Peer Recovery Coach Research Articles

Emotional exhaustion and workplace belongingness among peer recovery coaches during COVID-19

ABSTRACT Although peer recovery coaches are a growing sector of the addiction workforce, their work can be emotionally taxing, particularly within the context of concurrent public health crises. This study identifies correlates of emotional exhaustion among peer recovery coaches. Peers working for publicly-funded agencies in Michigan (N = 266) completed a web-based survey. In the multiple linear regression model, working in a rural community, longer tenure, and greater stresses related to COVID-19 were associated with greater emotional exhaustion. Greater workplace belongingness was associated with lower emotional exhaustion. Promoting workplace belongingness may prevent or reduce professional burnout among peer recovery coaches.

Partnering with recovery community centers to build recovery capital by improving access to reproductive health.

People with substance use disorders (SUD), especially opioid use disorder (OUD) have the highest rates of unintended pregnancies (80-95%) and report unmet reproductive health needs. Women of childbearing age have some of the highest death rates from opioids and are notably rising the most rapidly, and when pregnancy does occur overdose is one of the leading causes of maternal mortality. There are numerous gender-based health disparities and social determinants of health shaped by the distribution of power and privilege that influence the risk trajectories of people who can get pregnant or are pregnant with a substance use disorder (SUD). The purpose of this paper is to describe how reproductive health is essential to recovery and building recovery capital for people who can get pregnant, (1) introduce a pilot implementation science study working with trained peer support coaches to promote reproductive autonomy in the community, and (2) make policy and advocacy recommendations relevant to the new reproductive health landscape in the United States. We will also describe the adaptation and feasibility of the initial pilot study where we partnered with a recovery community center to train peer recovery coaches to provide low barrier resources (contraception, pregnancy tests and prenatal vitamins) and referrals to health care. This initiative is the merging of best practices in recovery and community-based global reproductive health, to empower people with SUD who can get pregnant in an implementation science framework. The pilot study will last 3 months in each city and aims to (1) assess and describe the effectiveness of the training of local peer recovery coaches on the link between recovery capital and reproductive health, and (2) assess the feasibility, acceptability, appropriateness, scalability, sustainability, and uptake and reach of low barrier reproductive health resources (pregnancy tests, prenatal vitamins, and emergency contraception). In this paper we are only reporting the initial findings regarding adaptation and feasibility. Informed by qualitative interviews with stakeholders and participants, the method of contraception was adapted from injectable to emergency to meet the needs and context of the community with SUD. Early outcomes such as uptake and acceptability indicate that this is a feasible model with peer recovery coaches and recovery community centers, with the greatest uptake of emergency contraception and pregnancy tests. Considering recent policies limiting access to reproductive health, innovative community-based solutions are needed to engage and empower people who can get pregnant or are pregnant while in active drug use and in recovery. Providing low barrier reproductive health items by people with lived experience with SUD can serve as a valuable harm reduction model and improve recovery capital. This is the first study to propose a methodology and context to implement a community-based study merging best practices in recovery with those in reproductive health with the potential to improve recovery capital and maternal/child health trajectories for people with SUD.

Roles and Effects of Peer Recovery Coach Intervention in the Field of Substance Abuse: An Integrative Literature Review

There are ongoing public initiatives to help substance abusers by involving peer recovery coaches (PRCs) in the field of substance abuse worldwide. This study examines the contents and delivery methods of PRC intervention programs and their effects from the participants' standpoint. An integrative literature search was conducted in seven electronic databases using English and Korean search terms. Two researchers independently reviewed the extracted papers and rated their quality based on predetermined inclusion and exclusion criteria, resulting in the selection of nine papers. Research on PRC participation in substance abuse treatment were predominantly US-based, and all articles derived were quantitative studies. The main roles of PRCs included liaising between treatment and community resources, assisting with stress management and coping skills, counseling and case management, and recovery and recurrence prevention education. In addition, the PRC-delivered intervention was tested with various outcome variables. It reduced participants' substance use and enhanced their treatment adherence rates, self-efficacy, quality of life, and stress control. This study confirmed the need to extend existing studies by testing the effects of PRC-delivered intervention through multidisciplinary efforts in more regions and establishing PRCs' role definition and concretization. The results of this study will serve as significant basic data in developing and applying for nursing intervention programs with PRCs in clinical and community nursing settings in the future.

