Supporting and retaining residential addiction treatment providers to improve client care: A cluster-randomized controlled trial of a participatory workplace intervention - The opioid epidemic is a public health crisis that has devastated families and communities across the United States. For people who experience addiction, enrollment in treatment programs is a cornerstone of the recovery process. Yet workers employed in residential addiction treatment facilities—many of whom are in recovery themselves—report unsustainable workloads, low pay, vicarious trauma, workplace violence, and lack of organizational support. High turnover rates in these facilities contribute to a projected national provider shortfall of 47% by 2036, exacerbating the opioid crisis by contributing to long wait times for treatment and reduced care continuity. The central premise of this study is that addressing stressful working conditions within residential addiction treatment centers will improve workforce retention and patient care, with effects mediated by improved worker wellbeing. The project is a partnership between the research team at the Harvard Chan School of Public Health Center for Work, Health, and Wellbeing, the Massachusetts Department of Public Health Bureau of Substance Addiction Services (BSAS), and community-based addiction treatment stakeholders. The proposed R61/R33 project will implement the Worker Input and Strategy Program (WISP), an evidence-based, participatory organizational intervention, in residential addiction treatment facilities in Massachusetts. WISP provides facilities with training, an intervention toolkit, and technical assistance to implement a continual improvement process in which a worker-manager committee identifies stressful working conditions (e.g., lack of career progression, vicarious trauma), and then develops and implements action plans to address these high-priority manager and worker concerns; these intervention activities are supported by a WISP stipend and a facility learning collaborative across facilities. The project will be conducted in two phases. The R61 phase will focus on adapting WISP to fit the specific needs of residential addiction treatment facilities; this includes developing a comprehensive WISP toolkit and piloting the intervention in three diverse facilities to evaluate intervention feasibility and acceptability. The R33 phase will involve a parallel two-arm cluster- randomized Hybrid II Effectiveness-Implementation study designed to evaluate the effectiveness and implementation of the WISP intervention in 40 residential treatment facilities employing approximately 680 workers. By improving the wellbeing, and thus retention, of workers in residential addiction treatment facilities, the project aims to enhance the quality of patient care and reduce the societal burden of substance addiction. By generating evidence for both intervention effectiveness and implementation, this project is expected to develop effective, sustainable strategies that can be scaled to other levels of care and other states. The ultimate goal of the project is to create a robust, stable, and thriving workforce capable of providing effective and compassionate care to the growing population seeking addiction treatment, thereby contributing to better health outcomes and reducing illness and disability associated with substance addiction. 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.
