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PROTECTING THOSE
WHO SERVE
Our Story
Our Origins
During the early stages of the overdose crisis in 2003, we discovered that law enforcement personnel on the front lines were often overwhelmed by their expanding role in overdose response. In interviews, officers expressed concerns about occupational safety risks like needlestick injury and bloodborne illness. They also voiced frustration about holding the bag for our society's failures to build effective supports for people struggling with drug use. “Doing too much with too little,” “shoveling shit against the tide,” and similar phrases reflecting stress, burnout, and a sense of futility among street-level officers emerged from these formative conversations.
The need for additional training and resources was obvious. In 2004, we piloted a new curriculum to better equip police for overdose crisis response. Set in Pawtucket (RI) Police Department, this training focused on averting accidental needle sticks, debunking myths about HIV transmission, and improving occupational wellness. It also highlighted the win-win scenarios where addressing officer safety also advances public health responses to drug use. This short module showed promise in improving officer knowledge, attitudes, and intended practices; the SHIELD (Safety and Health Integration in the Enforcement of Laws on Drugs) model was born.
Evolution of SHIELD
Implementation of SHIELD spans nearly two decades. During the 2000s, we deployed the original version of the training across the United States, including Baltimore, MD and Wilmington, DE police departments. Feedback from our trainees, behavioral health partners, and other community members helped to improve the model with addition of peer-to-peer and team-based delivery. This means that SHIELD trainings are presented by police trainers, working in tandem with trainers from the behavioral health workforce and people with lived experience of addiction and overdose.
The evolving role of police in overdose rescue spurred coverage of naloxone practices and policies. International work began to reach East and Central Asia. During this time, we realized that SHIELD trainings work best when they integrate local input and build more effective interfacing across communities. This is why a community planning process designed to inform customization and build connections between institutional stakeholders is now part of the SHIELD model.
The 2010’s saw an increase in the number of deflection, diversion, and other efforts to change how law enforcement contributes to overdose crisis response. Rather than further aggravating already high levels of stress and burnout among police, these measures provide opportunities for officers to shift unwanted tasks to the behavioral health system. The SHIELD curriculum evolved to maximize this win-win opportunity by communicating detailed, tailored information on service referrals. For example, through our multi-year partnership with the DOTS project, we have collaborated with an innovative peer coach program EPICC to streamline task-shifting for police departments across Missouri.
The ESCUDO Study
In 2015, the development of the SHIELD model got a major boost from the US federal government. The “ESCUDO” [SHIELD in Spanish] study was the first of its kind funded by the National Institutes of Drug Abuse (NIDA). This project delivered the training to over 1,800 police officers in the Tijuana, Mexico Police Department. We worked with nearly 800 of those trainees for two years to evaluate impact. Over time, we found significant reductions in accidental needle stick risk (16.2% decrease) at 3 months, with a sustained decrease of 17.8% through 24 months. Knowledge on key issues pertaining to infectious disease, drug policies, and referral to treatment also showed sustained improvement.
The SHIELD model also helped to bolster community health. Among people who use drugs, the implementation of the police training was associated with a 21% lower odds of recent incarceration per three-month period, averted 2% of new HIV infections, reduction in HCV infections and 12% of fatal overdoses. It also impacted officer willingness to make service referrals, as a mode of task shifting. In this setting, SHIELD proved highly cost-effective, demonstrating great promise as a model with dual benefits for occupational health of first responders and for community wellbeing.
SHIELD Today
As the overdose crisis has evolved, so has SHIELD. While staying true to the core model, our trainings have responded to new challenges and concerns facing officers. We continue to keep up with the latest science on stress, burnout, and resilience as they relate to overdose crisis response. This includes up-to-date occupational safety information on emerging topics, such as field exposure to fentanyl, xylazine response, and calls for service involving stimulants, like methamphetamines.
With support from state and federal agencies, our trainings are being delivered from coast to coast, including at the Indiana Law Enforcement Academy, the Municipal Police Training Committee (MA), the Criminal Justice Training Commission (WA), and the DOTS+MOBILE program (MO). This work is yielding positive results: For example, a recent evaluation of our Missouri trainings showed a doubling of intention to refer to a range of services among EMS and an increase by a third among police trainees.
Our work is always anchored to the experiences of those people working on the ground. Understanding these experiences and our impact through research has remained the engine of our evolution. We have generated an extensive track record of published evaluations in some of the world’s top scientific journals and conferences. For more information, see Research and Publications.
Police are not the only profession whose occupational health and wellness is impacted by the overdose crisis. In 2019, we adapted the curriculum to firefighters and emergency medical services. Since 2021, we have also expanded our efforts to reach prosecutors and defense attorneys, delivering the training across more than a dozen jurisdictions. Our team is currently developing materials for judges and corrections officers. Adaptations for community supervision staff, child/family services, and others are in the works.
We continue to conduct research on these efforts so we can improve our positive impact. In May 2024 we received an additional major grant from NIDA (R61DA060622) to support the development of SHIELD 2.0.