Factors related to substance use treatment attendance after peer recovery coach intervention in the emergency department

IntroductionBrief intervention with peer recovery coach support has been used to generate referrals to substance use disorder treatment from the emergency department (ED). This retrospective study evaluated factors associated with successful linkage to treatment following brief intervention in the ED. MethodsData were extracted from the electronic health record for patients who were referred to substance use treatment from the ED and for whom follow-up data regarding treatment attendance was available (n=666). We examined associations between demographic and insurance variables, substance use, mental health diagnosis, prior abstinence, and stage of change with successful linkage to substance use treatment after ED referral. ResultsThe sample was majority male (68%), White (62%), and had a mean age of 43 years (SD=12). Medicaid was the most common insurance (49%) followed by employer/private (34%). Multivariable logistic regression determined patients with Medicaid (OR=2.94, 95% CI:2.09-4.13, p=<.001), those who had a documented alcohol use disorder diagnosis (OR=1.59, 95% CI:1.074-2.342, p=.02), and those in the “Action” stage of change (OR=2.33, 95% CI:1.47-3.69, p=<.001) had greater odds of being successfully linked to treatment. ConclusionsThese results identify characteristics of patients available in the health record to determine who is more likely or less likely to attend substance use treatment following ED referral. Given appropriate screening, this information could be used to direct standard care resources to those with high likelihood of treatment attendance and strengthen follow-up interventions with peer recovery coaches for those with lower likelihood of treatment attendance.

Understanding the role of community pharmacies in current medication for opioid use disorder care practices

BackgroundMany barriers for patient access to medications for opioid use disorder (MOUD) exist in current care practices. Previous literature has evaluated subsets of pharmacists, patients, and prescribers; however, few have collectively evaluated the perspectives of all 3 groups. ObjectiveThe objective of the study was to identify barriers, facilitators, and opportunities for improvement in Indiana community pharmacy MOUD care practices from the perspectives of peer recovery coaches, community pharmacists, and prescribers to optimize patient care. MethodsIndividual semistructured interviews were conducted with each participant. Interviews explored stakeholders’ perspectives on their current role in MOUD care practices and how current pharmacy practices could be improved. Data were analyzed using preconceived deductive and iterative inductive codes. The first author analyzed all transcripts, of which 3 were also analyzed separately by the last author to confirm consistent utilization of codes. All transcripts were coded once, followed by a second coding to ensure inductive codes were thoroughly applied. ResultsTen peer recovery coaches, 10 pharmacists, and 6 prescribers were included. Interviews identified barriers, facilitators, and opportunities for improvement in current MOUD care practices. Stigma was a major barrier identified by all groups. Other barriers identified included limited patient engagement at pharmacies and lack of access to patient-specific health information in community pharmacy settings. Pharmacists also identified additional barriers including Drug Enforcement Administration regulations and difficulties balancing patient care with external factors like insurance and legal policies. Positive prescriber/pharmacist relationships were identified as a facilitator of care. Opportunities for improvement included having community MOUD resource information available at pharmacies, further education on MOUD for pharmacists, and increased collaboration between pharmacists and prescribers. ConclusionMany barriers exist in current MOUD care practices. Additional pharmacist MOUD education and intentional collaboration between pharmacists, peer recovery coaches, and prescribers would facilitate better care and leverage the accessibility of pharmacists within their communities.

