Multiprogram perspectives on the peer recovery specialist role, opportunities, and challenges.

Implementing peer recovery services for overdose prevention in Rhode Island: An examination of two outreach-based approaches

Taking a narrative turn in psychiatry

Peer recovery support services for Substance Use Disorder (SUD) are becoming increasingly more prevalent to support individuals in initiating and maintaining recovery. However, models that operationalize service delivery are lacking. Here we describe the Assertive Community Engagement (ACE) model, a new model that emphasizes personalization and peer recovery support with a social determinants of health focus. This article defines the tenets of the ACE model, provides evidence to support the model, and addresses applications of this model to different settings. We review literature on Assertive Community Treatment (ACT) programs and research using peer recovery coaching interventions to develop the ACE model tenets, implementation guidelines, and evidence in support of the model. The ACE model has ten core tenets for service delivery: (1) the target population is individuals with SUD; (2) peer recovery coach services as a single touchpoint; (3) service delivery relies on assertive engagement techniques; (4) comprehensive support services are provided; (5) services include long-term care; (6) community-based care is provided; (7) services have 24/7 crisis availability; (8) outcomes focus on both substance use reduction and quality of life improvements; (9) direct social support is provided; (10) services are personalized and flexible. Empirical evidence for the model includes evidence for increase engagement in treatment and other recovery support services, reduced substance use frequency, and decreased hospital utilization. The ACE model is a promising model of peer recovery support that deserves further investigation for improving substance use and quality of life outcomes.

To examine whether roles of peer specialists affect service use among Black, Latinx and White youth ages 16-24 with serious mental illness (SMI) in Los Angeles and San Diego Counties. Administrative data from 2015 to 2018 was used to summarize service use among 6329 transition age youth age 16-24 with SMI who received services from 76 outpatient public mental health programs with peer specialists on staff. Roles of peer specialists were assessed via a program survey. Generalized linear models were used to assess the relationship between peer specialist characteristics and service use outcomes (ie, outpatient and inpatient). Having a transition age youth peer specialist on staff (vs older peer specialists) and having peer specialists that provide four or more services (vs fewer services) was associated with an increase in annual outpatient visits in both counties (P=<.001 each). In Los Angeles County, having three or more peer specialist trainings (vs fewer trainings) was associated with lower use of inpatient services (P < .001). In San Diego County, having a transition age youth peer specialist and peer specialists that provide four or more services was associated with lower use of inpatient services (P < .001 each). Types of peer support and number of types of peer services were associated with mental health service utilization. Detailed examination of the roles of peer specialists is merited to identify the specific pathways that improve outcomes.

Social support theory has been postulated as underlying peer support and recovery programs. However, there is limited understanding of the underlying theoretical mechanism of peer support and recovery programs. The current study examines how the relationship between psychiatric symptoms and personal recovery depends on social support, as well as assessing the level at which social support influences personal recovery. A sample of 65 adults in a peer support and recovery program were surveyed in a northeastern city in the U.S. The interaction between psychiatric symptoms and peer support on recovery was significant. When peer support is low or average, there is a significant positive relationship between psychiatric symptoms and recovery. There was no significant relationship between psychiatric symptoms and recovery when peer support was high. Peer support and recovery programs may have to assess the level of support needed and tailor the support to the recovery needs.

Stigma Toward Peer Specialists on Inpatient Units.

