Meryl Schulman, MPH

July 19, 2018

When people with substance use disorders (SUDs) are hospitalized or visit the emergency department, there is a critical window of opportunity to connect them to recovery-related services and treatment. Yet, for a variety of reasons, these linkages are often not made, reducing the chance these individuals will receive needed supports and increasing the potential for poor outcomes and repeat hospital visits. Coordinating Care for Individuals with Substance Use Disorders (CCISUD), a unique peer navigator program in Pennsylvania’s Allegheny County, is seeking to take advantage of this critical window and link individuals who present with SUDs in hospital settings to recovery-oriented services.

David Gardner, CPS, CRS, senior peer navigator at the Western Psychiatric Institute and Clinic at UPMC in Pittsburgh, was the first peer hired for the program. But before connecting with patients, David had to gain the trust of health care professionals at the hospital and “mainstream” the peer approach into the hospital’s treatment and referral processes. Now three years after the program’s inception, David and his fellow peer navigators are recognized for their valuable roles in the hospital. Indeed, David recently received UPMC’s Award for Commitment and Excellence in Service — fewer than one percent of all UPMC staff are annually chosen for this honor. In nominating David, UPMC Clinical Nurse Manager Curt Bell, noted: “David is able to reach many clients with whom others cannot establish a strong rapport. His genuine caring and concern for each and every individual is recognized by all. He is truly a champion in the war against substance use disorder.” CHCS recently spoke with David who shared how the peer navigator program gained the respect of other health care professionals in the hospital and offered lessons for programs considering the integration of peer recovery supports.

Q: You were the first peer hired for the CCISUD program. What was the initial reaction from hospital clinical staff? How did you get buy-in regarding your work as a peer navigator?

A: Professional staff were totally unfamiliar with peer navigation and what peer navigators do daily. They assumed the referral process would necessitate an additional step in their already hectic workflow and thought that the navigation efforts would be redundant interactions with patients. For example, social workers thought they were already doing the work of a peer navigator. They did not understand what the peers would be doing differently.

To facilitate buy-in, we had to educate clinical staff. We did this by identifying champions within individual facilities and sought to get buy-in from key stakeholders. We also spent a lot of time discussing what a peer navigator is, and we specifically called out that nobody likes to change their workflow. My approach to the integration process was to ask staff, “What can I do for you?” I wanted to hear from them to understand the issues with this population. I wanted to identify what their barriers were with these patients, how I could make it easier for them, and how I could be a valuable resource and part of their team.

Q: Part of your job is helping new hospital employees understand how peer navigators can benefit hospital staff. Can you describe the key messages that you convey to new health care providers?

A: The key messages that we communicate regularly are, first, that peer navigation is a valuable resource, and second, that anyone may contact me or other peers directly with questions about supporting people who have a history of or currently use drugs or alcohol. We give a presentation to new hires on how easy it is to refer patients to peer navigators, and how it is valuable to connect peers to a patient in need because of my training and lived experience. I also convey that I am open and available to staff and to new hires. If they have any questions, or if they are having a situation with a patient, they can contact me.

Social workers, physicians, and all the referral sources that have benefited from the program also incorporate information on peer navigation into their trainings. I conduct a presentation for our graduate students of nursing, and peer navigation has been written into their health system orientation.

Q: Would you describe the referral process for providers?

A: Originally, we placed more responsibility on the referral source. Providers would ask patients if they wanted to speak with somebody with personal experience with drugs or alcohol. But, by the time patients got to their beds for treatment, many had changed their minds or were reluctant to speak with someone because they had been asked so many times about their substance use since admission. The last thing they wanted to do was talk to someone else. Soon after, I proposed that the criteria for referral would be if a patient had a history of substance use disorder and/ or if the substance use disorder is current. The referral is then made via secure email, voicemail or direct call. All providers need to do is include the patient’s medical number, first name, last initial, and his or her location in the hospital (e.g., room number). If it is urgent and a patient is in the emergency room, I will get a phone call. Those referrals always take precedence. It is also important to note that the Peer Navigators give the patient a Release of Information form to sign prior to consultation that reviews HIPAA information and specifically states: ‘Peer Specialist Consult. For the sharing of electronic information only; no records to be sent.’ This Release of Information form was reviewed and approved by UPMC’s legal department.

Q: Please describe a moment when you realized that your goal had been achieved — when your “peer” health care professionals recognized the value of your role.

A: In early November 2015, UPMC conducted a survey on general impressions of peer navigation and it was mostly positive. A year later, we conducted another survey that asked staff to describe the impact peer navigation had on them, and it was overwhelmingly positive. There was an immediate request for more peer navigators. At one point the number of referrals I was receiving within my facility outnumbered the number of hours in a day available to get to everybody. The referrals became overwhelming.

I also see the cultural change in the last three years within our facility, which was a caring facility to begin with. Dropping the stigma is most important. Saying the words that have been unspoken for so long and the assumptions dispelled, most find addiction is nothing to be frightened or ashamed of.

Q: Where do you see the future of the peer workforce going?

A: Peer services have found their way, especially in our Commonwealth. I attend many conferences, and there is always a component of peer navigation or peer support within the context of treatment and wellness. I see it only expanding. This program started with just three of us and has since doubled in size in very short order. We have hired more peer navigators, and more hospitals are asking for peer navigation services. The proof is also evident in the overall 30 percent reduction in patient readmissions since the initial peer navigation program began in 2015. So, when you have something with that measure of success, expansion and relevancy are inevitable.

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