for multilingual access;
    • open-source code and specific platforms create websites and code for you;
    • AI tools;
    • accessibility and usability guidelines;
    • website plugins for disabilities.

Automated and artificial intelligence tools

 

Automated tools are digital systems that can do tasks on their own, without manual effort. Artificial intelligence (AI) tools can help with tasks like answering questions, making suggestions, recognising patterns or sorting information. These tools can help to improve the efficiency and delivery of digital harm reduction services, especially when human capacity is limited. AI tools can be incredibly useful but should also be utilised with care as they may project their own biases onto what output they produce.

 

3. Meaningful involvement of community

The digital harm reduction service must meaningfully involve community members in the design, implementation and evaluation of the service

Reasons and methods for meaningful involvement

 

Meaningfully involving your target community within the design, delivery and evaluation of your project/service has many advantages, including:

    • Ensuring that the project/service targets specific needs within the community, and service delivery is able to be tailored to meet these needs. This includes bridging gaps in service delivery;
    • Increasing trust and engagement within the project/service;
    • Understanding what service delivery methods work best within the target community;
    • Empowering communities and promoting capacity building while protecting human rights of service participants.

These points can be considered a conceptual basis for the “meaningful” part of “meaningfully involving service participants” — how community engagement can improve the quality, usefulness and equity of your service.

Within community-based and community-led projects and services, the involvement of service participants is usually inherent by design, meaning that these advantages can often already be realised without further consideration. With peer-led and peer-to-peer initiatives, there is a porous definition between service participant and service provider. In other cases, by having a more structured understanding of the advantages of community engagement, you can establish what parts of your service’s design, delivery and evaluation might need more attention.

 

Do you want to ensure that your service is aware of new drug trends in your community?

Do you want to improve the engagement of young people within your service?

Do you want to identify barriers that might exist for service participants for accessing your service?

 

Depending on your reason for involving service participants, the most appropriate way of engaging with service participants will change. These methods can include:

    • Co-creation of online tools and services;
    • Focus groups and consultations;
    • Project/service usability tests and user experience (UX) interviews;
    • Peer moderation and integration within service staff;
    • Community-led feedback, including participatory data dashboards, in-app feedback tools, evaluation panels;
    • Involvement in management, organisation and leadership.

Recommendation: Establish a shared understanding of why meaningful involvement of service participants is important and what you are trying to address. then it is possible to determine the best way to involve service participants in a way that is meaningful and aligned with the goals of your project/service.

 

Digital inclusion and community engagement
Simon Community Scotland and Get Digital Scotland
Simon Community Scotland takes a gendered approach to harm reduction to support women who experience homelessness and use substances. Through their Design Labs, Simon Community Scotland collaborated with women supported by their services to identify barriers and challenges faced by women who use substances. These workshops often took place one-on-one, and either in person or online, to provide confidentiality and make sure everyone could participate. The stories and experiences these women shared led Simon Community Scotland to pivot from their initial goals and instead focus on creating a space where women felt safe and supported in sharing their trauma and loss. This included the creation of both educational and narrative resources that honour the stories of women experiencing homelessness and substance use (By My Side app, videos, podcasts, written material).
 

Community engagement — networks and partnerships

 

There is always a way to reach a new community, it just may require some extra work. Developing networks and partnerships with other existing organisations and communities can help to alleviate some of this work. Most community engagement will form from building relationships and connecting with community members.

 

Collaborating with other NGOs and organisations that are directly involved with your target community can also help with the implementation of your service. These other organisations may not necessarily be involved with harm reduction, but can help to connect your service to the community as well as identify specific needs, barriers and challenges that may exist for your target community.

 

Recommendation: Reach out to other organisations, projects and services similar to yours and explore the possibility of collaboration.

 

Community engagement — compensation and resource limitations

 

While the reason for involving service participants should help determine the involvement method, your funding and resource availability might ultimately decide what is possible. As important as community engagement is, you also must make sure that it is not exploitative, finding a balance between voluntary work and compensation.

 

Start by recognising the use of unpaid labour and if there is a potential for community members to be overworked and fatigued without compensation. This may especially be relevant when collecting feedback and evaluation, as these methods have the potential to cause feedback fatigue, both on the service staff and participants.

 

    • With digital and online tools, there are alternative ways to measure engagement and, therefore, collect feedback. This can include monitoring how many times a resource was downloaded, how many people interacted with embedded tools, or how many likes, comments or shares a post has. This can relieve some of the workload from service participants and can be useful when resources for compensation are limited.