Aims To compare short and long-term outcomes after tibial plateau levelling osteotomy (TPLO) and lateral fabello-tibial suture (LFTS) techniques for the management of cranial cruciate ligament disease in small dogs with high tibial plateau angles (TPA). Methods In this retrospective study, the medical records of two veterinary specialist practices in the United Kingdom were searched for dogs (<20 kg) that underwent TPLO or LFTS between 2000 and 2010, and had a preoperative radiographic TPA >30° with either short-term (6 weeks) and/or long-term (>3 months) follow-up data. Data collected at a 6-week post-surgical re-examination was derived from orthopaedic examination and radiographic assessment and included the incidence of major and minor complications and scoring of the short-term outcome. Long-term outcome was scored based on results of a subjective owner questionnaire and veterinary orthopaedic examination. Results A total of 61 (84 stifles) dogs were included in the study: 24 (30 stilfes) and 37 (54 stifles) dogs underwent LFTS and TPLO, respectively. Long-term clinical outcome was different (p = 0.017) between groups; 15/15 stifles in the TPLO group had a good or excellent long-term clinical outcome, compared to 4/8 (50%) in the LFTS group. There was no evidence of a difference in short-term post-operative outcome or owner subjective long-term outcome between treatment groups. Stifles in the LFTS group were more likely (p = 0.027) to have palpable stifle pain at long-term follow-up. Owners reported that 5/16 (31.3%) dogs in the LFTS group required oral non-steroidal anti-inflammatory drug (NSAID) treatment at least monthly (4/5 required daily treatment), whereas no dogs in the TPLO group required treatment with NSAID more frequently than three times per year (p = 0.011). No correlation was found between short-term outcome and owner subjective long-term outcome but there was a positive correlation between short-term outcome and long-term clinical outcome. There was no evidence of a difference in overall major complication rates between treatment groups. The occurrence of complications was associated with heavier body weight at the time of surgery. No other variables were shown to be risk factors for complications. Conclusion and clinical relevance Small breed dogs with high TPA that underwent TPLO had better long-term clinical outcomes and were less likely to require NSAID administration than those that underwent LFTS. The risk of complication increased with the weight of the dog at surgery. There was a positive correlation between short-term outcome and long-term clinical outcome.

Background The rise in drug overdose deaths in the United States necessitates novel approaches to reduce harms. In response, peer recovery support services for substance use disorder have been implemented in clinical and community settings in several states. Objectives This descriptive analysis aimed to describe the implementation of hospital-based peer recovery support services for substance use disorder. Methods We describe the implementation of the Peer Recovery Program, which delivers recovery support services 24 hours a day, seven days a week, for patients with substance use disorder in emergency departments and inpatient settings across 20 hospitals. We report program, patient, and referral characteristics and program process measures. Results From 2016 to 2019, Recovery Specialists received referrals during 30,263 patient visits. In 2019, 65.4% (n = 7,564) of patients were male. Across three subsamples of referrals, patient acceptance of continued recovery support services ranged from 74.8% to 83.0%. At affiliated hospitals in 2019, the median response time from referral to Recovery Specialist arrival at patient bedside was eight minutes (interquartile range = 4–16), and the median duration of initial bedside consultation was 35 minutes (interquartile range = 25–45). In 2019, Recovery Specialists and Patient Navigators attempted 113,442 follow-up contacts, and patients accepted 4,696 referrals provided by Patient Navigators to substance use disorder treatment and other medical, social, and recovery services and supports. Conclusions This study describes peer recovery support services for substance use disorder delivered in emergency departments and inpatient settings. Evidence of improved patient outcomes is needed prior to widespread adoption.

