Lessons learned from employing Medicaid-funded peer recovery support specialists in residential substance use treatment settings: An exploratory analysis

Abstract

IntroductionThis article explores the experiences of peer recovery support specialists (PRSS) and their colleagues working in residential adult services (RAS) facilities in a rural state to better understand how the role has been implemented in this setting. In West Virginia, PRSS and RAS services have been covered by Medicaid since 2018 for the treatment of substance use disorder (SUD). Thus, the aim of this study is to uncover what has and has not worked well in the early years of service implementation from the perspectives of both PRSS and their colleagues working in the SUD field. MethodsThe study interviewed forty-eight clinical and administrative staff at RAS facilities, including nine PRSS, across fourteen focus groups between 2020 and 2021. The study asked participants about general knowledge of West Virginia's 1115 Medicaid Waiver supporting the funding of PRSS, communication among providers, transitioning patients to other providers, scope of practice, barriers and facilitators to providing services, ethical challenges, and COVID-19. Data analysis utilized a phenomenological approach to describe individuals' unique experiences. ResultsThree core themes emerged from the analysis: (i) Lived Experience as Added Value, (ii) Inadequate Funding for PRSS Position, and (iii) Role Difficulties. Participants described the lived experience of PRSS as both beneficial to the recovery journey of patients with SUD and unique in that only PRSS can provide the specific skillset that benefits these patients; these characteristics also helped facilities to connect patients to supportive resources. Two funding limitations emerged as barriers to PRSS employment: funding available through Medicaid billing was insufficient to hire staff and the corresponding hourly compensation rate was not competitive against those offered via grants. Finally, participants identified an underdeveloped hiring system and an unclear scope of practice that led to staff feeling unsupported. ConclusionPRSS's experiential expertise complements clinical expertise by producing effective health care and support for patients. Despite their high value and expertise in SUD treatment, PRSS face major challenges in the workplace, including inadequate pay, underdeveloped support structures, and narrow job eligibility requirements. Future research should further quantify PRSS's levels of expertise and identify “value-added” benefits of this position.