Harm reduction in a Norwegian housing first project: a qualitative study of the treatment providers' practice

Purpose - Little is known about how harm reduction is practiced in Norwegian housing first (HF) projects. The purpose of this paper is to explore, describe, and interpret how providers apply a harm reduction approach within a housing project focused on individuals who are homeless with co-morbid substance use and mental health problems. Design/methodology/approach - This qualitative study was part of a larger evaluation study of a three-year HF project in a Norwegian municipality. Data were collected using four multi-stage focus groups with five providers working in the HF project. Focus group interviews were transcribed verbatim and analyzed using thematic analysis. Findings - Analysis resulted in three main themes: "Letting the service user sit in the driver's seat," "We don't follow service provision contracts, we do everything," and " Collaborating with the local community." Research limitations/implications - There is a need to develop increased knowledge about service users' experiences within the harm reduction approach. Practical implications - To practice effective harm reduction, treatment providers must have open authorizations and the opportunity to exercise professional judgment. Harm reduction practice must also focus on social, political, and economic factors influencing users' everyday lives. Originality/value - The paper contributes to the knowledge base on harm reduction within HF practice that differs from a traditional model wherein clients are expected to abstain from substance use. It highlights important preconditions for challenges practitionersmight encounter at both individual and service system levels.