Pushing the boundaries of outreach work: the case of needle exchange outreach programs in Canada.

In this paper, we examine the challenges of defining the boundaries of outreach work using the example of needle exchange programs. In particular, we examine the multiple and inter-related factors that extend needle exchange outreach work beyond its official mandate. Using semi-structured interviews, 59 workers at 15 programs in Ontario, Canada were asked questions about operational policies and routines. An iterative and inductive analytic process was used. Over time, most outreach workers develop a well-defined sense of the activities they consider to be consistent with a harm reduction approach and the types of conduct that are considered to be acceptable and professional. Workers conceptualize their roles to encompass education and support but are reluctant to impose a rigid definition of their roles. A pragmatic and humble stance combined with strong beliefs in social justice encourages workers to find informal solutions to meet client needs that extend beyond the program mandate. As a result, doing 'extra' is the norm. These extra efforts are informal, but often regular, expansions of the service complement. Construction of flexible boundaries provides opportunities to meet many client needs and unexpected situations; however, going the extra-mile strains resources. A minority of workers blur the boundaries between private and professional lives. Further, a variety of personal, social and socio-political forces encourage outreach workers to continually redefine the boundaries of their roles and service complements.