Associations of Mental Health Measures and Retention in a Community-Based Perinatal Care Recovery Support Program for Women of Childbearing Age With Substance Use Disorder

Objective: This research was undertaken to evaluate factors related to program retention among participants in a community-based peer recovery program for women of childbearing age with a history of substance use disorder. Methods: In all, 184 women of childbearing age with a history of substance use disorder were enrolled in a community-based peer recovery program. Half of the participants were pregnant or postpartum. The outcome of interest was retention in the program as measured at 2 and 6 months. Participants were paired with a peer recovery coach (PRC). PRCs were women with a personal history of substance use disorder who assisted with healthcare system navigation, facilitated access to local resources, and provided advice and emotional support. All PRCs were also licensed perinatal community health workers. Independent variables included gestational status, depression, anxiety, type and frequency of substance use, childhood trauma, abuse, readiness for treatment, and attachment patterns. Results: Anxiety was found to be a key factor associated with retention. Moderate anxiety was associated with higher rates of retention compared to normal to mild anxiety. Severe anxiety was associated with lower rates of retention compared to normal to mild anxiety. Attrition was highest in the first 2 months. Conclusions: Early integration with mental health services to address severe anxiety symptoms could potentially improve retention in substance use disorder recovery programs, thereby improving outcomes. More research is needed regarding severe anxiety and care-avoidant behaviors, particularly among women of childbearing age.

Attitudes Regarding Medications for Opioid Use Disorder Among Peer Recovery Coaches.

A growing number of individuals are employed as peer recovery coaches to mentor, support, and educate those in recovery. Despite the robust evidence base for the benefits of medications for treating opioid use disorder (OUD), prior research has identified peers in recovery to hold both positive and negative attitudes toward medications for OUD (MOUDs). We aimed to survey peer recovery coaches in Massachusetts about their attitudes toward working with individuals utilizing MOUDs. All 202 individuals certified as peer recovery coaches in Massachusetts were invited to participate in a brief, anonymous online survey between August and October 2020. The survey collected the respondents' age, sex, certification year, duration of employment as a coach, personal history of substance use disorders, and MOUD treatment. A total of 129 responses were received, representing a 63.9% response rate. Eighty-six (64.3%) reported a personal history of OUD, of whom 64 (74.4%) reported prior MOUD treatment. The majority held positive views about MOUDs, endorsing them as appropriate treatments to achieve sobriety. Coaches with personal history of MOUDs were more likely to report enjoying working with patients on methadone. Coaches without any personal history of OUD or MOUDs were older, more likely to have an alcohol use disorder, and more likely to encourage drug-free treatments before MOUDs and shorter duration of MOUD treatment. Results indicate that peer recovery coaches in Massachusetts hold generally positive attitudes toward MOUDs, but those without any personal history of OUD or MOUDs may be less likely to encourage MOUD treatment.

Sustained Management of COVID-19: Doing More of What Works to Control Future Surges.

Sustained Management of COVID-19: Doing More of What Works to Control Future Surges.

Impact of an osteopathic peer recovery coaching model on treatment outcomes in high-risk men entering residential treatment for substance use disorders.

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.

CPNP 2022 Annual Meeting Poster Abstracts

CPNP 2022 Annual Meeting Poster Abstracts

Acute Care Utilization After Recovery Coaching Linkage During Substance-Related Inpatient Admission: Results of Two Randomized Controlled Trials.

BackgroundFor patients with substance use disorder (SUD), a peer recovery coach (PRC) intervention increases engagement in recovery services; effective support services interventions have occasionally demonstrated cost savings through decreased acute care utilization.ObjectiveExamine effect of PRCs on acute care utilization.DesignCombined results of 2 parallel 1:1 randomized controlled trials.ParticipantsInpatient adults with substance use disorderInterventionsInpatient PRC linkage and follow-up contact for 6 months vs usual care (providing contact information for SUD resources and PRCs)Main MeasuresAcute care encounters (emergency and inpatient) 6 months before and after enrollment; encounter type by primary diagnosis code category (mental/behavioral vs medical); 30-day readmissions with Lace+ readmission risk scores.Key ResultsA total of 193 patients were randomized: 95 PRC; 98 control. In the PRC intervention, 66 patients had a pre-enrollment acute care encounter and 56 had an encounter post-enrollment, compared to the control group with 59 pre- and 62 post-enrollment (odds ratio [OR] = −0.79, P = 0.11); there was no significant effect for sub-groups by encounter location (emergency vs inpatient). There was a significant decrease in mental/behavioral ED visits (PRC: pre-enrollment 17 vs post-enrollment 10; control: pre-enrollment 13 vs post-enrollment 16 (OR = −2.62, P = 0.02)) but not mental/behavioral inpatient encounters or medical emergency or inpatient encounters. There was no significant difference in 30-day readmissions corrected for Lace+ scores (15.8% PRC vs 17.3% control, OR = 0.19, P = 0.65).ConclusionsPRCs did not decrease overall acute care utilization but may decrease emergency encounters related to substance use.Trial RegistrationClinicalTrials.gov (NCT04098601, NCT04098614)Supplementary InformationThe online version contains supplementary material available at 10.1007/s11606-021-07360-w.

