{
  "abstract": "Description Burnout, moral injury, and grief (BMG) are common experiences for staff in the homeless services sector. Addressing these challenges is essential for employee retention and continuity of care. This study aimed to assess BMG levels, evaluate preferred organizational interventions, and supervisor support among healthcare teams serving unsheltered homeless populations. Between Mar. and Dec. 2024, a cross-sectional survey was conducted with 309 attendees at 6 training sessions across 4 counties in California. The survey included questions on BMG, assessed via a 5-item Likert scale, a non-mutually exclusive set of options for preferred interventions, and a supervisor support measure. Participants were predominantly female (72%) and Hispanic/Latino (47%). ( Table 1) The survey revealed that greater supervisor support was correlated with lower levels of burnout (r = 0.25–0.38), moral injury (r = 0.13–0.21), and grief (r = 0.12–0.22). Most commonly endorsed interventions included free gym memberships (58.6%) for burnout, advocacy training (46.0%), team retreats (45.6%) for moral injury, and facilitated team debriefing (52.4%) for grief. (Table 2, figure 1, table 3) This research underscores the importance of evaluating BMG in this workforce and highlights the vital role supervisors play, suggesting implemented interventions should be role-specific and culturally tailored.Abstract 6 Table 1Demographics of survey respondents Characteristic N = 309 1 Role RN 34 (11.4%) LVN/MA 31 (10.4%) MD/DO 23 (7.69%) PA/NP 33 (11.0%) Community Health Worker 73 (24.4%) Case Manager 31 (10.4%) Housing Navigator 5 (1.67%) Social Worker 10 (3.34%) Administrative Support 42 (14.0%) Other 17 (5.69%) Gender Male 76 (25.8%) Female 212 (71.9%) Other 7 (2.37%) Race/Ethnicity Asian 37 (12.4%) Black 22 (7.38%) Hispanic/Latino 139 (46.6%) Other 21 (7.05%) White 79 (26.5%) Education GED, HS, or Less 20 (6.69%) Some College 34 (11.4%) Associates/Technical 50 (16.7%) Bachelors 88 (29.4%) Graduate 107 (35.8%) Abstract 6 Table 2Preferred interventions for burnout, moral injury, and grief by survey respondents Characteristic N=309 1 Reduce Burnout: Free gym membership or access to yoga classes 181 (58.6%) Reduce Burnout: Improved Health Benefits 168 (54.4%) Reduce Burnout: Vouchers for Other Healing Practices 158 (51.1%) Reduce Burnout: Free or low-cost individual 130 (42.1%) Reduce Burnout: Community Activities 96 (31.1%) Reduce Burnout: Free Spa Access or Massage Access 88 (28.5%) Reduce Burnout: Free or low-cost group therapy 75 (24.3%) Reduce Burnout: More Paid Time Off 49 (15.9%) Reduce Burnout: None 8 (2.59%) Reduce MI: Advocacy Training (more training and opportunities on how to interface with local decision makers, etc.) 142 (46.0%) Reduce MI: Team Retreats 141 (45.6%) Reduce MI: Reflective Debriefings Sessions 139 (45.0%) Reduce MI: More Paid Time Off 139 (45.0%) Reduce MI: Shadowing opportunities amongst individuals in the same organization (e.g. leadership shadows patient facing employee) 114 (36.9%) Reduce MI: Ride Alongs with other teams 104 (33.7%) Reduce MI: Improved Health Benefits 91 (29.4%) Reduce MI: Community Activities 84 (27.2%) Reduce MI: Vouchers for other Healing Practices 37 (12.0%) Reduce Grief: Facilitated team debriefing sessions 162 (52.4%) Reduce Grief: None 128 (41.4%) Reduce Grief: Memorializing Deaths of Patients 109 (35.3%) Reduce Grief: One-on-one professional psychological debriefing after a death of a patient 107 (34.6%) Reduce Grief: Clear policies and procedures of what to do if a patient death occurs 14 (4.53%) Reduce Grief: Vouchers that can be used for self-care practices 0 (0%) Reduce Grief: Paid Time Off following patients’ death 0 (0%) 1 n (%)Abstract 6 Figure 1Burnout, moral injury, and grief score by roleAbstract 6 Table 3Endorsement of strategies to reduce grief distribution by role Characteristic RN, LVN, MA N = 65 1 MD, DO, PA, NP N = 56 1 Case Manager, Housing Navigator N = 36 1 Social Worker N = 10 1 Community Health Worker N = 73 1 Administrative Support N = 42 1 Other N = 17 1 p-value 2 Reduce Grief: Memorializing Patients 21 (32.3%) 24 (42.9%) 11 (30.6%) 6 (60.0%) 26 (35.6%) 14 (33.3%) 7 (41.2%) 0.6 Reduce Grief: Team Debriefings 37 (56.9%) 31 (55.4%) 13 (36.1%) 3 (30.0%) 43 (58.9%) 26 (61.9%) 9 (52.9%) 0.2 Reduce Grief: Paid Time Off Reduce Grief: Professional Debriefings 23 (35.4%) 18 (32.1%) 11 (30.6%) 3 (30.0%) 39 (53.4%) 9 (21.4%) 4 (23.5%) 0.018 Reduce Grief: Clear Policies & Procedures 3 (4.62%) 2 (3.57%) 4 (11.1%) 0 (0%) 1 (1.37%) 2 (4.76%) 2 (11.8%) 0.2 Reduce Grief: Vouchers for Self-Care Reduce Grief: None 26 (40.0%) 21 (37.5%) 12 (33.3%) 4 (40.0%) 38 (52.1%) 21 (50.0%) 6 (35.3%) 0.4 Reduce Grief: Something Else 31 (47.7%) 28 (50.0%) 13 (36.1%) 2 (20.0%) 38 (52.1%) 13 (31.0%) 5 (29.4%) 0.10 1 n (%) 2 Fisher’s Exact Test for Count Data with simulated p-value (based on 2000 replicates)",
  "authors": [
    {
      "affiliations": [
        "USC Street Medicine"
      ],
      "name": "Emily Frink"
    },
    {
      "affiliations": [
        "USC Street Medicine"
      ],
      "name": "Corinne Feldman"
    },
    {
      "affiliations": [
        "Keck School of Medicine, University of Southern California"
      ],
      "name": "Alexis Coulourides Kogan"
    },
    {
      "affiliations": [
        "USC Street Medicine",
        "Keck School of Medicine, University of Southern California"
      ],
      "name": "Katherine Pocock"
    }
  ],
  "title": "6 Organizational interventions to address burnout, moral injury, and grief in the homeless workforce",
  "uid": "f133685e-429d-54c6-abb7-dadca439ff0f"
}