Angels in Motion

Angels in Motion (AIM), is a small non-profit and community mobilization effort located in Philadelphia, PA, which grew out of a mother’s efforts to support her son in active drug use. With four staff and over 100 volunteers, AIM conducts outreach, advocacy, education and direct services that address the health and social service needs of Philadelphia’s most underserved populations. AIM’s Mobile Syringe Services Program (MSSP) provides syringes and other injection supplies, overdose prevention education and naloxone, fentanyl test strips, safe sex supplies, wound care supplies, rapid HIV and HCV testing, ID assistance, and support with accessing housing and behavioral health care.

Consistently providing culturally sensitive and nonjudgmental care allowed AIM to develop trusting relationships with participants and the larger community, which supported the rollout of patient navigation. Many referrals came from word of mouth, and participants connected with the program after hearing it can help them obtain food, water, supplies, naloxone, and assist with their health needs or refer them to treatment. AIM proudly asserts that, “we have the most caring, empathetic group. The participants know they can come to us for support, assistance, to chill or even catch a laugh.”

Establishing and strengthening partnerships with community providers allowed AIM to connect participants to other health and social supports. For example, AIM staff received feedback that emergency department staff at Penn Presbyterian treated participants with dignity and respect. Therefore, AIM partnered more closely with Penn Presbyterian and guided participants there when necessary, resulting in many individuals staying throughout their course of treatment rather than leaving against medical advice, receiving wound care and treatment for soft-tissue infections, medication support, and referrals and linkages to substance use disorder treatment. AIM collaborated with the Philadelphia Department of Public Health on overdose prevention and response. Partnering during outreach allowed participants to receive information on bad batches and overdose spikes and supported AIM’s efforts to increase naloxone distribution and rapidly respond to overdoses in the community. Additionally, AIM worked with the Probation Department of Philadelphia to assist in getting low-level warrants lifted.

AIM grew rapidly to keep up with increasing need, and with external support from Vital Strategies, was able to hire additional staff for expansion to 5 mobile SSP sites across the city. One of AIM’s major goals for the project was to build out administrative and fiscal infrastructure to support staffing and services. With patient navigation resources, they started working with a new accounting firm, hired an administrative assistant, and adopted new technology for more efficient data collection practices.

AIM used their personal and community resources in creative ways to support participants, such as:

• Driving medication to a participant in Maryland (4 hours roundtrip) because the participant is worried about relapsing if they return to Philadelphia to collect their medication.
• Serving as a volunteer supervisor for Child Protective Services visits so a participant can see their children.
• Distributing donated hats, gloves, and scarves during the winter from a group of older ladies who knit them for program participants.

Initially, AIM encountered a series of challenges related to COVID-19, resulting in disrupted service access and increased isolation. When participants tested positive for COVID while undergoing inpatient SUD care, some treatment centers moved to discharge the participant to reduce the risk of transmission within the facility. AIM advocated with treatment centers and insurance companies for participants to be properly quarantined within a treatment facility, rather than discharged abruptly to shelters or recovery houses—congregate settings that posed a risk of COVID transmission without adequate SUD treatment services. Some staff and participants took advantage of unemployment benefits offered during COVID, which had the unintended consequences of causing understaffing at AIM and increased isolation that negatively impacted mental health and recovery. Social distancing guidelines also significantly impacted the availability and capacity of warming shelters throughout winter months, leaving many without shelter.

An unpredictable and unstable drug supply also caused many challenges for people who use drugs. As xylazine entered the local supply, skin and soft-tissue infections among participants increased. AIM noted that participants experiencing withdrawal from fentanyl and xylazine needed better treatment and medication options than what was currently available. 

Throughout the first year of the program, AIM provided patient navigation services to over 200 participants. AIM built a strong rapport with the community and developed strong ties to other organizations. The table below demonstrates the level of participant touchpoints with select services.

AIM Patient Navigation Encounters (September 2020 – June 2021)

Angels in Motion took a unique approach to collecting participant-level data. The patient navigators worked with participants to establish three goals they would like to achieve. The patient navigators helped the participants work towards these three goals, tracking and supporting their action steps and progress. AIM worked with one participant on several short and long-term goals, such as getting a cell phone and regaining custody of his son. While the participant is still working towards the latter goal, in three months of documented interactions with the participant he had been following through with appointments, despite struggles with anger and distractions from his environment. The participant had also been following through with supervised visits with his child; the patient navigator reported that seeing his child was highly motivating in keeping the participant focused on his goals.

AIM grew out of the dedication of one mother to support her son, to an informal group of volunteers in 2014, and an incorporated nonprofit. From 2019 to 2021, AIM grew from serving 200 participants to over 1000 participants. Through the patient navigation project, AIM expanded their efforts into West and North Philadelphia, offering harm reduction services to Black and brown Philadelphians at highest risk for overdose. AIM was able to deepen relationships with participants and local service providers, developing a multi-site patient navigation model to enhance participant access to much-needed services. The emotional support, encouragement, and motivational interviewing that AIM practiced was instrumental in increasing participants’ sense of self-efficacy to accomplish goals they set for themselves.

AIM had hoped to continue to adequately resource their expansion, open additional patient navigation sites, grow their staff and more comprehensively address the needs of PWUD. However, as AIM worked to keep up with increasing community need, they faced frequent staffing and funding issues and struggled to maintain stability. Like many small grassroots SSPs, they did not have the funding or infrastructure to hire and support staff at the level needed to be sustainable, and AIM could not continue with year 2 of the patient navigation project.