Compensation for community members within the project/service should be determined with the involved participants. Depending on the community, project/service and commitment, what is fair and ethical compensation will vary.

 

These discussions can begin by asking community members how best they would like to be compensated for the assigned task. Some community members may actively choose not to be compensated monetarily, while for others, small amounts of money can go a long way. The type of project/service can influence possible compensation options for involved participants.

 

Compensation in rave culture
Within the party/nightlife and rave culture scene, projects and services often compensate volunteers by providing festival or event tickets for free. This is a creative way to provide compensation that still values community members time and effort.
 

4. Accessibility – UX, UI and language

The digital harm reduction service must make accessibility considerations within the user-experience (UX) and user-interface (UI) and use of language

When considering the overall design of your digital harm reduction service, it is important to consider the user-experience (UX) and user-interface (UI).

User-experience → refers to the overall experience of a service or tool, including the ease of use, emotional impact and flow.
User-interface → refers to visual features and design elements that help to construct the user-experience.

Accessibility – UX

 

With reference to user-experience, accessibility of a project/service indicates how capable and able service participants are in utilising the service. 

 

Accessibility UX considerations include having:

 

    • Easy to navigate interface and an intuitive design;
    • Guidance or other explanatory tools on how to utilise the project/service;
    • Accommodations for diverse needs.

These considerations should be guided by the target community and context in which they are interacting with your project/service. Some of the factors that should be accounted for include:

 

    • Altered state of awareness — when and in what context are your service participants accessing your project/service?
    • Digital literacy — what technological knowledge and skills do your service participants have?
    • Digital access — what technology, devices, internet, do your service participants have?
    • Language — what language/s does your target community speak?
    • Disabilities and other diverse needs.

 

Accessibility – UI

 

These UX considerations can be accommodated through UI features and other technical considerations.

Altered state of awareness
    • UI considerations 
      • Simple graphics, soft and warm colours, clear buttons, simple fonts;
      • Visual feedback for interactions.
Digital literacy
    • UI considerations
      Simple graphics, iconographic buttons;
    • Technical considerations
      Explanatory guides/videos/material on how to use the service.
Digital access
    • Technical considerations
      • Configuration for low-bandwidth connection;
      • Configuration for different operating systems (iOS, android, etc.);
      • Downloadable material/offline access.
Language
    • Technical considerations
      Multilingual access, translation.
Disabilities and other diverse needs
    • Technical considerations
      Accessibility plug-ins, ability to adjust font size, colour contrast.

Accessibility – language

 

Providing multilingual access to your digital harm reduction service is one way to support accessibility through language. The choice of words and type of language utilised in service delivery can also ensure that your service does not exclude, confuse or alienate service participants, especially those who may face other barriers and stigma accessing harm reduction services. Accessible language considerations include:

 

    • Utilising clear and simple language that is easy to understand and considerate of your target community;
    • Utilising person-first, non-judgemental and non-stigmatising tone and language;
    • Providing explanations or examples if discussing complex topics;
    • Understanding slang, terms and concepts used within the community and digital space.

Recommendation: These considerations can be supported on an organisational level by implementing communication guidelines for service providers and staff as well as training on the appropriate use of language.

 

5. Data protection and data security

The digital harm reduction service must protect the data of service participants and take active measures to ensure data security

Data protection vs. data security

DATA PROTECTION → refers to the legal, ethical and procedural measures that guide how personal data is collected, stored, used and shared.
data security → refers to the technical and organisational measures used to protect data from unauthorised access, alteration, loss or theft.

Data collection considerations

 

Recommendation:

The best way to protect and secure data is to not collect any data at all. Collect the minimum required amount of data possible from your service participants.

 

Data collection may be unavoidable and necessary in the majority of service provision, especially with services that provide health/medical support or that utilise a login functionality. Other times, data might be collected for reporting or monitoring and evaluation  purposes, in these cases there are ways to ensure ethical data collection.

 

Therefore, before collecting any data from your service participants, it is important to ask — What is the purpose of personal data within your project/service? How necessary is it for the project/service to collect personal data from the service participants?

