Informed Foundations: Building Peer Grief Support for Direct Service Providers

Gabriel Quaglia is the program manager for the Direct Service Provider (DSP) Program at SADOD and Peer Support Community Partners (PSCP). Daily, Quaglia navigates the terrain of grief that comes with facilitating harm reduction, overdose response, and community outreach. Grief can weigh heavily on those who care for vulnerable populations – a burden Quaglia knows all too well. His deep understanding of the challenges DSPs face and his experience in harm reduction have given him expert insight into peer grief support.

Quaglia's journey began in 2015 when fentanyl was becoming prevalent in Western Massachusetts. "I was a person in long-term recovery," Quaglia recalls, "And I was attracted to harm reduction. Around that same time, fentanyl started to enter the drug supply in the United States, especially in Western Massachusetts. While I was doing this work, I also saw this huge increase in people passing away from overdose and ancillary issues such as infections and endocarditis."

This wave of deaths highlighted the urgent need for peer grief support, particularly for  DSPs on the front lines of the crisis. Quaglia witnessed the emotional impact the work had on his colleagues. "It comes with a toll," Quaglia explains. "Losing people whom you develop relationships with, sometimes even daily relationships, made me extremely concerned for the workforce."

At the time, Quaglia was working at Tapestry, and his involvement deepened when he participated as one of the key informant interviews for an exploratory project led by Franklin Cook for the Bureau of Substance Addiction Services. This project produced the document Coping with Overdose Fatalities: Tools for Public Health Workers and became the precursor to SADOD and Peer Support Community Partners. Together, their work laid the foundation for developing systems that could provide grief support for those in the field.

Understanding the Needs of Direct Service Providers

As Quaglia reflects on his time working directly with individuals in harm reduction, his deep understanding of the unique needs of DSPs comes into focus. "I was developing relationships with people long-term, talking with them consistently, especially in the field of harm reduction," Quaglia says. 

This closeness, combined with the frequency of loss in the field,  revealed a clear need for peer grief support. "I had  two participants I worked with, a husband and wife,” Quaglia says. “They had been homeless on the streets for quite a while. The wife went into a program and was kicked out after a couple of weeks for a minor infraction. She used that night and died," Quaglia recalls. "I only knew about this because I was still working with her husband. It made me wonder about the people I am working with who just disappear, and I never know what happens to them."

This sense of uncertainty and loss permeates the work of DSPs, but it is often compounded by the stigma society places on substance use. Quaglia is keenly aware of how this impacts DSPs and the people they serve. "As a society, we want to push it away and forget about it," Quaglia says. "That was a lot to think about and hold. When you see a disconnect between what a society purports to value vs. what it actually practices, it becomes hard to unsee, and hard to sit with."

Developing Peer Grief Support Systems

In his current role, Quaglia has drawn from these personal experiences to shape peer grief support systems designed specifically for DSPs. He creates spaces where his colleagues can address their own grief, an often-overlooked aspect of this line of work. "DSPs have a natural inclination to say, 'I'm here to help other people, not to talk about myself,'" Quaglia explains. "But it's okay for us to talk about our issues and what we're going through."

Quaglia and the direct service provider team have designed SADOD's peer grief support system to accommodate the unique needs of DSPs. One key component is a twice-weekly support group, one offered during work hours and one after, to ensure workers have access to these resources. "We wanted to make sure people could attend during work because that is something that makes people feel like their workplace is responsive to their needs," Quaglia says.

Beyond providing a space where workers can address grief, Quaglia has recognized the importance of normalizing these conversations. "We're seeing more and more organizations making peer grief support available or encouraging people to attend these groups and trainings," Quaglia notes. "It's a slow build, but I'm heartened by it."

In addition to support groups, PSCP has developed monthly training sessions that address grief and other work-related stressors. "We try to always give people some solutions or tools they can leave with when we do a training," Quaglia says. These trainings are offered in-person and online, but Quaglia notes that in-person sessions foster a deeper connection and allow participants to engage more fully.

Addressing Systemic Issues

A key element of Quaglia's expertise is his understanding of the systemic issues that contribute to grief in harm reduction. Quaglia sees these issues as inseparable from the suffering experienced by workers. "There's insufficient support for people experiencing homelessness," Quaglia explains. "You see people dying because the system isn't doing enough, and that's intimately tied to the grief."

He recalls one case where a friend died from exposure after overdosing outside. "He was found dead the next day," Quaglia says. "There are systemic failures that contribute to these deaths. These aren't isolated incidents. Workers are constantly up against a system that's not designed to support people, and that weighs heavily on them."

Quaglia's work focuses on helping workers process grief and advocating for systemic changes that could prevent further loss. The team's training encourages workers to engage in advocacy, helping them channel their grief and frustration into action. "If they find that circumstances are tied to systemic issues and they want to know how to do something about it, we help them figure out how to engage in advocacy," Quaglia explains.

Expanding Peer Grief Support Beyond Massachusetts

Quaglia sees excellent potential for expanding the peer grief support model beyond Massachusetts, emphasizing the importance of tailoring it to the needs of each community. "What works in Boston is different from what works in Western Mass, and what works in Kentucky might be closer to what works in Western Mass," Quaglia says. "We need to be responsive to the needs of different communities."

One of the key principles under which PSCP operates is the importance of co-designing grief support systems with the people it serves. The organization emphasizes that while it brings expertise in working with DSPs, the people it serves are also experts in their own experiences. The goal is to combine this collective expertise to design solutions for each community.

This co-design approach has allowed PSCP to adapt SADOD's peer grief support system to meet the diverse needs of Massachusetts communities. The organization is confident that this model can be implemented in other locations.

The Power of Connection

At the core of Quaglia's work is a deep respect for the people he serves and the relationships he builds. For Quaglia, peer grief support isn't just about providing a service – it's about honoring the human connections that form in the process. "I love the people I work with," Quaglia says.