An episode of Changing the Conversation podcast
Nuasheen Chowdhury and Rowan Willis-Powell discuss youth-centered harm reduction strategies with host Ashley Stewart.
February 3, 2025
Ashley Stewart, Host (00:05): Hello everyone and welcome to Changing the Conversation. I’m your host, Dr. Ashley Stewart, the Director of the Center for Health Equity at C4 Innovations. Today we have a very exciting episode on exploring harm reduction with nuance, a youth centered approach. To have this wonderful conversation with me, I have two of my colleagues. We have Nuasheen Chowdhury, who is joining from the South Shore area of Boston. She is a Youth Wellness Coach, primarily working in the Framingham High School and East Bridgewater High School. Hey Nuasheen.
Nuasheen Chowdhury, Guest (00:37): Hi Ashley. Thank you for having me.
Ashley (00:40): Thank you for being here. And we also have with us Rowan Willis-Powell, joining from Baltimore, Maryland. She is a subject matter expert and manager at C4 Innovations and is a member of the Center for Youth Wellbeing Team. How you doing, Rowan?
Rowan (00:57): Hey, Ashley, it’s great to join you.
Ashley (00:59): Both of these wonderful folks are here from the Center for Youth Wellbeing Team, really leading in subject matter expertise and innovation and working with young folks, working in schools, working in communities, and moving the work forward through this harm reduction lens. Maybe Rowan, you can get us started. What is harm reduction?
Rowan (01:23): I like to think of harm reduction in two different senses. The really broad worldview is that it’s something that refers to policies, programs, practices, procedures that aim to minimize the harm caused by something. I think generally, we hear about it being talked about in terms of drug use, but harm reduction has other applications as well. A friend of mine many years ago explained harm reduction to me by talking about seat belts and how they really are a form of harm reduction. You’re partaking in something which could potentially cause you harm or danger, and you’re taking a step to limit the impact of that harm. Harm reduction can also be viewed from those really minutiae small interactions and things that we do like wearing seat belts beyond those policies and procedures such as giving out Narcan or Naloxone to folks who may have need for them, or providing testing for folks who are concerned, they might have an STI, which is a sexually transmitted infection. But also, there are just things that we do in our everyday life that for some of us are probably really, really normal, like wearing a seat belt.
Ashley (02:39): That practicality is so helpful because I think sometimes when people hear harm reduction, there’s some natural biases or misconceptions that automatically begin to populate for folks. Nuasheen, what are some of those common misconceptions that you have heard about harm reduction?
Nuasheen (02:57): In my experience working at a harm reduction organization nonprofit where many of the folks accessing services were those in the community experiencing homelessness or were also struggling with substance use disorders. This phrase that I came across is called NIMBYS, which is Not In My Backyard. A lot of people just didn’t want those services being provided in their community because they thought it would attract folks that are going to bring more chaos into the community, “chaos” or possibly cause harm to the community in ways that they necessarily don’t want. And it was just very sad to witness because these are the kinds of people that need help more than anything.
Ashley (03:49): Absolutely, and I’m so glad that you bring up that NIMBY-ism because so much of that is what’s happening. People don’t know or understand a concept. They begin to hear about it from other people, and that begins to inform their perception of it. We don’t know what we don’t know. And so when we have one set ideas about what is harm reduction and whether it’s accurate or misled, that ends up being what guides us in our perception. And not only is it harmful because it’s creating spaces where we’re not able to serve as many people, but it’s also placing unfair, incorrect, biased characteristics on people, on us, on folks who are seeking support in a multitude of different ways. And so, I really think that the stigma piece is important to dive into.
(04:40): We know that stigma operates within institutions and systems. For example, schools, healthcare, community settings. Rowan, have you seen that and what has it looked like?
Rowan (04:51): When we have stigma existing at a systemic level, it can either completely block access and take away programming that’s really important and impactful to people’s lives, or make that programming incredibly hard to access and engage with. Sometimes this happens by programming only existing in specific types of neighborhoods. When I think of harm reduction programming, and I think of things like safe needle sites, I think of them only existing in very urban areas, which if you are someone that lives in a rural area, that means that your access to that type of service just doesn’t exist. And a lot of it has to do with that type of stigma. I’m also thinking about there is a very pervasive stigma that harm reduction isn’t something that should exist for young people. I think we still live in the world where we know that D.A.R.E. Didn’t entirely work, but we don’t know what a better option for it is because anything that isn’t that “absolutely say no” is really, really scary, especially for adults when thinking about youth.