 

After deciding what is the minimum amount of data required to be collected by your project/service, there are a few recommended measures that can be implemented to uphold data protection. These include:

 

    • Anonymising data;
      Can be useful when data collection is necessary for reporting or monitoring purposes, as one is able to collect research statistics (age, gender, location, etc.) without attaching these characteristics to service participants.
    • Code individual data with a unique number/keyword;
      For a project/service that allows service participants to login repeatedly or their data is stored within your system, you can code each individual entry through a unique number or keyword. This may be a good option if your project/service does not require sensitive data, but keeps track of its service participants. A unique number or keyword can also be provided for service participants to login into the project/service without having to provide any personal details.
    • Option to provide fake email address/name;
      Collecting emails can be useful from a service provision perspective for communication and marketing purposes. Likewise, collecting names can allow for greater personalisation of services, especially in peer support or counselling projects. However, this could interfere with service participants trust with the service or willingness to engage, as it adds an additional registration access barrier. Providing the option for service participants to register with a fake email address/name could mitigate these barriers.
    • Ability to manage personal data and preferences;
      This can provide service participants with greater autonomy over their data and can help uphold the ethical considerations of data collection. This is closely linked to informed consent (discussed in the following section).
    • Ability to request personal data and information to be deleted;
    • Compliance with relevant data protection regulations (eg. GDPR).
The General Data Protection Regulation (GDPR) is a comprehensive law concerning data protection, privacy and personal data. The GDPR was enacted by the European Union and, therefore, applies to all EU member states. Additional GDPR resources: 
Quick Guide to the Principles of Data Protection, Data Protection Commission
General Data Protection Regulation, European Union
 

Data security considerations

 

The required level of data security will depend on the sensitivity of the data your project/service collects. Data security measures include both the technical infrastructure that a project/service utilises, as well as organisational measures of the use of digital tools. Both technical and organisation measures should cover the:

    • Secure storage of data;
    • Secure management of data;
    • Secure means of communication.

Technical recommendations to achieve these data security goals include:

    • Utilising secure and encrypted operating systems/server for the collection of personal information and data of service participants;
    • Utilising messaging and video call services that employ end-to-end encrypted software;
    • Requiring two-step verification for service providers and staff to access data; 
    • Ensuring backup incase of technical failure. 

Organisational recommendations to achieve these data security goals include:

    • Implementing code of conducts, formal confidentiality agreements and privacy policies for the use of digital tools;
    • Regular data audits and review of what data is stored.

However, a large proportion of data security measures relies on the adequate training of service staff and service providers. Training service providers and staff on the secure use of digital tools can include basic digital security such as,

    • Not using USB sticks for the management and sharing of data;
    • Using different passwords for different services;
    • Accessing personal/sensitive  information only on secure services.

Digital security should also be built into operating procedures of service delivery.

 

Secure communication 
For example, in case where a service participant reaches out to your peer support service on Instagram DM, a platform that does not have secure messaging services but has been set up for the purpose of outreach and engagement, service protocol can include immediately referring them to a communication channel that is safer (eg. Telegram, Signal).
 

Data protection, data security and trust

 

Having clear and adequate data security and data protection measures that are well communicated to service participants can help to build trust between your project/service and service participants. In other cases, it is important to be aware that adequate data protection and security measures might already be assumed and expected by the service participants. Mistrust of a project/service may usually arise from the service itself, rather than the intricacies of the data infrastructure. It is important to build an ethical framework within your service delivery and design, and where possible, offer advice to service participants in protecting and sharing their data.

 

Data collection and informed consent

 

The digital harm reduction service must obtain informed consent from service participants before collecting personal data.

Obtaining consent is extremely important with reference to the ethical considerations of data collection. More specifically, consent should be informed, so that when service participants agree to provide any information they know exactly what data is being collected, why it is being collected, how it will be used and who will have access to it.

 

Given that service participants might be interacting with your project/service with an altered state of consciousness or the need to account for varying levels of digital literacy, informed consent can be difficult to obtain. Some strategies can include:

    • Summarising extremely long consent forms and privacy policies with simple and accessible language;
    • Providing service delivery options that do not require data collection;
    • Ensuring that consent is actively given (requiring service participants to tick a box to consent).

Consent should also be able to be withdrawn at any time without consequences. Therefore it is also important to provide features that inform service participants that they can update their preferences at any time, as well as making this clearly accessible within the UX.

 

6. Staff culture, training and operating procedures

The organisation of the digital harm reduction service must promote an inclusive and considerate staff culture. Service providers and staff must be adequately trained, supported and understand their roles and responsibilities.

Staff culture basics

 

Given the space that community-based digital harm reduction services operate in, it is important to foster a staff culture that is care-centred, non-hierarchical and supportive of service providers and peers. There can be the expectation from service participants that they can have unlimited access, 24/7 response and instantaneous response from digital harm reduction services. While this can be true, and reflect one of the advantages of digital service delivery, in projects and services that require staff to be online to deliver the service (for example, peer support and counselling services), this immediacy expectation can create a lot of pressure for the service staff. Depending on the project/service, service providers and staff can also be at greater risk for burnout given constant exposure to crisis or distress online, paired with the isolating nature of a virtual environment.