Design and Pilot Evaluation of a Cross-Training Curriculum for Intimate Partner Violence Advocates and Peer Recovery Coaches

ABSTRACT Substance use and intimate partner violence (IPV) co-occur, and experts have called for cross-training of IPV and substance use disorder (SUD) professionals. The purpose of this pilot study was to evaluate a cross-training curriculum for IPV advocates and peer recovery coaches. We used a one group pre-posttest study design to evaluate the efficacy and participant experience of the cross-training. Among IPV advocates, the training was associated with improving skills related to working with individuals with SUD, and improving self-efficacy related to working with survivors of IPV. Among recovery coaches, the training was associated with positive changes in self-efficacy regarding working with survivors of IPV and individuals with SUD. Overall, participants reported high satisfaction with the training. Participants indicated that they most appreciated the opportunity to connect with professionals in the other sector, suggesting that such collaborations may help to increase community capacity to respond to individuals experiencing co-occurring IPV and SUD.

Improving care for individuals with serious infections who inject drugs.

Hospitalizations for serious infections requiring long-term intravenous (IV) antimicrobials related to injection drug use have risen sharply over the last decade. At our rural tertiary care center, opportunities for treatment of underlying substance use disorders were often missed during these hospital admissions. Once medically stable, home IV antimicrobial therapy has not traditionally been offered to this patient population due to theoretical concerns about misuse of long-term IV catheters, leading to discharges with suboptimal treatment regimens, lengthy hospital stays, or care that is incongruent with patient goals and preferences. A multidisciplinary group of clinicians and patients set out to redesign and improve care for this patient population through a health care innovation process, with a focus on increasing the proportion of patients who may be discharged on home IV therapy. Baseline assessment of current experience was established through retrospective chart review and extensive stakeholder analysis. The innovation process was based in design thinking and facilitated by a health care delivery improvement incubator. The components of the resulting intervention included early identification of hospitalized people who inject drugs with serious infections, a proactive psychiatry consultation service for addiction management for all patients, a multidisciplinary care conference to support decision making around treatment options for infection and substance use, and care coordination/navigation in the outpatient setting with a substance use peer recovery coach and infectious disease nurse for patients discharged on home IV antimicrobials. Patients discharged on home IV therapy followed routine outpatient parenteral antimicrobial therapy (OPAT) protocols and treatment protocols for addiction with their chosen provider. An intervention developed through a design-thinking-based health care redesign process improved patient-centered care for people with serious infections who inject drugs.

Integrating oral health into community health worker and peer provider certifications in Michigan: A community action report.

A multi-disciplinary, community-university-government collaboration resulted in the development of Oral Health for Community Workers, a brief, oral health online e-learning module. The e-learning module was designed to improve oral health literacy among frontline health workers who are members of underserved communities, and to address oral health disparities in safety net medical and behavioral health settings. Community-based participatory methods were used to design and evaluate the e-learning module. Participants took pre-, post-, and 3-month follow-up surveys. Oral health literacy and confidence in incorporating oral health into practice improved. Satisfaction with the module was high. Oral Health for Community Workers is now sustained as a standard module within Community Health Worker, Peer Support Specialist, and Peer Recovery Coach Certification and continuing education offerings in Michigan.