(06:12): But really what that just means is that if a young person is struggling with substance use or their family is struggling with substance use and they’re being impacted by it just means that when they’re going to school, which is where they spend most of their time, if they need a service, it’s not going to exist for them. And that’s going to have ripple effects throughout their lives. And that’s not to say that these sort of services don’t exist at all, but it just means that they’re incredibly limited in scope and might have real restrictions on who can engage with it. You have to be of a certain income level and stuff like that. You have to live in a certain community, and that just really, really limits who can receive that kind of support.
Ashley (07:00): I’m so glad that you bring in programming that we have often tried to assert, a model that says that there’s one right way to engage, there’s one right way to cope, or there’s one style of coping. And that doesn’t resonate, nor does it take into account some of the various systemic and structural barriers that some young people are navigating. And so it also cuts out the opportunity in the conversation to talk about what young people are experiencing, assuming, that young people only have this one responsibility, which is to be a student or this one responsibility to be a young person, not recognizing the merit of things that young people are navigating and how not only do personal community and familial factors influence a young person’s life, but also all of the different social issues, how that impact young people and uniquely. So the stigma is creating a barrier to, it’s even talking about what does harm reduction look like when serving young folks?
(08:08): Nuasheen, you’re doing this right now in schools, you’re working in a project called Project Amp where you do SBIRT: Screening, Brief Intervention and Referrals to Treatment. Tell us a little bit about what it’s like doing SBIRT in schools and what your work with Project Amp has looked like.
Nuasheen (08:30): Students come to me with a myriad of experiences that inform their decisions and how they show up the way they do, and all I do is just try my best to respect that as best I can. Whether that’s through Project Amp or SBIRT screening, I believe this really establishes the basis of harm reduction. It’s about treating everyone with compassion no matter who they are and what circumstances they are in or are coming from. When that becomes the basis through which we move through the world, I think we can access a much more nuanced reality. One that may, in some circumstances, shed light to the darker sides of reality. But I think on the flip side, allows for more beauty to be felt and experienced.
(09:19): And I believe a real life application of this, for instance, is if a student is sent to me via administration for being caught vaping at school, my primary goal isn’t to correct behavior. Despite that being maybe what the administration wants from me. What I really care about is establishing a humane connection through which that student can hopefully develop a deeper understanding of themselves and why they do what they do. And maybe that will cause an immediate change in behavior or maybe that’ll just create a foundation. Otherwise, in both scenarios, I’m happy.
(09:56): And then beyond just that philosophical delving into harm reduction, I think there are more practical and tangible ways in which I engage with it. For example, at one of my schools, I’ve recently been tasked with managing a resource closet, which is essentially just filled with clothes, shoes, other things students may need. There are even prom dresses. Which is really cool. And then moreover, a very classical example of harm reduction, Youth Wellness Coaches recently have been trained with administering Narcan, which unfortunately is a necessary skill for those working in schools today.
Ashley (10:31): I love it. I love it. I’m sure that there are people who are listening who are like, “I hadn’t even considered that that’s an opportunity working for young folks.” And what I really feel like I’m hearing or something that’s coming up is when we’re talking about young folks, there’s multiple stigmas. There’s the stigma of harm reduction that we talked about earlier, but then there’s also a lot of stigma about young people and what young people know. And in some conversations that I’ve had, people often talk about young people thinking that they know it all, or young people thinking that they have it all figured out. But the opposite side of that assumption is that young people don’t know things and young people don’t have things figured out. And I think that is a huge misconception and creates such a wedge for us to be able to connect with the people and really understand what their unique experiences are, addressing issues that we might think the young folks aren’t worrying about, but are. And impact them in their day-to-day lives, that they’re actively challenging and addressing and confronting and have ideas and perspectives about it that are inherently unique, transformative, engaging.
(11:47): You talked about the Youth Wellness Coaches through the context of the screenings and wellness coaches working with and supporting young folks by being Narcan-trained. Rowan, can you tell us a little bit about what our Youth Wellness Coaches and what do they do?
Rowan (12:04): Our Youth Wellness Coach model has been something we’ve been working on for the past two years, born out of a collaboration with the state of Massachusetts, but also sparked by a project we’re working on with Massachusetts General Hospital, that is PCORI-funded.
