Co-production in syringe service programs: Implementation in a changing organisational field

Co-production in the human services is a way of working that includes the expertise of service users in service implementation. While co-production is often considered a net positive for the co-producing organisation, this can depend on how, with whom, and to what extent co-production is conducted. This study uses qualitative interview data from 26 employees at syringe service programs (SSPs) in a midwestern US state to examine how SSPs implement co-production, and how this challenges or maintains current power dynamics. As the structure of SSPs has been changing from a grassroots, peer-based model to one that includes the expertise of professional medical staff, it is important to consider what these changes might mean for co-production in the field. SSPs have a rich history of being peer-led, and this project uses interviews with SSP staff to determine how the transition into professional and bureaucratic organisations has affected co-production, and in turn, organisational power dynamics. Findings show that respondents reiterate the importance of co-producing services, although there are significant challenges in implementing co-production in an equitable and liberatory way. Staff (both peer providers and non-peer providers alike) remain enthusiastic about the role that peers play in the organisation and are able to acknowledge barriers in collaborative efforts. Implications for the use of co-production in rapidly changing fields is discussed.