Stress first aid for the harm reduction workforce: pilot test results of an occupational stress intervention

Harm reduction workers (HRWs), while fighting the overdose crisis, are exposed to lifetime occupational stress and trauma, which in turn are associated with the long-term work and social functioning of this key sector. There is a critical gap in research on the occupational health of HRWs. The aim of this study was to adapt and pilot Stress First Aid (SFA), a peer-to-peer occupational stress intervention, for HRWs. The adapted SFA/HRW model was a 2-hour, in-person training followed by four, 30-minute, monthly learning collaboratives piloted in a non-profit recovery community organization. A convenience sample of workers and organizational leaders (N = 35) was recruited from the pilot site. Participants completed surveys assessing knowledge, confidence, beliefs, and use of SFA and preliminary well-being outcomes at baseline, 2-months, and 4-months after the training. Participants also completed a preliminary implementation outcomes survey, and randomly selected participants (n = 13) completed 30-minute virtual implementation interviews of the SFA model. Quantitative analyses included descriptive statistics, paired tests between timepoints, and Bayesian hierarchical models to estimate changes over time and assess intervention effects with uncertainty quantification. Qualitative data were analyzed using applied thematic analysis. Results indicated a positive effect on knowledge (β = 0.87, 95% CrI, 0.56–1.17), confidence (β = 0.84, 95% CrI, 0.52–1.16), and beliefs (β = 0.29, 95% CrI, 0.11–0.48) in SFA with increased use of SFA (β = 0.91, 95% CrI, 0.39–1.44) and observation of others using SFA (β = 0.69, 95% CrI, 0.17–1.21). There was a positive effect on overall work engagement (β = 0.27, 95% CrI, 0.02–0.51). Results also indicate > 80% acceptability, appropriateness, and feasibility of SFA/HRW, with participants qualitatively reporting SFA aligned with their work and that SFA would be a valuable supplement to their pre-existing coping strategies. There was an increase in observed practices of SFA and stability in well-being, coping, secondary traumatic stress, burnout, and turnover intention. Additionally, participants reported a significant increase in work engagement. SFA is highly acceptable, appropriate, and feasible among HRWs. The next steps are to test the effects of SFA/HRW against a control group in a randomized controlled trial. The study NCT07149155 is registered on https://clinicaltrials.gov/study/NCT07149155.