Table 3 Challenges to SSP staff well-being during public health emergencies and corresponding strategies to promote well-being

Concerns of occupational exposures due to the emergency

Policy recommendations:

 Provide SSP staff with tailored technical assistance and training to implement modified and new services (e.g., administering naloxone, new infection control measures and testing services)

 Guarantee SSPs a steady supply of safety equipment (e.g., PPE and personal hygiene supplies) for staff and clients

 Ensure sufficient funding sources to cover any changes in operations and other necessary emergency-related purchases

 Provide staff hazard pay for expansion of responsibilities and work during an emergency

 Consider need to supplement technology resources for clients and staff to support virtual care delivery

Organizational-level recommendations:

 Leaders should be more visible and accessible to staff, and provide transparent, frequent communications regarding the emergency and related operational changes

Overextension from expanding services and roles

Policy recommendations:

 Increase transparency about shifting of SSP staff to other public health activities and involve all levels of SSP staff in organizational decision-making

 Initiatives involving task shifting of SSP staff should consider the adequacy of staffing within SSPs to maintain uninterrupted core harm reduction service delivery and low stress on remaining staff members

 Consider capacity-building (hiring, training, improvising program adaptations) in the timeline of implementing new service

 Ensure that funding to SSPs reflect any increase in the breadth of service provision and re-evaluate staff compensation to reflect increase in responsibilities

Organizational-level recommendations:

 Create an environment conducive to talking about fears, burnout openly (establish a culture of taking breaks and sick leave, implement an “open door” policy)

 Provide regular psychological care and mental health monitoring through counseling and check-ins with management

 Consider using longer interventions and online platforms in operationalizing mental health support; screen mental health of staff to identify individuals with the greatest need for targeted support delivery

Perceived reduced ability to help clients

Policy recommendations:

 Collaborate with SSPs to reduce service gaps for SSP clients by implementing strategies such as creating new accessible low-barrier clinical sites, increasing use of oral point of care HIV and STI testing, increasing mobile clinical services, or providing SSPs resources to develop alternative program adaptations

Organizational-level recommendations:

 Include SSP staff in decision-making, particularly staff involved in direct service provision

 Implement interventions targeting moral distress such as education, and staff reflection and discussions on moral distress

Workplace isolation

Organizational-level recommendations:

 Organize regular team-building exercises such as team huddles and virtual activities over videoconference

Adding meaning to work

Organizational-level recommendations:

 Recognize and appreciate staff work

 Minimize role ambiguity and role conflict