Mary Hawk’s research while affiliated with University of Pittsburgh and other places

Introduction Peer recovery support services (PRSS), an expanding component in SUD treatment, are delivered by individuals with lived experience of substance use disorder (SUD). Despite the growing importance of these peers and the unique challenges they face in a developing health profession, limited research has focused on their workforce outcomes. This review aims to map the literature on (a) workforce outcomes among peers and (b) the individual and organizational contributors to these outcomes. Materials and methods We conducted a scoping review of empirical literature from January 1, 1999 to January 26 2023 on APA PsycINFO®, Embase®, CINAHL®, Web of Science™, and Google Scholar. We also conducted a search of grey literature on institutional websites to locate additional articles. Search strategies targeted terms related to peers (e.g., peer specialist, people with lived experience), workforce outcomes (e.g., burnout, compassion fatigue), and organizational environments (e.g., workplace, volunteer). The review was preregistered with Open Science Framework ( https://doi.org/10.17605/OSF.IO/C9YNR ). Results Of the 16,361 total articles retrieved, 20 were included after screening, consisting of 9 quantitative, 9 qualitative, and 2 mixed-methods studies. Cross-sectional survey was the most common study design ( n = 9). Organizational factors, such as supervisory support and professional development opportunities, were linked to increased job satisfaction and retention while factors such as inadequate compensation and stigma were barriers to workforce sustainability. Individual challenges, including boundaries with clients and a lack of self-care, were associated with burnout and decreased job satisfaction. Conclusion Results highlight challenges faced by peers in SUD services which limit their ability to sustain well-being and achieve career longevity. Research gaps include the need for longitudinal studies, a clearer understanding of work settings, and an exploration of mediating or moderating factors affecting workforce outcomes. Future efforts to foster a sustainable peer workforce should focus on improving peer workers’ well-being through organizational support, professional development, and targeted interventions based on occupational health theories.

Background In addition to structural interventions such as syringe services and naloxone distribution, harm reduction (HR) is also a relational approach to care encompassing principles such as patient autonomy and pragmatism that can be implemented in healthcare teams to improve outcomes for people with HIV (PWH) who use drugs. Evidence suggests that using a relational HR framework to operationalize care for PWH who use drugs may improve the patient-provider relationship, thus positively impacting HIV outcomes. We previously found that negative attitudes toward people who use drugs are negatively associated with acceptance of HR; however, little is known about how HIV providers conceptualize the patient-provider relationship with PWH who use drugs. Objectives The aim of this study was to describe the ways healthcare workers (HCWs) characterize interactions with PWH who use drugs and if these characterizations reflect relational HR or missed opportunities to improve the patient-provider relationship. Design We used a qualitative descriptive design to characterize HCWs’ descriptions of their interactions with PWH who use drugs. Methods We interviewed providers ( n = 23) working at three HIV clinics in the United States to assess their interactions with patients. Providers included anyone who had worked at their respective clinic for ⩾1 year and who had face-to-face contact with patients (e.g., front desk staff, nurses, physicians, and social workers). Data were coded thematically via Dedoose. Results We discovered that HCWs characterize positive patient-provider interactions that both reflect HR principles and may not align with the principles of HR. Examples include when patients appear comfortable with and trusting of their provider, when patients feel heard by their provider, and when providers feel they are responsive to patient needs. However, other HCWs described positive interactions as counter to relational HR. Conclusion HCW descriptions of positive interactions in line with relational HR in their conceptualization of patient-provider interactions with PWH who use drugs have the potential to guide efforts in increasing the acceptability of HR in HIV care. Given evidence showing HR improves outcomes for those who use substances, findings suggest missed opportunities to incorporate relational HR into the patient-provider relationship in HIV primary care settings. Registration NCT05404750.

