Abstract
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.
