Multisectoral Organizational Collaboration: The Case of Syringe Service Programs in a Midwestern State

• In Event: Collaborative Governance for Systems Change

Abstract

Multisectoral collaboration involves the coming together of different people, organizations and actors from different organizational sectors (government, community-based nonprofit, corporate, academic, individuals) to work to solve problems that may affect a particular community (Hardy, Lawrence and Phillips, 2006). Multisectoral collaboration is one approach proposed to address “wicked problems,” inscrutable problems with no clear solution, that logical problem-solving can’t solve, and that requires tackling from multiple sectors (Jacquet et al., 2020). Overdose rates stemming from illicit substance use is an example of a wicked problem (McCrea, 2019), which has seen an increase in the United States since the COVID-19 pandemic in 2020 (CDC, 2023). As syringe services are increasingly being delivered through different sectors (government, academic and nonprofit/mutual aid), there have been some efforts to understand how these organizations collaborate with other actors in order to effectively provide services to those engaging in substance use. To explore issues of multisectoral collaboration, particularly among organizations working on controversial issues, I use this project to explore the benefits and challenges to these multi-sectoral collaborative partnerships.


This project involves 26 semi-structured, qualitative interviews with SSP employees at 22 SSPs in a Midwestern US state in 2020. 13 programs are SSPs run by public health departments, while nine programs are non-governmental SSPs. Interview questions focused on the inception of the syringe exchange, service practices, and how the respondent and the organization defined harm reduction. Transcribed interviews were analyzed using NVIVO. An interpretive framework with thematic analysis was used in analyzing the data, with member checking used to confer rigor.


This state-wide multi-sectoral collaboration to address the overdose crisis includes the state department of health and human services, academic partners, mutual aid organizations, public health departments, private nonprofit organizations, drug users’ unions and law enforcement. These actors meet monthly via Zoom to discuss issues they incur as SSPs. While many respondents spoke positively of the collaborative partnership, there were some clear tensions that emerged, which left some collaborative partners disillusioned with the collaboration effectiveness. Among the biggest sticking points was the lack of a cohesive definition of what their ultimate goals should be as harm reduction organizations. While respondents share a similar definition of harm reduction—that of reduction of harm from drug use—they differ on how harm reduction services are implemented in practice. Employees at 11 of 13 public health department SSPs describe their harm reduction efforts exclusively in terms of risk reduction of the harms of drug use, and indicate a preference for referring participants to abstinence-oriented services. In contrast, employees at community-based organizations described harm reduction in bodily autonomy terms, including self-determination in the right to use drugs. These conflicting perspectives were expressed during the monthly meetings, often with no agreement for a solution. This left some collaborative members feeling disenchanted and unheard, further distancing themselves from the collaboration. The failure of the multisectoral collaboration to address inter-organizational conflicts has implications for how the state will effectively address the overdose crisis.

References

Centers for Disease Control (May 2023) Provisional Data Shows U.S. Drug Overdose Deaths Top 100,000 in 2022. A Blog for the National Center for Health Statistics. Accessed October 12, 2023. https://blogs.cdc.gov/nchs/2023/05/18/7365

Hardy, C., Lawrence, T. B., & Phillips, N. (2006). Swimming with sharks: Creating strategic change through multi-sector collaboration. International Journal of Strategic Change Management, 1(1-2), 96-112.

Jacquet, N., Van Haute, D., De Corte, J., Nisen, L., Vandenbroeck, M., & Roets, G. (2020). Dealing with the wicked issue of child poverty: Inter‐organizational networks as forums for collective debate and reflection. Social Policy & Administration, 54(7), 1081-1095.

McCrea, A. M. (2020). Can administrative capacity address wicked problems? Evidence from the frontlines of the American opioid crisis. Administration & Society, 52(7), 983-1008.

Author

• Theresa Anasti, Washington University at St. Louis