Ashley (12:22): PCORI stands for Patient Centered Outcomes Research Institute.
Rowan (12:26): Where we are bringing youth peers directly into school systems. So it is a youth peer approach. It’s a little bit different than some other youth peer models, specifically in the sense that the Youth Wellness Coach model is wellness-oriented. A lot of times when we think about peer support work, we think about it being very directed at either mental health or substance use, sometimes both, but not approaching the fact that wellness is something that embodies all aspects. And I think a lot of this is actually born out of something that is very youth oriented and youth led.
(13:06): As I’ve done my work over the past 10 years, there’s been a really cool shift that I’ve seen of youth peer workers moving away from using very specific language to describe themselves, like being a mental health peer, being an SUD peer or talking about recovery in that very binary sense, and instead focusing on the fact that they’re a whole person and wellness is the ultimate goal that they’re looking for and describes their journey in the best sense.
(13:41): So our Youth Wellness Coaches are really implementing that model in the schools and focused on how they can fully support the wellness of these students, not just their mental well-being.
Ashley (13:55): Youth wellness model. What age range falls under that youth wellness model?
Rowan (14:02): So right now, our Youth Wellness Coaches are working in both high schools and middle schools throughout the state of Massachusetts. So really you’re looking at 10 to 17, I think, being the average. And most of our Youth Wellness Coaches are between the ages of 19 and 29, so well within that TAY age range, which means transitional age youth.
Ashley (14:32): Thank you so much for that clarification. To be honest, Rowena was trying to see if I made the cut for it. [Laughter] But you know what, while I might not make the cut, Nuasheen, you definitely are actively doing that work and representing that traditional aged youth, can you share from your perspective as a young person what role harm reduction has had in your life?
Nuasheen (15:02): I think that’s a really good question considering that many Youth Wellness Coaches have lived experience with a lot of the topics that we navigate and work through with the students that we do work with at the schools. And so in my personal life, I definitely experienced substance use in maybe not the best, most healthiest of ways. And so some things that have helped me throughout my life regarding that is, and I know it sounds corny, but text hotlines are the best things. It’s nice to have that constant reminder throughout the days like, oh, here you go, here’s some support and a reminder that you can keep going. And also apps like Smoke Free, which is really nice. It allows you to see how much of your body is feeling throughout the days when you do quit smoking. And things like maybe if you do smoke weed, if you’re concerned about how it’s impacting your lungs, maybe transitioning into edibles can be a form of harm reduction.
(16:11): These are very real conversations that I have with students, and I think it’s very much appreciated because I’m not going in with the perspective of you need to abstain 100%. Some of these students come to me telling me, “I do this because it’s hard to fall asleep,” despite there being research out there that weed doesn’t actually improve sleep quality. I still don’t want to completely neglect that real life experience of theirs, their difficulty to fall asleep, or if they smoke weed because they’re anxious. Just so many things that students come to me with. So I think having some real conversations around that being like, okay, see, these are some things, real life applications that can help you at least transition out of it rather than just going from zero to 100.
Ashley (17:10): That example is so profound too, because what you’re demonstrating is that you’re getting to the point of the conversation with folks about their inability to sleep, about their feelings of anxiousness, and then getting to the point where we can create a conversation about whether their current coping mechanisms are even assisting with that. That’s a part of the conversation that we’re not even getting to often because it’s like, well, you shouldn’t do this, don’t do this. But there’s even more pertinent information. It’s like, this might be detrimental to these areas of your life and it’s not improving the ones that you’re hoping it will, but maybe there’s something in that process that is helping you calm down, and let’s talk about maybe some of that deep breathing that you’re doing that is all helping you calm down, but we’re associating it with this particular coping mechanism, the substance, or whatever that looks like for that particular young person. So it’s getting to the point of the conversation where we can have productive insight into what will be needed to support this person and what they’re navigating. That’s a really powerful reframe and shift in the conversation that many of us haven’t had that chance to have.
(18:23): Rowan, I know that some of this may seem new or there may even be some apprehension to taking this approach or considering this as an option when working with young folks. For anyone who is interested in harm reduction, what kind of takeaways or insight would you provide to someone wanting to better support young people?
