An evaluation of the Compassion, Inclusion, and Engagement initiative: learning from PWLE and communities across British Columbia

BACKGROUND: The Compassion, Inclusion and Engagement initiative (CIE) was a social contact intervention that operated in British Columbia between 2015 and 2021. The primary objective of CIE was to increase the participation of people with lived experience of substance use (PWLE) in the planning, design, implementation, and evaluation of harm reduction supports and services. CASE PRESENTATION: CIE used the developmental evaluation methodology outcome mapping to define and measure progress towards its goals. Developmental evaluation emphasizes learning in contrast to other forms of evaluation which are often more focused on determining the value or success of a project or programme based on predetermined criteria. Outcome mapping is a relational practice which acknowledges that change is achieved by an initiative’s partners and the role of the initiative is to provide access to resources, ideas and opportunities that can facilitate and support change. CONCLUSIONS: Through the implementation and evaluation of CIE, it became clear that directly supporting PWLE facilitated more meaningful and lasting change than solely working to improve the health and social services that supported them. The impacts of the CIE initiative extend far beyond the outcomes of any of the dialogues it facilitated and are largely the result of an increase in social capital. CIE engagements created the opportunity for change by inviting people most affected by the toxic drug supply together with those committed to supporting them, but their ability to bring about systemic change was limited. Both PWLE and service providers noted the lack of support to attend CIE engagements, lack of support for actions that came from those engagements, and lack of PWLE inclusion in decision-making by health authorities as limiting factors for systemic change. The lack of response at a systemic level often resulted in PWLE carrying the burden of responding to toxic drug poisonings, often without resources, support, or compensation.