Coordinating Care for Individuals with Substance Use Disorders, a unique program in Pittsburgh’s Allegheny County, uses peer navigators to engage people with substance use disorder (SUD) who visit the emergency department or are hospitalized. This new workforce is comprised of individuals in recovery who are trained to assist those currently in the throes of addiction. As the program continues to grow, hospitals increasingly recognize the value of peers and how they are helping to reduce SUD-related readmissions.

Keirston Parham (“KP”), CPS, CPSS, CWF, recovery and peer services coordinator at Western Psychiatric Institute and Clinic (WPIC) of the University of Pittsburgh Medical Center (UPMC), heads the WPIC Recovery department, and oversees peer services throughout WPIC, including peer navigation. KP also helps recruit and train peer navigators for other UPMC hospitals. The Center for Health Care Strategies recently spoke with KP to learn key pointers for hiring and supporting peers to help them be successful in their jobs.

Q: Integration of SUD peers into the health care system is a relatively new recovery approach — what are the critical elements for a peer?

A: Peers must be progressed in their recovery — this is absolutely essential. A peer is someone in recovery from a substance, in a job where he or she is talking about substances all day. They’re signing up to face their triggers in order to help others, and we need to be confident that they are not reactive to those triggers. Peers often hear about trauma in people’s lives, like rape, abuse, homelessness, and other barriers that work against an individual’s recovery. Being progressed allows a peer to handle exposure to these traumas in addition to substance use. Peers are in this job from their heart – they’re not immune to the hardships that come along with it. But, being progressed means they are able to deal with these difficult situations and still maintain health and wellness.

Peers must also possess the ability to connect and engage with people naturally. A peer is not going to be great simply because he or she has used the same drug as a patient. It’s vital that the patient views the peer as their peer. If a peer is able to accomplish this, he or she can be a great motivator, strong source of encouragement, and help a person believe in themselves when they themselves cannot. The ability to connect quickly is important because a peer never knows how much time he or she has to make an impact in a patient’s life — we meet with people in crisis, and we need to be able to engage and connect quickly.

Natural motivational interviewing skills is another critical element. This includes empathetic listening and knowing how to ask open-ended questions to find a patient’s motivators. The information gathered from this type of engagement is vital to a recovery plan. The reason many people don’t meet their recovery goals is because their own motivations aren’t attached to the plan — someone else’s are, or a provider told them they have to do it. We gain more buy-in from patients when their motivations are included in the plan.

Q: When hiring a peer, how do you find the right candidate?

A: In addition to the critical elements above, peers must have 1-2 years in recovery. We also look for individuals who are diverse. They need to be able to connect with people from all walks of life regardless of gender, culture, age, religion, and background. This includes the ability to connect with clinical staff, too.

Role play is a helpful part of the interview process, which allows us to see peers engage in situations that are common on the job. The type of work we do is new for a lot of people — some have never worked in a hospital, and we need to make sure they realize the types of situations they’ll be exposed to on a regular basis, like visible detoxing, threat of violence, details of abuse, losing children, and other traumas. Role play also allows us to see how a person reacts to these types of scenarios, and whether the peer is able to not only stay cool, but maintain empathy for the patient.

Q: What type of training do new hires receive to help them be successful in their jobs?

A: We have an array of training for new peers. The Certified Peer Specialist program is an intense two-week training. In addition, I provide an all-day training that covers Recovery 101, The Guiding Principles of Recovery (SAMHSA), peer ethics and boundaries, the peer role, recovery language, Magellan’s Five Stages of Recovery, and peer competencies for UPMC role development. New hires are also paired with veteran peer navigators for shadowing in hospitals — first in the veteran peer’s hospital, and then in the new hire’s home hospital. Overall, training and orientation takes roughly 4-8 weeks.

Q: What type of ongoing training/certification is critical to help peers be effective in their roles?

A: Peer navigator training is ongoing. I provide onsite one-on-one training with the peer navigators, as well as hold a monthly “Recovery Supervision” meeting where peers can practice their skillsets and review the core peer competencies. I also do regular site visits at the hospitals to see peers demonstrate their skills with patients.

Q: In order to help others to recover, peers need to be well themselves. As a manager, how do you support peers in staying positive and avoiding burnout?

A: We regularly check-in with our peer staff to support their health and wellness and make sure they are not overloaded. The relationship between a peer navigator and supervisor is different than the average work relationship. Peers may need to share personal details with their supervisor that are not part of typical professional conversation — “I thought about having a drink this week” or “I saw someone who looked like my abuser.” By the very nature of what we do, we have to be more open with one another than in most professions. As managers, we are on the look-out for signs of burnout as well as making sure staff are comfortable letting us know when they need a wellness break. In addition to regular check-ins, we hold monthly wellness meetings to allow them the chance to validate one another, discuss challenges, share best practices and experiences, and discuss self-care.

Q: What are next steps for peer navigators?

A: I believe peer navigators are the missing piece for hospitals when it comes to SUDs. Traditionally (prior to peer navigators), patients leave the hospital without a true plan for recovery. Upon discharge they are exposed to everything that sent them there in the first place. With the use of a peer navigator, patients have the opportunity to identify situations that lead to crisis and barriers to recovery. We work with patients to create an individualized plan, connect them to resources in the community, and do follow-up calls post-discharge. Although Allegheny County does provide Medicaid-billable peer support services, this does not currently include the peer navigators. The county is actively working toward having this peer support role become Medicaid billable.

Hopefully peer navigation will expand to more hospitals, and additional peer navigators will be added to the hospitals with existing peer navigation programs. We need more peer navigators in order to cover more hospital shifts. Patients are coming in for SUD 24/7. We are also receiving queries from new hospitals that have seen the value that peer navigators bring, such as improvement in lowering readmission rates. Peer navigators can play a key role in recovery — we just need to get more of them out there.

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