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Schoenberger SF, Cummins ER, Carroll JJ, Yan S, Lambert A, Bagley SM, Xuan Z, Green TC, Cook F, Yule AM, Walley AY, Formica SW. "Wanna cry this out real quick?": an examination of secondary traumatic stress risk and resilience among post-overdose outreach staff in Massachusetts. Harm Reduct J 2024; 21:66. [PMID: 38504244 PMCID: PMC10949647 DOI: 10.1186/s12954-024-00975-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 02/26/2024] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND Post-overdose outreach programs engage overdose survivors and their families soon after an overdose event. Staff implementing these programs are routinely exposed to others' trauma, which makes them vulnerable to secondary traumatic stress (STS) and compassion fatigue. The purpose of this study was to explore experiences of STS and associated upstream and downstream risk and protective factors among program staff. METHODS We conducted a post-hoc analysis of semi-structured interviews with post-overdose outreach program staff in Massachusetts. Transcripts were analyzed using a multi-step hybrid inductive-deductive approach to explore approaches and responses to outreach work, factors that might give rise to STS, and compassion fatigue resilience. Findings were organized according to the three main constructs within Ludick and Figley's compassion fatigue resilience model (empathy, secondary traumatic stress, and compassion fatigue resilience). RESULTS Thirty-eight interviews were conducted with staff from 11 post-overdose outreach programs in Massachusetts. Within the empathy construct, concern for others' well-being emerged as a motivator to engage in post-overdose outreach work - with staff trying to understand others' perspectives and using this connection to deliver respectful and compassionate services. Within the secondary traumatic stress construct, interviewees described regular and repeated exposure to others' trauma - made more difficult when exposures overlapped with staff members' personal social spheres. Within the compassion fatigue resilience construct, interviewees described the presence and absence of self-care practices and routines, social supports, and workplace supports. Job satisfaction and emotional detachment from work experiences also arose as potential protective factors. Interviewees reported inconsistent presence and utilization of formal support for STS and compassion fatigue within their post-overdose outreach teams. CONCLUSION Post-overdose outreach program staff may experience secondary traumatic stress and may develop compassion fatigue, particularly in the absence of resilience and coping strategies and support. Compassion fatigue resilience approaches for post-overdose outreach staff warrant further development and study.
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Affiliation(s)
- Samantha F Schoenberger
- Boston Medical Center, Grayken Center for Addiction, Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, 801 Massachusetts Ave, 2nd Floor, Boston, MA, 02118, USA
| | - Emily R Cummins
- Boston Medical Center, Grayken Center for Addiction, Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, 801 Massachusetts Ave, 2nd Floor, Boston, MA, 02118, USA
| | - Jennifer J Carroll
- Department of Sociology & Anthropology, North Carolina State University, 10 Current Drive, Raleigh, NC, 27605, USA
- Department of Medicine, Brown University, 222, Richmond St. Providence, 02903, USA
| | - Shapei Yan
- Boston Medical Center, Grayken Center for Addiction, Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, 801 Massachusetts Ave, 2nd Floor, Boston, MA, 02118, USA
| | - Audrey Lambert
- Access, Harm Reduction, Overdose Prevention and Education (AHOPE), Boston Public Health Commission, 774 Albany Street, Access, Boston, MA, 02118, USA
| | - Sarah M Bagley
- Boston Medical Center, Grayken Center for Addiction, Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, 801 Massachusetts Ave, 2nd Floor, Boston, MA, 02118, USA
- Division of General Pediatrics, Department of Pediatrics, Boston University School of Medicine, Boston Medical Center, Boston, MA, 02118, USA
| | - Ziming Xuan
- Department of Community Health Sciences, Boston University School of Public Health, 801 Massachusetts Avenue, Boston, MA, 02118, USA
| | - Traci C Green
- The Heller School for Social Policy and Management, Brandeis University, 415 South Street, Waltham, MA, 02453, USA
| | - Franklin Cook
- Peer Support Community Partners, 30 Brimmer Street, Watertown, MA, 02472, USA
| | - Amy M Yule
- Department of Psychiatry, Boston Medical Center, Boston University School of Medicine, Boston, MA, 02118, USA
| | - Alexander Y Walley
- Boston Medical Center, Grayken Center for Addiction, Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, 801 Massachusetts Ave, 2nd Floor, Boston, MA, 02118, USA
| | - Scott W Formica
- Social Science Research and Evaluation, Inc, 84 Mill Street, Lincoln, MA, 01773, USA.
