The Behavioral Health Workforce in Harm Reduction Community Based Organizations

Background: The opioid epidemic continues to define the pervasiveness and severity of the behavioral health challenges impacting every neighborhood, community, and strata of American society. The CDC estimates that more than 100,300 drug-related overdose deaths occurred in the past 12 months, an alarming 28.5% increase from the previous 12-month period. One promising means of preventing and treating opioid use disorder and substance misuse is at the intersection of behavioral health care and harm reduction. However, little is known about the behavioral health workforce within the field of harm reduction. Surveying directors of harm reduction organizations across the U.S., this study explored the composition of harm reduction workforce, the types of behavioral health providers and services offered, and hiring and workforce issues these community-based organizations face.

Methods: Primary data was collected using electronic survey data through a purposive sample of community-based syringe service organizations that are registered with the National Association of Syringe Exchange Network (n=350); The survey yielded a 48% response rate (n=168) and examined organization characteristics, the workforce providing behavioral health services, the types of behavioral health services being delivered, and the referral process within harm reduction organizations. Organization characteristics and types of behavioral health providers and services were summarized using descriptive statistics. The relationship between behavioral health providers, the referral process, and the provision of specialty mental health services were analyzed using Pearson’s chi-squared and t-tests to assess group differences and a Cramer’s V test to determine the strength of association.

Findings: Over 50% of the organizations were located in the regions of Atlanta, Chicago, and San Francisco. Almost half of the organizations exclusively offered services in a primary location, while the other half had a mobile location or pop-up site. Among the four types of services offered at harm reduction agencies, behavioral health consists of the smallest proportion of services offered. Moreover, clinical social workers made up less than 10% of the behavioral health workforce within harm reduction organizations. Behavioral health staff within harm reduction agencies were significantly and strongly associated with having a formal referral process (p<.001, V= 0.330) and a follow-up process with clients (p<.001, V= 0.302). The provision of specialty mental health services was not significantly associated with behavioral health workforce.

Conclusions/Implications: Findings from this study highlight the need to bolster the behavioral health workforce, especially social workers, in the field of harm reduction. Social workers are uniquely qualified to fill this gap in care as they can perform multiple functions such as behavioral health screening, assessment, and the integration of evidence-based models of care. Considering harm reduction organizations often serve individuals with comorbid substance use disorders and mental health disorders, these agencies would greatly benefit from the coordinated provision of behavioral health services and harm reduction efforts. Further, increasing the behavioral health workforce within the field of harm reduction could expand the provision of specialty mental healthcare (i.e., evidence-based mental health interventions).