 

To help promote a staff culture that is supportive and values open communication, some recommendations include:

 

    • Providing realistic trainings and resources concerning service delivery;
    • Providing additional intersectional training and education for service providers and staff;
      Further information about training and education are outlined in the proceeding sections.
    • Clearly describing procedures and protocols concerning service delivery;
      Further information about protocols and procedures are outlined in the proceeding sections.
    • Encouraging service providers and staff to set professional boundaries;
      These include both boundaries with service participants, in services that involve peer counselling and support, as well as boundaries that promote a sustainable work-life balance.
Voice messages
A professional boundary that a service provider might set up with service participants is the type of messages they are open to receive. For example, voice messages can sometimes be hard to listen to, or voices might be muddled or hushed, and therefore, it is difficult to provide an adequate response as a service provider. Requesting that service participants only send text messages when utilising a messaging service (Telegram, Signal, etc.) can be a technological boundary set by the service provider.
 
    • Providing support to service providers and staff in managing work-related stress, mental health and professional boundaries.
    • Setting service delivery boundaries for service participants;
      This should be set up when developing the aim of your project/service and involves clearly communicating to service participants what they can expect from your project/service as well as establishing limitations of working hours. By setting clear expectations from the beginning, you help foster mutual respect and support the long-term wellbeing of both staff and service participants.
    • Utilising automated systems;
      Automated systems can help to maintain these boundaries by managing communication outside of working hours or screening service participants inquiries. They can reduce the pressure on staff to respond immediately while still engaging with service participants. Automated systems such as scheduled messaging, appointment booking platforms, auto-reply features can be utilised for administrative communication or chatbots can be utilised for more sophisticated auto-response functionality.
    • Understanding the motivations of service providers and staff.
      Building an inclusive and considerate staff culture also involves understanding the motivations of the people working within the project/service. How might these motivations influence how people interact with others and their counselling style? What values and expectations do you hold for your staff? Discussing shared values, communication practices and boundaries help to create a foundation of trust and mutual understanding among service providers and staff.
    • Weekly/bi-weekly/monthly team check-ins;
      Checking in with how your service providers and staff are doing in a team meeting setting can provide the space to discuss whatever has been happening recently or any situations that were difficult or weren’t anticipated. These do not have to be super formal meetings and can mostly be just to check-in.
 

Training and education

 

The most useful training that can be provided for service providers and staff are the ones that reflect real-life service delivery scenarios.

 

For example, a peer-to-peer counselling service could role play certain scenarios that might occur to provide service staff experience in dealing with crisis situations.

 

Recommendation:
Provide service providers and staff with realistic training and case-based examples of service delivery.

 

In an ideal situation, without funding, time and other resource limitations, service providers and staff would be able to access and be provided extensive training and education that ensure that they are comfortable and knowledgeable with the service delivery and related topics. Area of additional staff training could include, but is not limited to:

 

    • Intersectional topics related to drug use, harm reduction and digital services;
    • Digital relationship building and trust within virtual environments;
    • Use of appropriate language (non-stigmatising, inclusive, etc.);
    • Digital platforms (use, function, troubleshooting, security, etc.);

However, there are many considerations in service organisation and provision that may limit training and education ability of staff. These include:

 

    • Workload and availability of service providers and staff;
      Required training, support, learning modules and other materials can be fatiguing for staff when they already have a high workload. This is particularly relevant if service providers and staff are peers or volunteers.
    • Funding and resource availability;
    • Staff commitment to training;
    • Volunteers and ‘crowd-sourced’ staff;
      One of the key differences with digital harm reduction services that operate in a community forum setting, is that community members can facilitate the delivery of harm reduction. An example is online trip-sitting servers, where community members are available to support others during the night. In these types of services, it can be difficult to ensure that community members are trained properly to provide service, as this is based on existing trust within community networks.