Objective To investigate the influencing factors of short-term and long-term outcomes in patients with acute ischemic stroke. Methods From March 2015 to March 2016, patients with acute ischemic stroke treated at the Department of Neurology, the Second Hospital of Tianjin Medical University were enrolled prospectively. The demographic and baseline clinical data of the patients were recorded. The modified Rankin scale (mRS) was used to assess the short-term outcomes at 14 d and one year after onset. Good outcome was defined as mRS 0-2, and poor outcome was defined as >2. Death or new cardiocerebrovascular events were recorded. Multivariable logistic regression analysis was used to determine the influencing factors of short-term and long-term outcomes in patients with acute ischemic stroke. Results A total of 514 patients with acute ischemic stroke were enrolled, including 338 (65.8%) with short-term good outcome and 176 (34.2%) with poor outcome. There were significant differences in age, atrial fibrillation, history of past stroke or transient ischemic attack (TIA), etiological typing of stroke, baseline NIHSS score, severity of stroke, pulmonary infection, dysphagia, and urinary incontinence between the short-term good outcome group and the poor outcome group (P<0.05). Multivariable logistic regression analysis showed that history of past stroke or TIA (odds ratio[OR]2.188, 95% confidence interval[CI]1.192-4.014; P=0.011), baseline NIHSS score (OR 1.504, 95% CI 1.362-1.661; P=0.001), and urinary incontinence (OR 4.114, 95% CI 1.934-8.751; P=0.001) were the independent influencing factors of short-term outcome. A total of 467 patients completed 1-year follow-up, including 315 (67.5%) with long-term good outcome and 152 (32.5%) with poor outcome. There were significant differences in age, history of ischemic heart disease, stroke or TIA, etiological typing of stroke, baseline NIHSS score, severity of stroke, pulmonary infection, dysphagia, urinary incontinence, secondary prevention of antiplatelet drugs and statins between the long-term good outcome group and the poor outcome group (all P<0.05). Multivariable logistic regression analysis showed that age (OR 1.029, 95% CI 1.004-1.055; P=0.022), past history of stroke or TIA (OR 1.983, 95% CI 1.082-3.633; P=0.027), baseline NIHSS score (OR 1.271, 95% CI 1.153-1.400; P=0.001), urinary incontinence (OR 4.996, 95% CI 2.308-10.813; P=0.001), and secondary prevention using antiplatelet drugs (OR 0.227, 95% CI 0.125-0.414; P=0.001) were the independent influencing factors of long-term outcome. The baseline NIHSS score (OR 1.184, 95% CI 1.070-1.310; P<0.001) and secondary prevention using antiplatelet agents (OR 0.064, 95% CI 0.014-0.284; P<0.001) were the independent influencing factors of death or occurring vascular events. Conclusion Age, past history of stroke or TIA, baseline NIHSS score, urinary incontinence, antiplatelet drugs for secondary prevention were independently associated with the outcomes in patients with acute ischemic stroke. Early and targeted intervention of modifiable factors and the emphasis on the use of antiplatelet agents in secondary prevention might reduce stroke recurrence and improve outcomes. Key words: Stroke; Brain Ischemia; Treatment Outcome; Risk Factors; Time Factor

Mental health peer specialists develop peer-to-peer relationships of trust with clients to improve their health and well-being, functioning in ways similar to community health workers. Although the number of peer specialists in use has been increasing, their role in care teams is less defined than that of the community health worker. This qualitative study explored how the peer specialist role is defined across different stakeholder groups, the expectations for this role and how the peer specialist is utilised and integrated across different types of mental health services. Data were collected through interviews and focus groups conducted in Massachusetts with peer specialists (N = 44), their supervisors (N = 14) and clients (N = 10) between September 2009 and January 2011. A consensus coding approach was used and all data outputs were reviewed by the entire team to identify themes. Peer specialists reported that their most important role is to develop relationships with clients and that having lived mental health experience is a key element in creating that bond. They also indicated that educating staff about the recovery model and peer role is another important function. However, they often felt a lack of clarity about their role within their organisation and care team. Supervisors valued the unique experience that peer specialists bring to an organisation. However, without a defined set of expectations for this role, they struggled with training, guiding and evaluating their peer specialist staff. Clients reported that the shared lived experience is important for the relationship and that working with a peer specialist has improved their mental health. With increasing support for person-centred integrated healthcare delivery models, the demand for mental health peer specialist services will probably increase. Therefore, clearer role definition, as well as workforce development focused on team orientation, is necessary for peer specialists to be fully integrated and supported in care teams.

