Community-wide effects of building a resilient community healthcare workforce

Background: Two points of consensus in harm reduction workforce development appear contradictory: while lived experience assists community healthcare workers (CHWs) in relating to people who use drugs (PWUD), CHWs are faced with reliving traumas that can precipitate burn-out. To address this crucial conflict that puts organizations at risk for personnel loss, we have developed policies and practices related to both management and training that maximize the benefits of lived experience while minimizing the chances for burn-out.

Methods and Results: Consequently, our setting – New London, Connecticut, USA – has become an exemplar statewide for local harm reduction efforts. This was not always the case. New London was once a conservative bastion opposed to syringe access programs and devoid of opioid agonist treatment programs that provided prompt access and minimal patient burden. The about-face to a community more accepting of harm reduction and of PWUD themselves involved triangulated cooperation among a revitalized community agency that prioritized delivery of harm reduction services, researchers at academic institutions with a long history of harm reduction research, and an opioid action team that brought together disparate elements of the community to discuss and implement strategies for reducing drug-related harms and promoting the health and well-being of people who use drugs. In 2016, in the face of rising opioid overdose deaths as fentanyl replaced heroin, CHW activities began in New London. Empowered by a supportive harm reduction environment, CHWs with degrees of lived/living experience[KH1]  and employed by multiple New London agencies came together to build constructive bonds with each other whether they were performing mundane or life-altering work on the behalf of PWUD. The leadership that supported communication amongst CHWs, provided sufficient resources and opportunities for CHWs to voice their concerns to reduce stressors, and encouraged CHWs to continue their harm reduction education. Trainings for CHWs, developed in partnership with academics, have improved CHWs’ evidence-based knowledge on the interaction of nature, nurture, experience, linguistic and cultural forces that influence the substance use trajectories of their clients. They have become experts in communicating using non-stigmatizing language. The gains in expertise and competence have allowed CHWs to implement effective strategies to reduce problematic drug use.

Conclusion: As a result, their impact has been community wide and the positive outcomes clear. CHWs have (1) routinely advised the local opioid action team as a welcomed voice of expertise, (2) increased naloxone saturation leading to reduced opioid overdose deaths, (3) initiated contacts leading to street-based buprenorphine induction, and (4) assisted PWUD experiencing chaotic drug use by finding housing when facing homelessness, discharged from hospitalization, or released from incarceration.