The Impacts of the COVID-19 Pandemic on Syringe Service Program Staff Wellbeing

ABSTRACT

Introduction: Syringe service programs (SSPs) provide a range of harm reduction services to people who use drugs and were deemed essential public health services in the United States in the COVID-19 pandemic. During the pandemic, SSPs underwent unprecedented shifts in operational procedures, including closures of physical sites and staff redeployment into pandemic response efforts. Given the critical role of SSPs during this crisis, we sought to examine SSP staff experiences and wellbeing to inform future pandemic preparedness and emergency response efforts. Method(s) From July-October, 2020, we conducted semi-structured interviews with SSP staff from four community-based SSPs in Massachusetts that were sampled to represent different organization sizes, pre-pandemic modalities (e.g., fixed site, mobile delivery, or both), and geographic location (e.g., region, urbanicity). Trained interviewers administered virtual qualitative interviews via secure videoconferencing on tablet computers, which were audio-recorded, transcribed verbatim, and coded using NVivo v12. Thematic analysis identified common occupational experiences and related impacts on wellbeing during the COVID-19 pandemic. Result(s) Among 18 participants, 12 (67%) had client-facing roles (e.g., harm reduction specialists, counselors, and outreach workers) and 6 (33%) worked in program coordination, management, and leadership. SSPs rapidly adapted and extended their services (e.g., food distribution and SARS-CoV-2 testing of clients and surrounding communities) to meet increased client needs during the pandemic;however, this role expansion led to staff overexertion. While some narratives revealed SSP staff resilience, participants described frequently feeling anxious about the risk of occupational exposures to SARS-CoV-2, and simultaneously concerned about reduced social connection with clients and coworkers due to operational adaptations to accommodate infection prevention (e.g., physical distancing, personal protective equipment). Despite the numerous challenges to participants' wellbeing, many also described positive operational changes that increased their comfort, motivation, and satisfaction at work. Participants cited their appreciation for transparent communication from organizational leadership regarding rapidly changing guidelines and resources of PPE, being engaged in organizational decision-making, and measures to support their physical and mental health such as increased compensation for new duties in the form of hazard pay and paid sick leave, an increased frequency of wellness checks between managers and staff, and the promotion of taking time off. Conclusion(s) Unlike other health services occupations, SSP staff are often the only prevention service providers with whom SSP clients have regular contact, filling a critical service gap for the socially and structurally marginalized populations they serve. In the face of challenging circumstances during the unprecedented COVID-19 pandemic, SSPs effectively adapted to maintain the provision of their staple harm reduction services. While SSP staff and leadership should be commended for the incredible efforts undertaken during this period, our study identified factors that could negatively impact SSP staff wellbeing. Our findings suggest that during prolonged, complex public health emergencies, enhanced occupational supports should be provided to SSPs to prevent burnout and promote wellness for this essential sector of the public health workforce.