Introduction Peer recovery support services are a promising approach for improving harm reduction, treatment, and recovery-related outcomes for people who have substance use disorders. However, unique difficulties associated with the role may place peer recovery support staff [i.e., peers] at high risk for negative workforce outcomes, including burnout, vicarious trauma, and compassion fatigue. Objective This scoping review protocol aims to describe a proposed effort to review the nature and extent of research evidence on peer workforce outcomes and how these outcomes might differ across service settings. Results of the review described in this protocol will help to answer the following research questions: 1) What is known about workforce-related outcomes for peers working in the substance use field?; 2) What is known about how the structure of work impacts these outcomes?; and 3) How do these outcomes differ by service setting type? Methods A scoping review will be conducted with literature searches conducted in PsycINFO®, [EBSCO],Embase® [EBSCO], CINAHL® [EBSCO], Web of Science™ [Clarivate], and Google Scholar databases for relevant articles discussing US-based research and published in English from 1 January 1999 to 1 August 2023. The proposed review will include peer-reviewed and grey-literature published materials describing the experiences of peers participating in recovery support services and harm reduction efforts across a variety of service settings. Two evaluators will independently review the abstracts and full-text articles. We will perform a narrative synthesis, summarizing and comparing the results across service settings. Expected outputs Publishing this protocol will help accelerate the identification of critical workforce issues, and bolster the transparency and reporting of the final review. The proposed review will assess the state of the literature on peer workforce-related outcomes and how outcomes might vary by service setting context. Results of the proposed review will be disseminated in peer-reviewed publications and conference presentations. Findings will inform the field regarding future directions to support the emerging peer workforce. Trial registration Systematic review registration Submitted to Open Science Framework, August 22nd, 2023.

This JAMA Insights explores how clinicians can use the harm reduction communication framework to engage with patients who have opioid use disorder, which could help prevent overdose and other substance use–related harms.

Background Utilizing iterative and collaborative tools, Human-centered Design (HCD) facilitates the creation of tailored solutions for multifaceted issues by fostering empathy and a deep understanding of human behaviors. This paper presents insights gleaned from employing HCD tools to center communities in global health intervention development. Purpose The study team collaborated with community members in Dailekh, Nepal to co-design interventions to address harms associated with menstrual seclusion, known as chhaupadi. Research Design and Study Sample A Community Design Team, comprising 10 women representing various castes and ages convened for a four-day intervention co-design workshop in the community. A Community Validation Team, comprising 12 individuals from diverse occupational and caste backgrounds provided feedback on the interventions. Additionally, six village leaders participated in Key Informant Interviews to garner additional insights. Data Collection In the study’s initial “discovery” phase, the Community Design Team employed HCD tools to generate a nuanced understanding of the context, stakeholders, and community experiences. Subsequently, in the second “design” phase, the Community Design Team crafted interventions to address harms associated with chhaupadi. Results Invaluable lessons gained from this study underscore the necessity of crafting contextually suitable tools, checklists, and prompts for participants, allocating sufficient staff, time, and resources, and adapting to participants’ literacy levels and engagement preferences, whether through group or individual activities. Conclusions Reflecting on these insights, our experience suggests HCD offers promising tools to authentically and equitably involve participants with diverse backgrounds in articulating their own ideas for community-based solutions in Nepal. Health practitioners, researchers, and intervention development experts are encouraged to consider adopting HCD methodologies to prioritize community voices in devising solutions for complex health challenges.

In Nepal, menstrual practices, and particularly chhaupadi, impose restrictive norms affecting women's daily lives. Chhaupadi is a tradition that involves isolating women and girls during menstruation and after childbirth, along with following other restrictions, which have physical and mental health implications. To date, interventions have yet to fully and sustainably address harms associated with chhaupadi across the country. This two-phase study conducted in Dailekh, Nepal facilitated the development of community-created solutions to mitigate chhaupadi's adverse impacts on women's health. Using Human Centred Design and a community-engaged approach, the discovery phase identified key stakeholders and contextualised chhaupadi, while the subsequent design phase facilitated the development of five community-created interventions. These included leveraging female community health volunteers (FCHVs) for counselling and awareness, targeting mothers to drive behavioural change, engaging the wider community in behaviour change efforts, empowering fathers to catalyse change at home, and training youth for advocacy. The FCHV intervention concept was selected as the most promising intervention by the women co-design team, warranting broader exploration and testing. Additionally, while it is imperative for interventions to prioritise tackling deleterious aspects of chhaupadi, interventions must also acknowledge its deep-rooted cultural significance and history and recognise the positive aspects that some women may wish to preserve.