Emergency Department Community Health Worker-Peer Recovery Navigation for Linkage to Recovery: A Mixed Methods Evaluation
University of California, Los Angeles
Summary
This is an observational, prospective case-control study evaluating the effects of an emergency department community health worker-peer recovery specialist program (PCHW), the Substance Misuse Assistance Response Team (SMART). Aims of this study are to 1) understand participant experiences working with a SMART PCHW and identify possible mechanisms for successful recovery linkage; 2) Evaluate SMART effectiveness on patient-centered outcomes, building recovery capital, and recovery linkage; 3) Evaluate SMART implementation and effectiveness on patient outcomes over time. Using a combination of surveys and data linkages to state administrative databases, study investigators will prospectively compare changes in addiction treatment engagement, recovery capital, health related social needs, acute care utilization, and death between people receiving a ED PCHW and those who do not. After consenting to study participation, participants will complete surveys at time of study enrollment and 3 and 6 months after their initial ED visit. Primary outcomes include engagement in addiction treatment, social services engagement, acute care utilization, and mortality will be assessed through linkages to state administrative databases.
Description
The emergency department (ED) is on the front lines of the overdose epidemic, treating an increasing number of people with substance use disorders (SUD). In the year after a substance use-related ED visit, risk of death is six time higher than other patients, and for people treated after an opioid overdose, more than one in twenty patients will die. Each substance use-related ED visit represents a crucial opportunity to link patients to recovery services, however there are significant gaps in service provision with less than one in three receiving behavioral counseling and only one in five lin…
Eligibility
- Age range
- 18+ years
- Sex
- All
- Healthy volunteers
- Yes
Inclusion Criteria: 1. Adults 18 years old or older 2. Seen and treated at Rhode Island or The Miriam Hospital ED for a substance use-related concern including intoxication, withdrawal, opioid overdose, opioid withdrawal, or substance use-related infection 3. Able to provide informed consent 4. Able to provide at least two forms of contact (personal phone, social media, email, or contact information for family or friends) 5. Participants may speak languages other than English but require use of interpreter services. Consents will be available in English, Spanish, and Portuguese, the three mos…
Interventions
- BehavioralSubstance Misuse Assistance Response Team (SMART)
The study intervention is engagement with a Substance Misuse Assistance Response Team (SMART) community health worker-peer recovery specialist (PCHW). SMART PCHWs engage ED patients with substance use disorders and facilitates ED services provision and linkages to outpatient care. Services provided include supporting ED initiation of buprenorphine, harm reduction services, social services (transportation, housing assistance, etc.), and engagement in peer recovery, behavioral health services, and addiction treatment services. Services are provided at the time of the ED visit. A subgroup of patients is provided short term case management and outpatient services navigation depending on PCHW caseload availability and individual needs.
- OtherUsual Care Group
Patient not seen by a SMART community health worker in the emergency department. Care and treatment referral at discretion of emergency department treating team.
Location
- Rhode Island HospitalProvidence, Rhode Island