Peer specialists are hired, trained, and accredited to share their lived experience of psychiatric illness to support other similar individuals through the recovery process. There are limited data on the role of peer specialists in suicide prevention, including their role in intervention development. To better understand peer specialists within the Veterans Health Administration (VHA), we followed partnership community engagement and a formative research approach to intervention development to (1) identify barriers, facilitators, and perceptions of VHA peer specialists delivering a suicide prevention service and (2) develop and refine an intervention curriculum based on an evidence-informed preliminary intervention framework for veterans with serious mental illness (SMI). Following the community engagement approach, VHA local and national peer support and mental health leaders, veterans with SMI, and veteran peer specialists met to develop a preliminary intervention framework. Next, VHA peer specialist advisors (n=5) and scientific advisors (n=6) participated in respective advisory boards and met every 2-4 months for more than 18 months via videoconferencing to address study objectives. The process used was a reflexive thematic analysis after each advisory board meeting. The themes discussed included (1) the desire for suicide prevention training for peer specialists, (2) determining the role of VHA peer specialists in suicide prevention, (3) integration of recovery themes in suicide prevention, and (4) difficulties using safety plans during a crisis. There were no discrepancies in thematic content between advisory boards. Advisor input led to the development of Suicide Prevention by Peers Offering Recovery Tactics (SUPPORT). SUPPORT includes training in general suicide prevention and a peer specialist-delivered intervention for veterans with SMI at an increased suicide risk. This training aims to increase the competence and confidence of peer specialists in suicide prevention and the intervention supports veterans with SMI at an increased suicide risk through their recovery process. This paper intends to document the procedures taken in suicide prevention intervention development, specifically those led by peer specialists, and to be a source for future research developing and evaluating similar interventions. ClinicalTrials.gov NCT05537376; https://classic.clinicaltrials.gov/ct2/show/NCT05537376.

The Recovery Coach and Peer Support Initiative (RCPSI) in Indiana focused on implementing peer recovery coaches (PRCs) to engage opioid overdose patients in emergency department (ED) settings and promote entry into recovery services. State workers and researchers organized an informal learning collaborative primarily through teleconference meetings with representatives of 11 health service vendors to support implementation. This study presents qualitative analysis of the teleconference meeting discussions that guided RCPSI implementation to display how the informal learning collaborative functioned to support implementation. This informal learning collaborative model can be applied in similar situations where there is limited guidance available for a practice being implemented by multidisciplinary teams. Authors conducted a thematic analysis of data from 32 stakeholder teleconference meetings held between February 2018 and April 2020. The analysis explored the function of these collaborative teleconferences for stakeholders. Major themes representing functions of the meetings for stakeholders include: social networking; executing the implementation plan; identifying and addressing barriers and facilitators; educating on peer recovery services and target population; and working through data collection. During the last 2 months of meetings, stakeholders discussed how the COVID-19 pandemic created multiple barriers but increased use of telehealth for recovery services. Teleconference meetings served as the main component of an informal learning collaborative for the RCPSI through which the vendor representatives could speak with each other and with organizers as they implemented the use of PRCs in EDs.

The emergence of peer specialists with histories of suicidality in mental health care services is a recent but scarcely researched societal phenomenon. The current study aimed to explore how peer specialists who have experienced suicidality (either attempted suicide or suicidal ideation) use their experiences to contribute to suicide prevention in mental health care services. Qualitative interviews with 20 peer specialists who have personally dealt with suicidality in their past were conducted. Interviewees perceived their work to have unique value in terms of their approach to making contact with suicidal care consumers on an emotional level, which was perceived to lead to less reluctance on the part of suicidal care consumers to talk about suicidality, as well as affect feelings of being acknowledged and heard. However, the lack of professional distance was perceived to carry several risks, including burdening clients with the peer specialists' own suicidal experiences, perceived reluctance of coworkers to let peer specialists work with suicidal clients, and the burden of working with suicidal clients for the peer specialists. Specific conditions that were perceived to be needed in order to work with suicidal clients consisted of personal distance to own process of recovery and suicidality, establishing boundaries with the team or colleagues for the peer specialists' work concerning suicide risk assessment, safety, privacy, and sharing responsibility. Further discussion between mental health care clinicians and peer specialists regarding the role of the peer specialist in suicide prevention is needed to further clarify and optimize their role. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

