Homelessness, mental health, and more recently, the opioid crisis: Librarians across the country have been on the front lines tackling these issues for years. They guide patrons towards health literature. They connect them to the right care. And they even administer the opioid overdose antidote, naloxone, when necessary.
Photo by Nema Etebar
While many recognize librarians as key partners in this fight, few dig deep to make them better at it. Enter the Healthy Library Initiative.
For the last four years, the HLI, a partnership between the University of Pennsylvania and the Free Library of Philadelphia, has been conducting research on the role of libraries in public health and training their staff to better respond to the community’s evolving needs.
“We think of libraries as community sentinels,” said Eliza Whiteman, PhD, a researcher at HLI. “They have their finger on the pulse, and they are an amazing resource for alerting the public health community about what issues are coming up.”
The group’s latest study, published in May in the journal Preventing Chronic Disease (PCD), produced a glaring finding on opioids: 12 percent of the public libraries in Pennsylvania experienced a drug overdose in the past year. People knew overdoes were happening in libraries, but this is the first study to quantify their frequency. It’s an unfortunate trend mirrored not only in urban libraries but also rural ones as the opioid crisis worsens, the researchers found.
“For some libraries, responding to overdoses has become a routine occurrence,” Carolyn C. Cannuscio, ScD, a social epidemiologist with HLI and an associate professor of Family and Community Medicine at Penn Medicine, and her co-authors wrote in the Philadelphia Inquirer earlier this month.
“But in today’s reality, library staff must be prepared,” they continued. “They need further training to understand and respond to the needs of patrons with substance use disorder, including those at risk of overdose. Library staff need naloxone close at hand, and, importantly, a willingness to intervene. With these assets, library staff can and will save lives while on the job.”
The researchers tallied the overdoses from a 100-question survey sent to 621 public library directors in Pennsylvania. Such incidents were later confirmed by dozens of in-person interviews at the Public Library Association annual meeting in Philadelphia in March, which drew nearly 8,000 people.
“There was a lot of receptiveness from librarians at the conference for health programming and trainings in general, but specifically opioid training because a lot of the librarians that we spoke to said the overdoses were becoming a real strain,” Whiteman said.
HLI has been working with the Philadelphia Department of Public Health on opioid awareness and overdose reversals with naloxone at library branches in the city for some time, and this meeting was an opportunity to build upon that. Over the course of the meeting, HLI and the public health department trained 75 more library staff members from around the country.
“These efforts are small but important steps in confronting the opioid epidemic,” they said.
Other data emerged from the PCD study.
Researchers know that librarians engage in health-related conversations with patrons, but less is known about how they’re assisting them with social determinants of health, like housing and employment. How often does it happen? Turns out, quite a bit. And how prepared are they to handle these inquiries? Not very.
Employment was by the far the most common, with 94 percent of respondents reporting frequent interactions with patrons on the topic. Nutrition (70 percent) was next, followed by exercise (66 percent), and social welfare benefits (51 percent.) Library staff also field inquiries around immigration and trauma.
“Being on the front lines, librarians are in many ways like health care providers or social workers,” Whiteman recently told the PCD Sound Bites podcast. “But as we found in our study, librarians feel like their formal professional training has inadequately prepared them for this central part of their jobs. Sometimes patrons' health and social needs can seem insurmountable, which can be very stressful for librarians, who are often highly committed to public service.”
To help close this gap, HLI created a Community Health Specialist training program for library staff in Philadelphia, which they first piloted two years ago and has since grown.
“The goal is to not only teach librarians,” Whiteman said, “but also the entire staff, including security guards or those conducting afterschool programs -- anyone who has regular contact with patrons -- to be able to recognize what the issue is, engage the patron around the inquiry, and refer them to the appropriate services.”
So far, the team has trained 40 specialists within the Free Library of Philadelphia system. HLI has also received multiple requests for the trainings from libraries outside of the state.
The program is continually evaluated too. A recent study in Health Promotion Practice found the training “significantly improved comfort, confidence, and preparedness” among librarians who went through it.
“It was a good space to talk about issues that we’ve all dealt with in different branches that not a lot of people know we deal with working in libraries,” one trainee said.
The team – which represents schools and disciplines across Penn, including medicine, public health, and design – also recently evaluated a Philadelphia library program for refugees and new immigrants called the Edible Alphabet Program, which combines ESL, cooking, and life skills instruction for patrons, that’s led by library staff.
Next, HLI will be rolling out a national version of the survey conducted in Pennsylvania, which will not only paint a better picture of what’s happening at libraries across the country, but also takes a deeper dive into the impact of the opioid epidemic and immigration issues.
These are all important steps, the team said, but more can be done, like reforming the curriculum of library science degrees to incorporate elements of health and social work and creating more formal partnerships between universities, health systems, and public libraries – which host well over a billion visits every year, with over one-third of those visits incorporating questions about health.
“As a public health professional, I see public libraries as an engine for community health and wellbeing,” Cannuscio said. “They are trusted institutions with deep connections to their local communities, and they are vital allies who can help us advance our core mission of improving health and alleviating human suffering in communities across the country, including our own.”