Peer Recovery Coaches in the Emergency Department: A New Resource

Introduction

 Peer recovery coaching in the emergency department is critical in supporting patients with substance abuse disorders. They facilitate recovery through development of individualized plans and pathways as well as provide diversified support in emergency departments. Recovery coaches are trained personal mentors who are engaged in the recovery process from addictions such as alcohol and other substances (Luthra, 2016). As such, these personnel are essential in providing immediate support in the event of crisis in the emergency department to help in achieving and sustaining recovery.

 Considering the role of peer recovery coaches in the emergency department, it is evidence that their engagement in the process of treatment improves the patient outcomes. Patients presenting in the emergency department expressing desire and motivation to recover from harmful substances and drug abuse require the incorporation of a recovery coach in their treatment plan to recover and sustain their wellbeing.  Therefore, the purpose of this project, Peer Recovery Coaches in the Emergency Department: A New Resource, is to examine the roles and importance of the peer recovery coaches as a new resource in the emergency department. The goal of the project is to bring access to the new emergency department resource, peer recovery coaches, through the optimization of multidisciplinary approach to the complex public health concern of addiction, physical and mental health supports and services.

The paper contains the introduction section with an overview of the project, the goal statement, project objectives, evidence-based review of the literature for project justification, methodology section, resources, summative and formative evaluation, and the timeline for the project under the appendices.

Goal Statement

 Drug and substance abuse addicts experience multiple challenges during the process of treatment. In this case, they require help and support on how to successfully complete the recovery journey and prevent the relapse of addictions. Peer recovery coaching presents a solution to this problem since it provides a wide array of support services to the patients and helps them achieve their recovery goals. In this case, I seek to provide a solution to increased recovery rates of the emergency department patients through the incorporation of peer recovery coaching techniques, a resource, that encourages quick recovery and sustains the health status of the an addicted individual. I also intend to provide additional resources that bring about value and optimize the quality of services delivered in the emergency department.

 The project focuses on improving the support mechanisms for individuals addicted to substances and alcohol with the motivation to change. Moreover, it addresses the public health crisis associated with physical, mental health and addiction thorough effective management and individualized treatment. Therefore, it focuses on the areas of treatment and development of individualized plans through careful examination of each patient’s individual needs. The population addressed by this project includes the mental, physical and addicted patients in the emergency room department in crisis and expressing the need, motivation and desire to receive help regarding substance abuse.

 The project is characterized by the improvement of the healthcare systems to better the patient experiences and improve their outcomes. The processes associated with the project include the alignment of the community resources with the shared goals of the emergency department through the incorporation of peer recovery coaches in treatment of the addicted patients. The project also provides evidence based treatment interventions for addiction based on the needs of individual patients. In addition, it provides tools and practices that improve the effectiveness of coaching support and services as well as integrates the recovery supports with the emergency department services through the peer recovery coaches. This will help resolve the healthcare crisis associated with relapse of addictions and increased rates of coping inefficacies as well as lack of adherence to treatment plans provided.

Project Objectives

• To provide new resources to improve the quality of service provision in the emergency department.
• To incorporate peer recovery coaches in the emergency department to increase the patient outcomes.
• To optimize the recovery of emergency department patients seeking help from addictions.
• To reduce the emergency care visits and operations of emergency room through prevention of addiction relapses.

Evidence-based review of the literature for project justification:

 According to Center for Community Health Engagement and Equity Research (2017), the rate of overdose deaths in Indiana have increased over the years. However, peer recovery coaches have brought about an engaging and supportive approach towards the treatment of opioid use disorder. Multiple previous researches have indicated that peer recovery coaching has reduced the rate of recidivism and substance abuse in comparison to the standard treatment options (DeKemper & Rush, 2017). James, Rivera and Shafer (2014) report an increased abuse of methamphetamine in 2012 which has increased the crime rates and the annual cost of healthcare in the United States. Numerous negative consequences have been observed over the years thus necessitating the need for an effective approach to the healthcare crisis. Peer recovery coaches have been found to be effective in the management of target substance abuse as well as provide supports, strength-based recovery services and networks of person-centered (James, Rivera & Shafer, 2014).

 A systematic review by Bassuk et al. (2016), involving nine studies that examined the effectiveness of peer recovery coaching confirms the effectiveness of the support services in alcohol and drug addiction patients in the US. Similarly, Eddie et al. (2019) conducted a systematic research that indicated that peer recovery coaching provided support services as the new model for caring substance abuse disorder addiction patients. The study recognizes the increased adoption of the strategy in a wide range of clinical emergency department settings. The effectiveness has been found in preventing co-occurring psychological disorders and in the development of personalized treatment plans for substance disorder patients.

