Testing an occupational stress intervention for harm reduction workers in substance misuse settings

“这项研究是NIH帮助结束长期成瘾（HEAL）计划的一部分，旨在加快国家阿片类药物公共卫生危机的科学解决方案。NIH HEAL倡议支持整个NIH的研究，以改善阿片类药物滥用和成瘾的治疗。 除了预防、治疗和减少供应之外，减少危害是国家药物管制战略的基石。然而，有一个关键的差距，在减少伤害的工人（HRW），谁是暴露于高利率的终身和职业压力和创伤的职业健康研究。高比例的未解决的职业压力已被证明对患者护理产生不利影响，并与未满足的心理健康需求，营业额，倦怠和复发有关。人权工作者需要一个职业压力干预计划，解决系统和个人的职业挑战，同时促进能力，以满足复杂的需求，提供安全的高质量的伤害减少护理的人谁使用毒品（PWUD）。压力急救是一种很有前途的干预措施，已经在几个第一反应小组和医疗机构中实施，但它需要适应人权工作者，需要在严格的临床试验中对对照组进行研究。在本提案的R61规划阶段（目标1-4），将召集由人权工作者和人权组织领导人组成的焦点小组，以调整SFA培训内容，并告知将在实地测试中试行的SFA培训提供方法（N = 15）。研究结果将纳入临床试验方案。在本提案的R33阶段（目标5和6），我们将进行一项群集随机混合I型试验（N = 534），测试参与成瘾技术转移中心（ATTC）促进的SFA培训和学习协作支持与无治疗对照条件相比在以下主要结局方面的有效性：社会支持、倦怠和使用SFA 理念的次要结果是继发性创伤压力，使用心理健康护理，参与和营业额。我们工作的长期目标是在全国范围内对人权工作者实施可持续和有效的职业压力干预，以加强他们在药物滥用工作队伍中的重要作用。主要创新包括：1）使用ATTC为人权工作者的SFA培训提供总体结构，以加强组织实施和加速将结果付诸实践的能力; 2）首次根据人权工作者独特的职业背景和需求调整压力急救; 3）使用定性方法， 4）加强ATTC和人权工作者之间的信任和接触的潜力，这可以促进最佳做法的传播。如果有效，广泛采用SFA可以提高工作人员的能力，为PWUD提供高质量的护理。

“This study is part of the NIH’s Helping to End Addiction Long-term (HEAL) initiative to speed scientific solutions to the national opioid public health crisis. The NIH HEAL Initiative bolsters research across NIH to improve treatment for opioid misuse and addiction.” Alongside prevention, treatment, and supply reduction, harm reduction is a cornerstone of the National Drug Control Strategy. However, there is a critical gap in research on the occupational health of Harm Reduction Workers (HRWs), 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. HRWs need 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 harm reduction 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 HRWs and it needs to be studied against a control group in a rigorous clinical trial. In the R61 planning phase (Aims 1-4) of this proposal, focus groups comprised of HRWs and leaders from HROs will be convened to adapt the SFA training content and to inform the SFA training delivery methods that will be piloted in a field test (N = 15). Findings will be integrated into a clinical trial protocol. In the R33 phase of this proposal (Aims 5 and 6), we will conduct a cluster-randomized hybrid type I trial (N = 534) testing the effectiveness of participation in an Addiction Technology Transfer Center (ATTC)-facilitated SFA training and learning collaborative support compared to a no treatment control condition on the following primary outcomes: social-support, burnout and use of SFA concepts. Secondary outcomes are secondary traumatic stress, use of mental health care, engagement, and turnover. The long-term goal of our work is to implement a sustainable and effective occupational stress intervention for HRWs nationally in order to strengthen their important role in the substance misuse work force. Key innovations include: 1) use of ATTCs to provide overarching structure to SFA trainings for HRWs in order to strengthen organizational capabilities to implement and to accelerate findings into practice; 2) first ever adaptation of Stress First Aid to unique occupational context and needs of HRWs; 3) use of qualitative methods to co-adapt and co-design Stress First Aid content, training methods and research methods with and for HRWs; 4) potential to enhance trust and engagement with between ATTCs and HRWs which could enhance diffusion of best practices. If effective, widespread adoption of SFA could improve workforce capacity for high quality care for PWUD.