The GiruGaia Project sees its funding renewed and presents innovations in its approach
GIRUGaia is a multidisciplinary outreach team that, since 2003, has been involved with people who use psychoactive substances in the municipality of Vila Nova de Gaia. It is governed by the principles of Risk Reduction and Harm Minimization, where health promotion is addressed in concomitance with the various dimensions that involve the individual (social, psychological, biological and civic). It offers several services, including PTCSOBLE, the Preventive Materials Programme (Syringe Exchange Programme; availability of silver and pipes, “take home” Naloxone) combined with education for lower risk consumption practices, distribution of sexually transmitted infections prevention material, screening for STIs, social case management and psychosocial support. The project is co-financed by SICAD – Serviço de Intervenção nos Comportamentos Aditivos e nas Dependências, and has recently seen the renewal of this funding.
The Low Threshold Opioid Combined Therapy Programme (PTCSOBLE), in operation since 2007, guarantees close access to the administration of medication (antiretroviral, antibacillary, psychiatric, etc.) combined with opioid replacement and is aimed at people with addictive behaviors that do not join the formal network’s responses because they are in a situation of great socio-sanitary fragility. In this new project cycle this programme has seen its methodology reformulated in form and frequency. The flexibility of PTCSOBLE allows adapting the programme to the needs and profile of each user, promoting different dosing regimes observed that may vary between daily face-to-face contact or the availability of home therapy. In addition, and taking into account the absence of negative side effects associated with the availability of the therapy verified in the pandemic period, the team suspended the in-person take on Sunday. Considering that the fact of allowing each person to experience one day a week in which the confrontation with the symbolic presence of dependence is suspended, can bring psychological gains, autonomy and therapeutic involvement.
This change is based on the permanent effort to improve and adapt to the needs of the target population in the constant attempt of the team to reinvent itself, avoiding the possible trend of accommodation after 18 years of operation. Having introduced a series of changes in the operation of the service – suspension of daily departures to the ground, availability of home therapy, distribution of professionals in order to reduce contacts – it was clear that there is no valid criterion to make it impossible to take non-face-to-face in the regime that is now proposed. With these changes, there were no negative consequences on consumption, treatment, psychiatric and social issues, increased empowerment, self-responsibility and self-knowledge of subjects in a management/accountability process related to their therapy. In this way, together with the physician accompanying the team, the clinical protocol was reevaluated and criteria were included that allow individuals to withdraw their therapy (one day), if this is constructive in the therapeutic process of the user, discussed in the multidisciplinary team meeting.
GIRUGaia also provides services promoting citizenship and social inclusion, referring and accompanying individuals to the structures of the formal network. In its ongoing effort to improve the team, it also introduced a new working methodology, with a view to strengthening the exercise of citizenship and the empowerment of users’ autonomy. It has now made the “andante” available to individuals who need to go to some service and who already demonstrate the ability to do so independently, but do not have the financial capacity to ensure travel.
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