Rowan (18:45): I think first I want to reflect on exactly what you just talked about, and Nuasheen talked about, the fact that being open and flexible with these conversations and not just jumping to the, you must do X, you learn more about a person. And we know that when doing work with youth, learning more about them is sometimes the hardest part, but it’s also the most important part. So on the very basic level of that, that adapting a harm reduction approach can help you build that rapport, that’s a win already.
(19:21): I think things to keep in mind, if you are wanting to dive into harm reduction with youth, I think one, doing some education, doing some Googling, doing some learning, having conversations with people like Nuasheen that are doing the direct work, but also taking some time to acknowledge your own discomfort with certain things that come up for you.
(19:50): I think something that, as adults, we sometimes have a hard time naming is the fact that we innately as humans feel very protective of young people. So when we see them making choices that we disagree with, that we might see harm in, our gut response is to restrict and protect. And that doesn’t always help. I think if we can think back to when we were young and people restricted things for us, it didn’t usually go well, and it didn’t usually help build a relationship or build trust, which is the groundwork of every positive thing that grows in this world. And I think another thing to keep in mind is if you were doing this work already or you’re doing work at all with young people, uplift them and listen to them. Let them be the guiding factor there. Have conversations with them. Bring them to all of the tables the conversations are happening, and actually listen to the guidance and feedback they’re providing you, even if it’s hard, even if it’s challenging, it’s an incredibly worthwhile process, and it can help make this journey something that we’re all together on and help set up the end result to be more mutually beneficial for everyone.
Ashley (21:17): I want to honor the work that you’re doing, Nuasheen, and the work that you’re doing, Rowan, and the Youth Wellness Coaches and Center for Youth Well-being, there’s a powerful shift and almost for someone else, it feels like a movement to create a new way of thinking, of engaging. And most importantly, of creating change, inspiring hope, helping and healing young folks. And I know that this is credited, and there are folks who do this all around, but having you all here as subject matter experts who are doing it, what are some of the immediate benefits that you are seeing from this approach in the schools, in the communities that you’re serving? Rowan, what are you seeing?
Rowan (22:07): I mean, in all honesty, Ashley, I think the Youth Wellness Coach model is one that I’ve seen when I started doing this work, programs like this were very hard to find, if existing at all. So to me, that really speaks to the impact of the model and the benefit of it, and the fact that if we’ve gotten this far where we actually have people providing these services in schools, then we know it works. And we know that it helps, and we know that it has an impact not just on one person, but an entire community and a system. And that is really, really cool to see.
Ashley (22:48): Did you all hear what Rowan just said? Oh my goodness. Nuasheen, what about you?
Nuasheen (22:55): This is precisely why I love my job. I think there are so many benefits to students, and I felt that on a personal level. I’ve had so many students come back to me telling me that they were just so happy that I was there for them. They remember conversations we had long ago. I’ve had even hour long conversations with students during SBIRT screening and have learned so, so much from these students. And I think that’s just to emphasize that it’s not a one way street. I’m not the only one who’s helping these students, as corny as that sounds.
(23:37): Yeah, it’s just a poignant reminder that these are, in some ways, like many adults, they have such full lives, and I just feel honored to be in their presence most of the time. There’s so much good that comes out of it, and I wish services like these were more present, and I wish I had it growing up, and I just wish to be that for others.
Ashley (24:04): That reciprocal benefit Nuasheen talked about, I love that. What can we learn from others around us that is cultural humility to recognize that age is an element of culture. We have so much to learn, we have so much to share, we have so much to give, and when we collaborate and provide an opportunity for perspective to be gained and shared and part of the conversation, it benefits us all. Rowan, thank you so much for your time and your expertise.
Rowan (24:38): Thank you, Ashley. It was really fun to have this convo with you all.
Ashley (24:41): And Nuasheen, thank you for your lived expertise and for your incredible leadership in schools with young folk.
Nuasheen (24:49): Thank you, Ashley. I really appreciate that.
Ashley (24:52): And to our listeners, join us next time on Changing the Conversation.
Erika Simon, Producer (24:58): Visit C4innovates.com and follow us on Twitter, Facebook, LinkedIn, and YouTube for more resources to grow your impact. Thank you for joining us. This episode was produced by Erika Simon and Christina Murphy. Our theme song was written and performed by Peter Hanlon. Join us next time on Changing the Conversation.
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