 

Creative solutions can help to overcome resource limitations and provide alternative methods of training and education. These include:

 

    • Prioritising necessary training for service delivery;
    • Integrating training into workflows;
    • Acknowledging gaps in capability/knowledge and provide linkage to other resources;
      One advantage of digital service delivery is the ability to immediately direct or link service participants to other available resources and services, both online and offline.
    • Providing easy access to documentation and other resources
    • Utilising new technologies (AI tools, chatbots, resources) that can maintain a certain quality threshold;
    • Utilising existing and open-source resources;
    • Promote collaboration and knowledge sharing between service providers and staff;
      One way to achieve this is through a working book, where staff and peers are able to add how they implement protocols and discuss methodology. This is closely linked to standard operating procedures within your project/service organisation, and can be useful in streamlining service delivery.
    • Recognise the value of experience as an alternative form of training.
      This can be useful in examples such as the online trip-sitting servers and other crowd-sourced staff projects.

 

Service protocols and procedures

 

Clear service protocols and procedures can help to ensure that your staff are knowledgeable and comfortable in service delivery. Some useful protocols and procedures include:

 

    • Clearly defined service provider and staff roles, responsibilities and expectations;
    • Standard operating procedures for service delivery;
      A standard operating procedure is a detailed, written set of instructions that describe how to carry out tasks or processes in a consistent and safe way. They are useful in training and guiding new staff as well as maintaining the quality of service delivery.
    • Communication protocols for engagement with service participants (consistent use of tone, accessible language, etc.).
    • Crisis response and emergency procedures;
    • Available resources for alternative service referrals;
    • Regular monitoring and updating of information;
    • Clear sourcing and verification of information.

Recommendation: define procedures, roles and protocols in advance (as much as possible), and in an accessible way, to provide clarity and support for service providers and staff.

 

With these procedures and protocols it is also important to find the right balance between being too extensive and being too simplified. If procedures are overly specific, they might be too confusing or end up unread. If procedures are too simplistic, they might not provide enough support or clarity.

 

    • Introducing a working book, as previously discussed, can help with developing procedures in an accessible way. This way, service providers and staff are able to add their own experiences with service delivery and help out others.

Recommendation: In service examples where a direct line of communication exists between the service providers and service participants (eg. online counselling services), the digital interface may make it more difficult to connect with the service participant. To help build a foundational level of trust and respect for the service participant, service providers can check with them how they would like to be addressed (names, pseudonyms, pronouns) and how they would like to be spoken to.

 

Colophon

Title

Best Practices and Recommendations for Digital Harm Reduction Services: Guidance for community-based and community-led organisations.

Authors 

Oldfield, J.: Conceptualisation, Writing – Original draft; Investigation; Data curation; Formal analysis; Rigoni, R.: Methodology, Writing – Review & Editing, Supervision, Project administration, Pérez Gayo, R.: Conceptualisation; Methodology; Supervision, Rogialli, A.: Project administration, Schiffer,K.: Funding, Digital Expert Group*: Data provision; Validation.

*Group authorship. List of contributors in Appendix 1. 

 Design 

Jesús Román!

Acknowledgements

We are grateful to the digital expert group who attended the digital expert meeting as well as the participants of the Delphi study who completed the online surveys . Special thanks to Lella Cosmaro, Raquel Carvalherio, Alexei Lakhov, Stefan Pejic, Tom Platteau, Galina Sergienko, Adam Stasiak and Konrad Wäch for their additional insightful and constructive comments on this publication. 

Recommended citation 

Oldfield, J., et al. (2025). Best Practices and Recommendations for Digital Harm Reduction Services: Guidance for community-based and community-led organisations. Amsterdam: Correlation – European Harm Reduction Network. 

Published by Correlation – European Harm Reduction Network (C-EHRN) and protected by copyright. Reproduction is authorised provided the source is acknowledged.

This Publication has been co-funded by the European Union. Views and opinions expressed are,however, those of the author(s) only and do not necessarily reflect those of the European Union or HaDEA; neither the European Union nor the granting authority can be held responsible for them.

 

 

Correlation – European Harm Reduction Network

c/o De Regenboog Group

Stadhouderskade 159 | 1074 BC Amsterdam | The Netherlands

www.correlation-net.org

Appendix 1: Group authorship

Name 
Organisation

Mireia Ventura

ABD

Konstantina Logkari

ABD

Kushakov Vyacheslav

Alliance for Public Health

Galyna Sergienko

Alliance for Public Health

Konrad Waech

Drogeninformationszentrum (DIZ) Zurich

Alexei Lakhov

EuroNPUD

Raquel Carvalheiro

FEANTSA

Tom Platteau

Institute of Tropical Medicine Antwerp

Lella Cosmaro

Lila Milano

Zuzanna Bien

London School of Hygiene & Tropical Medicine

Nina Sasic

ReGeneration

Stefan Pejic

ReGeneration

Florian Scheiben

South East Technological University