Impact of Stress First Aid for Workers in Substance Misuse Settings

Alongside prevention, treatment, and supply reduction, outreach work is a cornerstone of the National Drug Control Strategy. However, there is a critical gap in research on the occupational health of substance use outreach workers, who are exposed to high rates of lifetime and occupational stress and trauma. High rates of unaddressed occupational stress have been shown to have an adverse impact on patient care and are linked to unmet mental health needs, turnover, burnout, and relapse. The substance use outreach workforce needs an occupational stress intervention program that addresses both systems and individual occupational challenges while promoting the capacity to engage with the complex demands of delivering safe high-quality substance use care to people who use drugs (PWUD). Stress First Aid is a promising intervention that has been implemented with several first responder groups and in healthcare settings, but it requires adaptation to the substance use outreach workforce and it needs to be studied against a control group in a rigorous clinical trial. In the R61 planning phase of this study, focus groups comprised of workers and leaders from organizations doing substance use outreach work were convened to adapt the SFA training content and to inform the SFA training delivery methods that were piloted in a field test (N = 35). Findings were integrated into a clinical trial protocol. In the R33 phase of this study, we will conduct a cluster-randomized hybrid type I trial (N = 500) testing the effectiveness of participation in a 2-hour virtual SFA training and six 30-minute monthly learning collaboratives compared to a no treatment control condition on the following primary outcomes: supervisor and coworker support and burnout. Secondary outcomes are use of SFA concepts, job related affective well-being, secondary traumatic stress, coping strategies, self-efficacy, work engagement, turnover intention, and moral injury symptoms. The long-term goal of our work is to implement a sustainable and effective occupational stress intervention for the substance use outreach workforce nationally in order to strengthen their important role in the substance misuse work force.