Harm Reduction: Meeting People Where They Are

Guest Contributor – Jaymie Kahn-Rapp

Finding My Path in the Field

I began my career in this field at 25, after earning my first master’s degree in Rehabilitation Counseling. My first job was as a vocational counselor at Odyssey House, a therapeutic community where I worked at their Lower East Side location in New York City. I worked with adolescents, most of whom were mandated there due to marijuana-related offenses.

Questioning the Therapeutic Community Model

I quickly realized that while the therapeutic community model worked for some, it did not align with my values. I did not believe in breaking individuals down in order to rebuild them. In general meetings, I was often mocked by colleagues and called “soft” because I refused to curse at teenage kids to break them down. Instead, I spoke about consequences, decision-making, and the importance of taking ownership of one’s actions. I wanted them to understand their goals and how their choices impacted those goals. Little did I know that, even then, I was a harm reductionist at heart.

Discovering Harm Reduction

My next job was at Housing Works, the first of many organizations I would work for that operated under the harm reduction model. During my interview, the executive director asked me what I knew about harm reduction. I didn’t know anything about it, so I answered with what I did know—universal precautions. He quickly educated me on harm reduction, and I was enthralled—it completely aligned with my beliefs.

A Defining Moment in My Interview

The interview process had three parts, the last of which involved meeting with colleagues and program participants. During that final interview, a participant had a loud emotional outburst. I didn’t even flinch. My time in the therapeutic community had already exposed me to intense group dynamics, and I had learned not to be shaken by big emotions. But more importantly, my instinct wasn’t to ignore or suppress the outburst—it was to make sure that individual was okay. So, I turned to those interviewing me and asked if they wanted to step out and help.

Without realizing it, I was already practicing harm reduction. Harm reduction isn’t just about substance use; it’s about meeting people where they are—whether they’re in crisis, processing emotions, or just trying to get through the day. A job interview might have been important for me, but ensuring the well-being of participants—the people we serve—always comes first. That moment wasn’t about proving my ability to stay composed; it was about demonstrating that I prioritize the dignity, safety, and needs of those in front of me. Apparently, that was what sold them on hiring me.

Understanding the True Meaning of Harm Reduction

One of my first trainings at Housing Works was with a founder of the harm reduction movement. She introduced the concept in a way that was eye-opening. She explained that many people mistakenly believe harm reduction is just an excuse to use drugs. But harm reduction isn’t about enabling—it is a compassionate, practical approach that prioritizes reducing harm over insisting on abstinence, recognizing that not everyone is ready or willing to stop using substances.

It emphasizes meeting people where they are, respecting their autonomy, and providing tools and support to help them live safer, healthier lives on their own terms. Harm reduction is ultimately about dignity, empowerment, and minimizing the negative consequences of drug use and other high-risk behaviors without judgment or coercion. At its core, harm reduction is exactly what it sounds like: reducing harm. It’s about helping people live longer, healthier lives.

Meeting People Where They Are

Not everyone wants to stop using drugs. Not everyone wants custody of their children. Not everyone wants to live independently. But what do they want? And how can we support them in achieving it?

Maybe someone does use drugs, but they’ve worked incredibly hard to regain custody of their children. They don’t use when their kids are around. They provide a clean, safe home. They have a job that supports their family. They put food on the table. That’s okay.

Challenging Bias and Redefining Support

Harm reduction challenges stereotypes. It forces us to set aside our biases—our beliefs about how people should live—and instead help them live the best life for them.

When working with people, our first question should always be: What do you want? If someone is actively using and not ready to stop, then our role is to educate them on how to use safely so that we can keep them alive. Because if we can’t keep them alive, then what’s the point of helping them set goals?

A Core Value, Not Just a Professional Approach

At the end of the day, it’s not about us. It’s not about what we want for people. It’s about what each individual wants for themselves.

For me, harm reduction isn’t just a professional approach—it’s a core value. No matter where I work, I will always incorporate harm reduction into what I do.

Jaymie Kahn-Rapp is a passionate and results-driven leader dedicated to harm reduction and creating systems that prioritize individuals’ well-being. With over two decades of experience in healthcare and social services, her career has focused on reshaping programs to be more person-centered, ensuring that those affected by HIV/AIDS, substance use disorders, mental illness, and other challenges receive the support they need to thrive. She has led transformative initiatives that meet the evolving needs of communities, consistently staying ahead of the curve by embracing innovative care approaches. Through spearheading system redesigns, securing vital funding, and fostering partnerships, she has expanded services that make a tangible impact. Jaymie’s work is grounded in her vision to build inclusive, supportive environments where people are empowered, treated with dignity, and given the opportunity for recovery and growth.