“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.

Harm Reduction Workers (HRWs) play a critical role in the substance misuse continuum of care but they are exposed to high rates of lifetime and occupational stress and trauma which is linked to adverse impacts on patient care, unmet mental health needs, turnover, burnout, and relapse. This research will adapt, field test, and conduct a hybrid-type I efficacy trial comparing the effects of Stress First Aid for HRWs versus a no- treatment control condition on social-support, burnout, 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.