The United States has witnessed a disproportionate rise in substance use disorders (SUD) and co-occurring mental health disorders, paired with housing instability, especially among racially minoritized communities. Traditional in-patient residential treatment programs for SUD have proven inconsistent in their effectiveness in preventing relapse and maintaining attrition among these patient populations. There is evidence showing that peer recovery programs led by individuals who have lived experience with SUD can increase social support and foster intrinsic motivation within participants to bolster their recovery. These peer recovery programs, when coupled with a standardized training program for peer recovery coaches, may be very efficacious at improving patient health outcomes, boosting performance on Substance Abuse and Mental Health Services Administration (SAMHSA) national outcome measures (NOMs), and helping participants build an overall better quality of life. The goal of this study is to highlight the efficacy of a peer recovery program, the Minority Aids Initiative, in improving health outcomes and associated NOMs in men with SUD and/or co-occurring mental health disorder. Participants received six months of peer recovery coaching from trained staff. Sessions were guided by the Manual for Recovery Coaching and focused on 10 different domains of recovery. Participants and coaches set long-term goals and created weekly action plans to work toward them. Standardized assessments (SAMHSA's Government Performance and Results Act [GPRA] tool, Addiction Severity Index [ASI]) were administered by recovery coaches at intake and at the 6-month time point to evaluate participant progress. Analyses of participant recovery were carried out according to SAMHSA's six NOMs and assessed the outcomes of the intervention and their significance. A total of 115 participants enrolled in the program over a 2-year period. Among them, 53 were eligible for 6-month follow-up interviews. In total, 321 sessions were held, with an average of three sessions per participant. Participants showed marked improvement across five of the six NOMs at the end of the 6-month course and across all ASI outcomes, with the exception of three in which participants reported an absence or few symptoms at intake. Our study shows that participants receive benefits across nearly all NOM categories when paired with recovery coaches who are well trained in medication-assisted treatment (MAT) and medications for opioid use disorder (MOUD) over a 6-month period. We see the following: a higher rate of abstinence; increased housing stability; lower health, behavioral, and social consequences; lower depression and anxiety; longer participant-recovery coach exposure time; and higher follow-up rates. We hope that our results can contribute to advancements and greater acceptance in the implementation of peer recovery coaching as well as an improvement in the lives of the communities affected by substance use.

Birth defects have brought about major public health problems, and studying the clinical outcomes of the most common prenatal central nervous system abnormality, namely, fetal ventriculomegaly (VM), is helpful for improving reproductive health and fertility quality. This is a retrospective cohort study from 2011 to 2020 in the West China Second University Hospital, Sichuan University, aiming to evaluate the short-term and long-term outcomes of VM over 37 weeks’ gestation to exclude the influence of preterm birth. The study analyzed data from 401 term pregnancies, with 179 VM and 222 controls. From the short-term outcomes, the rate of the neonatal intensive care unit (NICU) admission under the VM group (10.06%) was comparatively higher than the control (0.45%), but Apgar scores between both groups at 1 min, 5 min and 10 min were not significantly different. From the long-term outcomes, there were more infants with abnormal neurodevelopment under the VM group than control (14.53% vs. 2.25%, p < 0.001). In addition, NICU admission (p = 0.006), peak width of lateral ventricles (p = 0.030) and postnatal cranial ultrasound suggestive with VM (p = 0.002) were related to infants’ long-term outcomes. NICU admission during the perinatal period was an independent risk factor for the adverse long-term outcomes (OR = 3.561, 95% CI 1.029–12.320, p = 0.045). In conclusion, VM impairs short-term and long-term outcomes of term infants. Short-term outcome, especially NICU admission, could predict their adverse long-term outcomes.