top of page

Peer Recovery Coaches in Hospital Emergency Departments: Changing Hearts and Minds about Addiction

Project Lead: Laura B. Monico, PhD

Background

While peer recovery interventions have demonstrated success in linking hospital emergency department (ED) patients with care in the community upon discharge, implementation efforts have been met with skepticism from existing hospital staff due to ongoing stigma associated with opioid use disorder, an overburdened medical staff, and a desensitization toward opioid use outcomes. This study sought to generate novel pilot data to explore how the implementation of peer recovery coaches (PRCs) in hospital ED settings can combat this skepticism and create buy-in among existing medical staff members.

Methods

This pilot study completed a total of 14 semi-structured interviews with key stakeholders across three hospitals that implemented a PRC program; representing different community sizes, treatment capacities, and organizational characteristics. Participants included individuals directly involved with PRC program implementation including, local site leader (e.g. ED Medical Director, Nursing Leader, or Behavioral Health Leader), ED Nursing Director, Peer Supervisor, PRC, or Behavioral Health Champion. Participant recruitment was purposive, targeting approximately 5 staff members in each hospital ED. Semi-structured interview guide questions queried and probed experiences involving PRC program elements (e.g., screening, assessment, treatment, and linkage), PRCs role in facilitating these services, PRC care coordination with community treatment providers, expectations of program effectiveness at inception, and the participant’s current views of the program, with an emphasis on patient outcomes and related experiences that may have shaped those views. Grounded theory methodology was applied to explore the qualitative data in Atlas.ti using a constant comparative method. Open coding was utilized to segment the data into similar groupings, axial coding to assemble categories and build logical connections among codes, and selective coding to identify and assemble themes for theory development.

Results

From a resourcing and operational perspective, PRCs offered an opportunity to have staff available in the ED with lived experience to spend the appropriate time with substance use disorder (SUD) patients and effectively link them to care in the community. Following implementation, EDs would now have individuals on-site with a specialized and working knowledge of addiction and recovery, as well as the time and bandwidth to meet with patients for as long as necessary to complete interventions and link them to community care whenever possible. Their sole purpose in the ED was to be the resource of knowledge and time that the ED was lacking prior to implementation.  

​

From an attitudinal perspective, PRCs became fully embraced team members who offered a personal view into the life of an individual who experienced addiction and recovered to be a functional, professional member of the ED staff. ED staff participants reported sharing their personal struggles or the struggles of their friends and family members, and PRCs were able to mutually share the intimate stories of their addiction and recovery journey and the stigma they faced when seeking care in a busy hospital system. ED staff were able to see the ways in which PRCs recovered from addiction to offer hope to others still struggling – it was in this safe space created by the PRCs that ED staff were able to increase their level of understanding and empathy toward use disorders and patients with SUDs. As these levels of understanding and empathy increased, the overall attitudes of the ED staff began to improve, and a new resilience emerged among the staff that encouraged the belief that they had the agency to make a meaningful impact in the lives of their patients with SUD. Interview data from hospital ED staff and PRCs also generated hiring and employment considerations for future EDs considering the implementation of PRCs in the future.  

Discussion

While PRCs filled a practical knowledge and resource gap that had been lacking in the ED setting to fulfill the needs of patients presenting in the ED with SUDs, their placement among other ED medical staff had the unintended benefit of improving staff attitudes toward SUD patients and reducing the likelihood of stigmatizing behaviors during ED encounters. Implementing PRC-based interventions in ED settings appears to be an effective strategy for addressing resource and knowledge gaps within hospital systems while also generating positive attitudinal shifts among existing ED medical staff.  

  • Facebook
  • YouTube

Innovations in Recovery through Infrastructure Support

iris@ssw.umaryland.edu

UM_School_SocialWork_black (1).png
Logo & Full Name_Black_1200x1200_BHWell.png

University of Maryland, School of Social Work, 525 W Redwood Street, Baltimore, MD 21201

bottom of page