This study is part of the NIH’s Helping to End Addiction Long-term (HEAL) initiative to speed scientific solutions for the overdose epidemic, including opioid and stimulant use disorders. The NIH HEAL Initiative bolsters research across NIH to address the national opioid public health crisis and improve treatment for opioid misuse and addiction. More than 1 million people have died of a drug-related overdose since 1999. The U.S. National Drug Control Strategy emphasizes that reducing overdoses requires the expansion of harm reduction (HR) services that reduce the negative effects of substance use without expecting or requiring abstinence. Unfortunately, HR providers are often underprepared and under-supported while working under stressful conditions, placing them at high burnout risk. While all HR workers risk burnout, peer recovery support specialists (PRSS) have higher potential vulnerability. PRSSs are paraprofessionals with lived recovery experience who provide mentoring, coaching, educational, and social support services. Burnout among PRSSs can result in poor job performance and lower service quality with spillover effects that can negatively impact client outcomes at the individual and system levels. Burnout also places a PRSS’s personal recovery in jeopardy by raising relapse potential. PATH (Peer Advanced Training in Harm reduction) is a workforce intervention that uses virtual education and case-based learning approaches to support PRSSs who deliver HR services. Building on this team's prior work in harm reduction support delivery and peer support services, this study will test PATH’s effectiveness at reducing PRSS burnout and (secondarily) improving service quality and service system outcomes. We will accomplish this by leveraging the current efforts of Indiana—a state that ranks high in overdoses and is accelerating substantially in methamphetamine use—to expand peer services. The study will employ a stepped wedge design with mixed methods to assess PATH among a sample of 10 Recovery Works-certified Recovery Community Organizations (RCOs). The study has the following aims: (Aim 1) develop stakeholder engagement to enhance PATH feasibility, sustainability, and scalability; (Aim 2) investigate PATH’s impact on workforce outcomes (with the primary outcome being burnout); (Aim 3) determine PATH’s impact on service system outcomes; (Aim 4) use a rigorous mixed methods approach to understand how processes initiated by PATH lead to observed outcomes. Following the stepped-wedge approach, 10 organizations delivering PRSS services will be assigned to one of five cohorts that will cross over into the intervention period (i.e., receive PATH) at different time points. We expect to recruit 100 staff and obtain administrative data for 8,640 clients. This project’s success will result in a sustainable and replicable intervention for reducing burnout and improving service quality and service system outcomes among PRSSs. Supporting the PRSS workforce to deliver HR services can lead to considerable population health gains by reducing behaviors known to raise overdose risk, as well as risks related to the contraction, transmission, and progression of diseases associated with substance use.

Project Narrative This study aims to test PATH (Peer Advanced Training in Harm reduction) as a system-level workforce intervention for reducing burnout among peer recovery support specialists (PRSSs) who provide harm reduction (HR) services, as well its ability to improve service quality and service system-level outcomes. PATH addresses a recognized need to support the national expansion of PRSS and HR services to support people with substance use disorders and reduce overdose rates. If successful, PATH can serve as a model program to be scaled nationally.