Advancing the Health and Wellbeing of Addiction Treatment Providers and Hospital Workers: Working Conditions and Occupational Vicarious Trauma

Abstract

Healthcare workers and social service providers are the bedrock of United States’ social welfare and healthcare systems, providing critical services to millions of individuals every year. While important occupational populations unto themselves, protecting and supporting these workers is also critical to promoting the health of communities across the country. Utilizing a Total Worker Health framework and theories of stress and trauma, this dissertation focuses on contextual factors and working conditions shaping the health of two specific workforces, addiction treatment providers and low and middle-income hospital workers, with a particular focus on occupational vicarious trauma.

Paper 1 assesses the ecological factors that influenced residential addiction treatment providers’ health and wellbeing and staff turnover through qualitative analysis of interviews and focus groups of addiction treatment providers (N=49) working in residential facilities across Massachusetts. Four primary socio-contextual themes emerged from this analysis: 1) changes in substances and client needs are not reliably accompanied by shifts in treatment practices; 2) challenges with balancing state requirements and state-provided resources; 3) influence of structural discrimination and addiction stigma on pay and professional advancement for providers, many of whom are in addiction recovery themselves, and 4) geographic location of facilities shape work and quality of life in important ways. Findings from thematic analysis were used to develop a conceptual model to situate addiction treatment providers’ health and wellbeing as key components to effective addiction treatment provision, which has ramifications for improving addiction treatment for the larger population.

Paper 2 describes the development and testing of a new instrument, the Vicarious Occupational Trauma Exposure (VOTE) Index. This instrument is designed to identify where and how often workers are exposed to vicarious trauma in their work environments. Following standard measurement development methods, the VOTE Index was developed over three phases: 1) vicarious trauma exposure identification via analysis of qualitative data from Paper 1 and systematic review of literature (N=109) to develop index items; 2) index modification following cognitive interviews of addiction treatment providers (N=19) and expert feedback sessions (N=9); and 3) survey testing in a national sample of the addiction workforce (N=1,415). The VOTE Index demonstrated strong convergent validity when regressed on validated measures of psychological distress and job satisfaction; discriminant validity when regressed on participants’ interest in celebrities; and test-retest reliability as measured by intraclass correlation coefficient scores. This instrument appears to provide a valid and stable method to systematically measure vicarious occupational trauma exposure for addiction professionals.

Paper 3 investigates the prospective relationship between vicarious trauma symptoms and common gastro-intentional problems, known as disorders of gut-brain interaction, using data from the Boston Hospital Workers Health Study’s 2018 survey of hospital workers (N=775) linked to these workers’ health insurance expenditures. Multilevel logistic regression analysis indicates that participants with high vicarious trauma symptoms had 3.46-times the odds of developing disorders of gut-brain interaction compared to participants with low vicarious trauma symptoms, controlling for preexisting disorders of gut-brain interaction, demographic, work structure, and supportive work environment variables. This analysis appeared robust across several sensitivity and post-hoc analyses, indicating that vicarious trauma symptoms appear to adversely affect gastrointestinal health.