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Beaugard CA, Formica SW, Cummins ER, Bagley SM, Beletsky L, Green TC, Murray SP, Yan S, Xuan Z, Walley AY, Carroll JJ. Privacy and confidentiality in Massachusetts' post-overdose outreach programs: Mixed methods analysis of outreach staff surveys and interviews. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 124:104310. [PMID: 38181671 DOI: 10.1016/j.drugpo.2023.104310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 12/11/2023] [Accepted: 12/20/2023] [Indexed: 01/07/2024]
Abstract
BACKGROUND Public health-public safety partnerships for post-overdose outreach have emerged in many communities to prevent future overdose events. These efforts often identify overdose survivors through emergency call data and seek to link them with relevant services. The aim of this study was to describe how post-overdose outreach programs in Massachusetts manage the confidentiality of identifiable information and privacy of survivors. METHODS In 2019, 138 Massachusetts programs completed surveys eliciting responses to questions about program operations. Descriptive statistics were calculated from the closed-ended survey responses. Thirty-eight interviews were conducted among outreach staff members during 2019-2020. Interview transcripts and open-ended survey responses were thematically analyzed using deductive and inductive approaches. RESULTS Of programs that completed the survey, 90 % (n = 124/138) reported acting to protect the privacy of survivors following overdose events, and 84 % (n = 114/135) reported implementing a protocol to maintain the confidentiality of personal information. Interviews with outreach team members indicated substantial variation in practice. Outreach programs regularly employed discretion in determining actions in the field, sometimes undermining survivor privacy and confidentiality (e.g., by disclosing the overdose event to family members). Programs aiming to prioritize privacy and confidentiality attempted to make initial contact with survivors by phone, limited or concealed materials left behind when no one was home, and/or limited the number of contact attempts. CONCLUSIONS Despite the establishment of privacy and confidentiality protocols within most post-overdose outreach programs, application of these procedures was varied, discretionary, and at times viewed by staff as competing with engagement efforts. Individual outreach overdose teams should prioritize privacy and confidentiality during outreach to protect overdose survivors from undesired exposure. In addition to individual program changes, access to overdose survivor information could be changed across all programs to bolster privacy and confidentiality protocols. For example, transitioning the management of overdose-related information to non-law enforcement agencies would limit officers' ability to disseminate such information at their discretion.
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Affiliation(s)
- Corinne A Beaugard
- Boston University School of Social Work, 264 Bay State Road, Boston MA 02215, United States.
| | - Scott W Formica
- Social Science Research and Evaluation, Inc., 84 Mill St., Lincoln, MA 01773, United States
| | - Emily R Cummins
- Ariadne Labs, Harvard T.H. Chan School of Public Health, 405 Park Drive, Boston, MA 02215, United States
| | - Sarah M Bagley
- Boston Medical Center and Boston University Chobanian & Avedisian School of Medicine, Grayken Center for Addiction, Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, 801 Massachusetts Ave, 2nd Floor, Boston, MA, 02118, United States
| | - Leo Beletsky
- Northeastern University School of Law, Bouvé College of Health Sciences, and the Action Lab 416 Huntington Ave, Boston, MA 02115, United States
| | - Traci C Green
- The Heller School for Social Policy and Management at Brandeis University, Institute for Behavioral Health, 415 South Street MS 035, Waltham, MA 02453, United States
| | - Stephen P Murray
- Boston Medical Center, Grayken Center for Addiction, Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, 801 Massachusetts Ave, 2nd Floor, Boston, MA, 02118, United States
| | - Shapei Yan
- Boston Medical Center, Grayken Center for Addiction, Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, 801 Massachusetts Ave, 2nd Floor, Boston, MA, 02118, United States
| | - Ziming Xuan
- Boston University School of Public Health, Department of Community Health Sciences, Crosstown Building - CT 454, 801 Massachusetts Ave, 4th Floor, Boston, MA 02118, United States
| | - Alexander Y Walley
- Boston Medical Center and Boston University Chobanian & Avedisian School of Medicine, Grayken Center for Addiction, Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, 801 Massachusetts Ave, 2nd Floor, Boston, MA, 02118, United States
| | - Jennifer J Carroll
- Department of Sociology & Anthropology, North Carolina State University, 10 Current Drive, Raleigh, NC 27605, United States
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