“Coupled with the Correct Therapy, Peer Support, Stipulations, and Adherence to the Program… it Can Be a Benefit for a Period of Time”: A Qualitative Examination of Peer Recovery Coaches’ Attitudes Toward Medications for Opioid Use Disorder

“Coupled with the Correct Therapy, Peer Support, Stipulations, and Adherence to the Program… it Can Be a Benefit for a Period of Time”: A Qualitative Examination of Peer Recovery Coaches’ Attitudes Toward Medications for Opioid Use Disorder

Obituary: Paul Edward Bowman, recovery advocate

Paul Edward Bowman Jr., 58, a treatment and recovery advocate who has often been a source for ADAW, died Nov. 22. A Massachusetts resident, Bowman worked for the Massachusetts Department of Housing and Community Development on housing and homelessness. He retired and went on to become a peer recovery coach for Massachusetts General Hospital, South End Community Health Center and, finally, at the time of his passing, Boston Medical Center. Bowman received the Richard Lane/Robert Holden Patient Advocacy Awardfrom the American Association for the Treatment of Opioid Dependence in 2018 (see Christie gives powerful speech at AATOD awards banquet, March 19, 2018; https://onlinelibrary.wiley.com/doi/10.1002/adaw.31902); spent many hours at dog shows with his Great Dane, Natalie; and drove Nellie the Clydesdale through his beloved Boston. Bowman became a Certified Medication Assisted Treatment Advocate (CMA) with NAMA Recovery, taught CMA classes, served as chapter director of Boston NAMA Recovery, served on the NAMA Recovery Board of Directors and became a peer recovery coach as well as being involved in activities with addiction research, education, decreasing stigma and overdose prevention. Donations in his memory can be made to The Paul Bowman Memorial Fund for Housing Support at Boston Medical Center at http://bmc.convio.net/goto/paul_bowman, and to The Great Dane Rescue of New England at gdrne.org. Bowman's death was due to overdose, yet another sign that nobody is immune. Nobody.

Estimating the impact of neonatal abstinence system interventions on Medicaid: an incremental cost analysis

BackgroundNeonatal abstinence syndrome (NAS) incidence has significantly increased in the US in recent years. It is therefore important to develop effective intervention protocols that mitigate the long-term consequences of this condition for the mother, her child, and the community.MethodsWe used Monte Carlo simulation to estimate the impact of four interventions for NAS and their combinations on pregnant women with opioid use disorder. The key outputs were changes in incremental costs from baseline from the Medicaid perspective and from a total systems perspective and effect size changes. Simulation parameters and costs were based on the literature and baseline model validation was performed using Medicaid claims for Indiana.ResultsCompared to baseline, the resulting simulation estimates showed that three interventions significantly decreased Medicaid incremental costs by 8% (mandatory opioid testing (MOT)), 4% (patient navigators), and 3% (peer recovery coaches). The combination of the three interventions reduced Medicaid direct costs by 26%. Reductions were similar for total system incremental costs (ranging from 2 to 24%), though MOT was found to increase costs of overdose death based on productivity loss. NAS case reductions ranged from 1% (capacity change) to 13% (MOT).ConclusionsUsing systems-based modeling, we showed that costs associated with NAS can be significantly reduced. However, effective implementation would require the involvement and coordination of several stakeholders. In addition, careful protocols for MOT should be considered to ensure pregnant women don’t forgo prenatal care for fear of punitive consequences.

Implementing a peer recovery coach model to reach low-income, minority individuals not engaged in substance use treatment

