Impact and implementation evaluation of Stress First Aid for the Substance Use Outreach Workforce (SFA/SUOW): protocol of a hybrid type I cluster randomized control trial.

Abstract

Background: Stress First Aid (SFA), an evidence-informed peer support intervention to address occupational stress, has been adapted to the needs of the substance use outreach workforce (SUOW) (SFA/SUOW) and pilot tested with initial positive outcomes. The goal of this study is to test and evaluate the effectiveness, implementation and sustainability of SFA/SUOW compared to a no treatment control condition in a hybrid-type I cluster-randomized controlled trial (RCT).

Methods: Approximately 500 substance use outreach workers (SUOWs) and leaders from approximately 90 substance use outreach (SUO) organizations, Community Health Worker programs, and peer support programs arranged in 10 regions based on geographic co-location across Texas, Louisiana, Arkansas, Oklahoma, New Mexico, and tribal areas will be 50:50 randomized to the intervention group or the control group. Treatment will consist of a 2-hour virtual SFA training and up to six virtual 30-minute monthly learning collaboratives. All participants will be asked to complete a baseline assessment prior to randomization, and 2 follow-up assessments at 2-month and 6-month to assess occupational stress primary outcomes: 1) supervisor and coworker social support and 2) burnout. We will also assess use of SFA, job-related affective well-being, secondary traumatic stress, use of coping strategies, general self-efficacy, work engagement, turnover intention, and moral injury symptoms. Additionally, we will conduct interviews and focus groups with RCT participants, RCT non-participants, and addiction professional staff to evaluate the reach, effectiveness, adoption, implementation, and maintenance of SFA/SUOW.

Discussion: This RCT provides a robust trial of SFA/SUOW that has not been done before. The aim of the study will result in a national implementation plan to improve SUOWs well-being and subsequently improve quality care for persons who use drugs.

Trial registration: The study NCT07177014 is registered on clinicaltrials.gov https://clinicaltrials.gov/study/NCT07177014 . Registered on September 09, 2025.