 Notably, the emergency department is considered to be the most critical healthcare setting for addicted individuals. Carey et al. (2018) describes the emergency department as the location whereby the identification and treatment of patients for opioid addiction are identified and treated. The peer recovery coaching model of healthcare is employed in the identification, training, credentialing and supervision of substance abuse disorder patients within at least two years of recovery (Waye et al., 2019). Consequently, the combination of the peer recovery coach and adoption as well as the use of emergency department Naloxone distribution consultation program presents effectiveness in the management of addiction disorder (Samuels, Baird, Yang & Mello, 2018).

 Following the above evidence-based research from previous literature review, it is clear that the emergency department encounters increased alcohol and substance abuse patients every day. This has caused a healthcare crisis due to lack of effective measures to manage, treat and sustain the patients. In this case, the project provides a new resource that resolves the substance abuse treatment problem through the adoption of peer recovery coaching in the emergency department.

Methodology

 The project utilized electronic medical record (EMR) review and retrospective provider surveys to investigate the rate of hospital visits by substance use disorder patients in the emergency department. Moreover, the implementation and effectiveness of use of the peer recovery coach resource in the emergency healthcare was explored. Self-report with novel survey was used to measure the provider adoption of the new emergency department resource. The electronic medical record of patients discharged from the emergency department with the risk of substance abuse overdose were examined in three stages namely the maintenance, post-implementation and pre-implementation phases. The outcomes of the primary study involved the provision of recovery coach consultation. The referral to treatment made up the secondary outcomes of the study. The comparison of the study periods involves the use of Chi-square analysis while poison regression and logic regression were employed during the examination of moderators and changes over time respectively.

Resources

 This project will require the peer recovery coaches and the emergency department. These individuals are responsible for providing the required support to the addicted patients in the emergency room department.

Formative evaluation

 This evaluation will be conducted after every four weeks. This is because; the follow-up plans for the patients are conducted during this time and hence, this will help determine the progress of their treatment and the effectiveness of the peer review coaching emergency department resource.

Summative evaluation

 This evaluation will be conducted after 12 months. It will involve the review of the patients EMR to determine their recovery trends. Since the project runs for an year, the results will confirm or dispute the effectiveness of peer recover coaching resource in the emergency department.

References

• Bassuk, E. L., Hanson, J., Greene, R. N., Richard, M., & Laudet, A. (2016). Peer-delivered recovery support services for addictions in the United States: A systematic review. Journal of substance abuse treatment, 63, 1-9.
• Carey, C. W., Jones, R., Yarborough, H., Kahler, Z., Moschella, P., & Lommel, K. M. (2018). 366 Peer-to-Peer Addiction Counseling Initiated in the Emergency Department Leads to High Initial Opioid Recovery Rates. Annals of Emergency Medicine, 72(4), S143-S144.
• Center for Community Health Engagement and Equity Research. (2017). The Use of Peer Recovery Coaches to Combat Barriers to Opioid Use Disorder Treatment in Indiana. Retrieved from https://fsph.iupui.edu/doc/research-centers/recovery-issue-brief.pdf on June 18,2019
• DeKemper, S. & Rush, N. (2017). Addiction recovery coach training. Indiana Counselors Association on Alcohol and Drug Abuse, Indianapolis, IN.
• Eddie, D., Hoffman, L., Vilsaint, C., Abry, A., Bergman, B., Hoeppner, B., … & Kelly, J. F. (2019). Lived Experience in New Models of Care for Substance Use Disorder: A Systematic Review of Peer Recovery Support Services and Recovery Coaching.
• James, S., Rivera, R., & Shafer, M. S. (2014). Effects of peer recovery coaches on substance abuse treatment engagement among child welfare-involved parents. Journal of Family Strengths, 14(1), 6.
• Luthra, S. (2016). Could peer-recovery coaches help fight drug addiction epidemic? CNN, Retrieved from http://www.cnn.com/2016/10/24/health/peer-recovery-coaches-drug-addition-epidemic/index.html on June 18,2019
• Samuels, E. A., Baird, J., Yang, E. S., & Mello, M. J. (2019). Adoption and utilization of an emergency department naloxone distribution and peer recovery coach consultation program. Academic Emergency Medicine, 26(2), 160-173.
• Waye, K. M., Goyer, J., Dettor, D., Mahoney, L., Samuels, E. A., Yedinak, J. L., & Marshall, B. D. (2019). Implementing peer recovery services for overdose prevention in Rhode Island: An examination of two outreach-based approaches. Addictive behaviors, 89, 85-91.

Appendix

Project Timeline