DENVER – The managers of Denver’s syringe access and sharps disposal programs need to do more to ensure city resources are allocated efficiently and to determine the programs’ success in reducing harm and connecting people to health services, according to a new audit from Denver Auditor Timothy M. O’Brien, CPA.
“People are more likely to get the treatment they need for substance misuse when they have access to and use a syringe access program,” Auditor O’Brien said. “We need to use the resources available to us to get the services the city already has to the people who need them most.”
Our auditors used research and data analysis to examine how the city allocates its resources and works with the three syringe access providers it contracts with. We found a lack of communication and trust between the city and its service providers about how data is collected, used, and shared, which impacts the city’s ability to measure whether its efforts are working.
The Denver Department of Public Health and Environment’s Community and Behavioral Health Division oversees most of the city’s substance misuse and opioid prevention and treatment programs. Syringe access and sharps disposal programs seek to reduce harm for the community at large by providing access to sterile injection equipment and safe disposal options. Syringe access programs do not include or involve supervised injection sites, which are not allowed under state law.
Although duties supporting the syringe access and sharps disposal programs are spread across many roles, Public Health and Environment primarily administers contracts with three community partners: The Harm Reduction Action Center, the Denver Colorado AIDS Project, and Vivent Health. City ordinance caps the number of syringe access programs to three, although the department received a variance to operate a fourth program itself.
Two of the service providers operate at fixed locations in Denver; the third runs only a mobile unit. The city has its own mobile unit called the “Wellness Winnebago,” which was intended to provide general wellness services including syringe access but has been repurposed for now to respond to COVID-19.
Our audit found that, by more regularly analyzing existing data, collecting the right data, and conducting needs assessments, the city could better understand the risks and areas of concern as well as better allocate resources.
As an example, we used Denver 311 reports, 911 call reports and crime reports of drug use, drug sales, overdoses and needles or other drug paraphernalia to create this map. While this information is based only on reports and does not show confirmed crimes or drug activity, a map like this could be used as a starting point for the city to determine which areas are most in need of outreach.
As you can see, syringe access facilities and sharps disposal locations are not always near the highest-need areas. Using available data and other sources of information as a starting point would allow program managers to deploy limited resources more strategically and efficiently.
“I recognize data on people who use drugs or inject substances can be difficult to collect and that both the people using the services and those providing them might be hesitant to share too much,” Auditor O’Brien said. “However, my audit analytics team was able to find useful ways to combine multiple data methods and sources as an example of how to reach a fuller understanding of the population.”
The audit team also found the data the city receives from its service providers can vary, because reporting is inconsistent. The service providers told our team they do not know how the city uses their data, so they are reluctant to provide more information than what is required by contract. The providers said they are also worried the department would share the data for use in policing or clearing homeless camps.
“The city needs to build trust in our community,” Auditor O’Brien said. “City leaders want to help, but those most in need also need to be able to trust their city officials enough to accept that help.”
The audit team found a lack of communication and coordination with the providers contributes to the providers’ distrust. We found informing stakeholders about the results of evaluations and about how data is used in program decisions are key components of creating buy in and developing effective relationships.
City managers also need to take a more coordinated approach to overseeing provider and program success in line with the contracts. We found the Community and Behavioral Health Division does not conduct outcome evaluations and does not regularly communicate with program providers about program challenges and successes. The city could also use partnerships with agencies like the Department of Parks and Recreation or local veterinarians to assess more areas of need, especially for sharps disposal locations.
Also, because program duties are spread across multiple staff members, we found several instances when different people on the same team all thought someone else was taking care of specific tasks or projects. Decentralized management led to opportunities for miscommunication.
“Collaboration, open lines of communication, and increased trust will go a long way toward improving the effectiveness of Denver’s syringe access and sharps disposal programs,” Auditor O’Brien said.
By ensuring the collection of complete, accurate, and comparable data, the Department of Public Health and Environment will have the necessary tools to accurately evaluate the performance of its syringe access and sharps disposal programs and assess their effectiveness and success.
The department agreed to all our recommendations.