Background: Low-income, racial/ethnic minority individuals face significant barriers in access to substance use (SU) treatment. Peer recovery coaches (PRCs), individuals with lived experience with substance use disorder (SUD), may be uniquely well suited to assist those encountering barriers to treatment. PRCs can also help reach those not engaged in treatment to promote harm reduction and support linkage-to-care when embedded in community rather than clinical settings. This study evaluated a community-based program in which a PRC facilitated linkage to and supported retention in SU treatment. Methods: Guided by the RE-AIM framework, we evaluated implementation of the intervention in a community resource center (CRC) serving homeless and low-income residents of Baltimore City. We examined the reach, effectiveness, adoption, and implementation of this PRC model. Results: Of 199 clients approached by or referred to the PRC, 39 were interested in addressing their SU. Of those interested in addressing SU, the PRC linked 64.1% (n = 25) to treatment and was able to follow up with 59.0% (n = 23) at prespecified time points after linkage (24–48 hours, 2 weeks, and 1 month). Fifty-two percent (n = 13) of clients linked to SU treatment remained in treatment at 30 days post-linkage. Of clients who did not remain in treatment, 77% (n = 10) continued contact with the PRC. Conclusions: Results indicate the utility of the CRC’s approach in linking people to treatment for SU and addressing barriers to care through work with a PRC. Findings also highlight important barriers and facilitators to implementation of this model, including the need for adaptation based on individual goals and fluctuations in readiness for treatment.

219 A Non-Inferiority Trial of Peer Recovery Coaches for Screening, Brief Intervention and Referral to Treatment for Substance Use Disorders via In-Person versus Telehealth Interviews

Screening, Brief Intervention, and Referral to Treatment (SBIRT) has become an impactful method of addressing at risk/problematic substance use in the emergency department (ED). However, employing full-time peer recovery coaches (PRCs) may be challenging for some EDs. Additionally, it is unclear whether telehealth serves as a constructive medium for PRCs to deliver brief interventions (BI) and provide linkage to treatment. This study assessed the effectiveness of PRC evaluation and intervention via in-person versus telehealth interaction for patients screening positive at ED triage for at risk/problematic substance use. A prospective cohort study was conducted from July 1, 2020 to February 28, 2021 between two free-standing EDs in Maryland, one with an annual volume of 28,000 visits and one with an annual volume of 32,000 visits. Patients who arrived at the ED and received a BI were enrolled in our study. Since not all BI are eligible for referral, we further defined a subgroup of “high-risk” BI, excluding those BI performed exclusively for marijuana use or those who triggered positive at ED triage but did not have a specific substance identified, to evaluate the proportion of high-risk BI that were provided referral to treatment. A research assistant collected demographic and clinical information from the electronic medical record including modality of PRC interaction-in-person, tele-video, and telephone-referral to treatment, and confirmation of linkage to substance use treatment post-referral. Patients under the age of 18, prisoners, pregnant women, and patients who had received a referral without ED BI were excluded. BI provided and referral versus linkage to treatment for in-person versus telehealth PRC interactions were compared using a test of proportions and non-inferiority was defined by a fixed margin of less than -0.1. In the 8-month enrollment period, 1,144 patients had a positive ED triage screening and received a BI. In-person BI received had a proportion of 0.70 (±0.46) compared to telehealth BI with a proportion of 0.64 (±0.48), with an absolute risk difference of 0.06 (95% CI -0.03-0.08 p<0.05). Of the 331 patients who received a high-risk BI, 57 patients were referred to treatment, with a proportion of 0.61 (±0.08) of patients who received in-person and 0.52 (±0.11) received a telehealth high-risk BI that linked to treatment, with an absolute risk difference of 0.09 (95% CI 0.18-0.35 p=0.52). Our study demonstrated non-inferiority for patients with at risk behavior/problematic substance use to receive PRC BI via in-person versus telehealth. Non-inferiority was not demonstrated for linkage to treatment amongst the high-risk BI referral group, though non-inferiority would have been achieved for this cohort for a fixed margin of less than -0.2. Additional research with a larger sample is needed to corroborate these observations; however, this study suggests some EDs could consider implementing SBIRT with a hybrid PRC model or isolated telehealth staffing to assist in the care of patients with substance use disorder.

20 The Effect of Peer Recovery Coaches on Emergency Department Utilization by Patients With Substance Use Disorders

Although emergency departments (ED) frequently provide care for patients with substance use disorders (SUD), there are many barriers to connecting them with appropriate long-term treatment. One approach to subside risk in this population is the peer recovery coach (PRC). PRCs are individuals with a lived experience of the rehabilitation process and are a powerful resource to bridge this gap in care by engaging patients and their families and providing system navigation, self-empowerment for behavior change, and harm reduction strategies.