Certified peer support specialists are quickly becoming an essential part of substance use disorder (SUD) treatment in the United States.
Having gone through the recovery process successfully, peer support workers are driven to help others facing similar hardships in their lives. Addiction rehabilitation centers are now relying more on that connection and experience to create effective programs.
At the Hazelden Betty Ford Foundation in Chicago, peer recovery specialists are used to complement continuing care and recovery support services, and to provide training across the country incorporating the approach into recovery-oriented systems of care, according to Bob Poznanovich, the organization’s chief business growth officer.
Certified peer recovery specialists have become a vital component in the Foundation’s continuum by “providing support and resources to help people get firmly established in their recovery and community, avoid returning to use, and quickly rebound if a return to use does occur,” Poznanovich told Addiction Treatment Business.
Other leaders in the SUD space support those ideas.
Aware Recovery Care, a drug and alcohol addiction rehab company that provides personalized and comprehensive care to individuals in their homes across 11 states, also employs peer support personnel.
Known as “peer coaches” at Aware, they provide in-home addiction treatment services, supported by virtual clinical resources including nurses, social workers and nurse practitioners. Aware CEO Brian Holzer told ATB the benefit of the peer coach model is that coaches are almost entirely in recovery or have a deep connection to the recovery journey, allowing them to offer a compassionate lived-experience perspective.
“It provides an element of credibility and trust that is built to a degree that I have not seen in health care with regards to the interactions between professionals and patients,” Holzer said.
The lived experience that peer support provides has had a significant financial impact on SUD treatment programs as well.
Holzer said Aware receives per member, per month savings data from their insurance partners that shows dramatic reductions in utilization of emergency rooms, hospitalizations and other levels of behavioral health care. While the data can’t be specifically broken down to peer codes alone (Aware also operates medical and behavioral models), Holzer stressed the importance of the peer coach model to their program.
“I don’t believe it works without the peer coach model. The lived experience piece unlocks the value of the rest of the model,” he said.
Peer review
Poznanovich said Hazelden Betty Ford’s training and consultation division has worked across the country to help integrate peer recovery specialists into recovery-oriented systems of care, alongside physicians, nurses, counselors and therapists, corrections officials, emergency responders, school officials and more.
Hiring peer support specialists and fostering an effective integration requires collaboration and mutual respect.
“One key to success is respecting the unique role of peers – their distinct value in openly sharing lived experience and walking alongside patients and clients, rather than having the authoritative relationship that is inherent, even when not emphasized, in other professional roles,” Poznanovich said.
Holzer agreed.
“There’s no secret sauce with regards to hiring the right employee,” he noted. “The reality is someone who has two years or more in recovery, that has been through and recovered from the trauma of an addiction, is the right person for the job.”
While organizations can’t teach someone what it’s like to go through addiction, both Aware and Hazelden Betty Ford give peer recovery specialists additional tools to help them perform their jobs effectively.
“Peer recovery specialists need training, certification and tools to help them follow evidence-based approaches to improving outcomes,” Poznanovich said. “They also need appropriate supervision and a voice – a valued seat at the multidisciplinary table.”
Holzer said Aware tries to nurture employee environments, predicated on training and advancements.
“We want to create a foundation that someone, who may or may not have a lot of corporate experience, can come in, go through a rigorous training and preceptorship process, and ultimately be mentored to the point where they can grow and be part of a corporation,” he explained.
Payments for peers
To ensure the peer-first approach endures, organizations must find ways to pay for the services.
Funding can come in various forms. Many states reimburse organizations for peer support for substance use disorders, and commercial payers are also covering peer support services more often.
Aware currently operates under a bundled payment model with its clients, who are commercial insurers. The company previously operated under a fee-for-service model, but in 2016 Anthem Blue Cross and Blue Shield of Connecticut partnered with Aware, and they secured a monthly bundle payment model for the totality of their services.
Those services included all of Aware’s clinical resources, including peer coaches.
“That affords us the ability to deliver the right amount of care at the right time over an extended period of time and not have to worry about individual per widget billings,” Holzer said.
Poznanovich said Hazelden Betty Ford also bundles their program into some of their commercial payer contracts.
“We think all patients benefit from ongoing peer support services – and through our outcomes research, payer strategies and external collaborations – we will continue to work toward ensuring all patients have access to such services,” he said.
Future support network
As the confidence in utilizing peer support specialists grows, so has the advocacy among organizations.
Poznanovich and Holzer are confident that the use of peers in SUD will increase.
“Peers are being plugged into all kinds of settings now, such as emergency rooms and social service centers where they can make a life-changing and life-saving difference,” Poznanovich said.
Holzer said that the demand for peer coaches on the client side will continue to grow because having staff who can relate to people going through mental illness or addiction experience makes a difference.
“Having somebody who has walked in the shoes of the client is so powerful in its ability to create credibility,” he said.. “In our case at least, we see it as so effective in terms of the outcomes.”
Peer support is also having a tremendous impact on the other side – the lives of the specialists who provide it.
“The ability to give back to those in addiction helps people who are in recovery to continue to lifelong recovery,” Holzer said. “Not only is it rewarding from the standpoint of helping people, but there’s also a personal element that helps keep them on the right path and sustain their recovery journey.”