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Peer Support and Case Management in the ED.

Learn the essential role of peer support in managing substance use disorders, how to integrate it into ED settings, and explore peer support as a burgeoning profession.

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Peer Support and Case Management in the ED.

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  1. Peer Support and Case Management in the ED. Laura Beal, APRN-CNP ED Substance Use Case Manager MetroHealth Medical Center

  2. Objectives • To identify the role of peer support in case management of substance use disorders. • Become familiar with the use of peer support and case management in the ED setting. • Become familiar with peer support as a growing profession

  3. Definitions OUD: Opioid Use Disorder SUD: Substance Use Disorder Peer: Individual with OUD/SUD

  4. What is a Peer Supporter? • Peer support workers are people who have been successful in the recovery process who help others experiencing similar situations. Through shared understanding, respect, and mutual empowerment, peer support workers help people become and stay engaged in the recovery process and reduce the likelihood of relapse. Peer support services can effectively extend the reach of treatment beyond the clinical setting into the everyday environment of those seeking a successful, sustained recovery process (SAMHSA, 2018).

  5. Ohio Peer Supporter Requirements • Completed the required 16 hours of E-Based Academy courses; and • Passed the OhioMHAS Peer Supporter Exam • Passed the BCI background check • Completed an approved 40 hour in-person peer support training OR have a minimum of 3 years verifiable experience as a peer support, peer recovery coach, peer specialist, or peer navigator

  6. Peer Support Code of Conduct 1. The primary responsibility of Adult Peer Support Specialists is to help individuals achieve their own needs, wants, and goals. Adult Peer Support Specialists will be guided by the principle of self-determination for all. 2. Adult Peer Support Specialists will maintain high standards of personal conduct. Adult Peer Support Specialists will also conduct themselves in a manner that fosters their own recovery. 3. Adult Peer Support Specialists will openly share with consumers and colleagues their recovery stories from mental illness/substance use disorders and will likewise be able to identify and describe the supports that promote their recovery. 4. Adult Peer Support Specialists will, at all times, respect the rights and dignity of those they serve. 5. Adult Peer Support Specialists will never intimidate, threaten, harass, use undue influence, physical force or verbal abuse, or make unwarranted promises of benefits to the individuals they serve.

  7. Conduct (cont.) 6. Adult Peer Support Specialists will not practice, condone, facilitate or collaborate in any form of discrimination on the basis of ethnicity, race, sex, sexual orientation, age, religion, national origin, marital status, political belief, mental or physical disability, or any other preference or personal characteristic, condition or state. 7. Adult Peer Support Specialists will advocate for those they serve that they may make their own decisions in all matters when dealing with other professionals. 8. Adult Peer Support Specialists will respect the privacy and confidentiality of those they serve. 9. Adult Peer Support Specialists will advocate for the full integration of individuals into the communities of their choice and will promote the inherent value of these individuals to those communities. Adult Peer Support Specialists will be directed by the knowledge that all individuals have the right to live in the least restrictive and least intrusive environment. 10. Adult Peer Support Specialists will not enter into dual relationships or commitments that conflict with the interests of those they serve.

  8. Conduct (cont.) • 11. Adult Peer Support Specialists will never engage in sexual/intimate activities with the consumers they serve. • 12. Adult Peer Support Specialists will not abuse alcohol or illegal substances under any circumstances. • 13. Adult Peers Support Specialists will keep current with emerging knowledge relevant to recovery, and openly share this knowledge with their colleagues. • 14. Adult Peer Support Specialists will not accept gifts of significant value from those they serve - Adapted from SC Code of Ethics January 2007

  9. Peer Support v Sponsor What’s the difference?

  10. Case Management in the ED • Identify opioid use disorder(OUD)/substance use disorder(SUD) patients • Assist ED providers with developing a treatment plan-MAT induction/withdrawal management/harm reduction strategies • Connect patient to behavioral health treatment while in the ED; schedule appointments, submit PAs for medications, overdose education- naloxone; connection with peer support • Follow up with patients after discharge-encourage them to continue and provide them with ongoing resources

  11. Peer Support v Case Management Peer supporter Case Manager Provides clinical services, directly involved in care. Contact outside entities directly on behalf of patient-make appointments, Arranges transportation to appointments and educates patient regarding available services Provide legal information or direct referrals to legal professionals • Provides contact information for clinical care (hospitals, treatment centers, etc.) • Provide resources/contact information to peer for outside entities- as advocate. • Share referrals to available transportation options. • Direct peers to case management or social services for assistance. • Referrals to legal aid

  12. Why the ED? • Available 24/7 • Response to overdose • Doctor shopping • Frequent visits-ED is PCP for many • Available support for other social issues

  13. ED overdose visits in US • Opioid overdose ED visits rose from 2016 to 2017. From July 2016 through September 2017, opioid overdoses increased for: • Men (↑30%) and women (↑24%) • People ages 25-34 (↑ 31%), 35-54 (↑36%), and 55 and over (↑32%) • Most states (↑ 30% average), especially in the Midwest (↑70% average) SOURCE: CDC’s National Syndromic Surveillance Program, 52 jurisdictions in 45 states reporting.

  14. Support for ED intervention The California Society of Addiction Medicine (CSAM) drafted a statement of support for ED-initiated addiction treatment: “The emergency department is a health care setting in which patients with opioid use disorders commonly present, seeking more opioids to maintain their addiction, seeking help with opioid withdrawal, or in some tragic instances, needing emergency resuscitation for opioid overdose. Emergency physicians are thus uniquely positioned to intervene to help patients with opioid use disorders at a critical moment in the addiction cycle.” —David Kan, president-elect, CSAM (Herring, 2016)

  15. Benefits to using peer supporters in the ED • Therapeutic relationship for the peer • Budget-friendly • Assist with ED staff workload • Decrease ED visit time/visits* • Provide linkage to other self-directed programs • Educate ED staff-break down stigma

  16. To detox or not detox- that is the question - f beliefs Peer Support Goals in ED

  17. Forms of Peer Support • Response to Overdose • Hospital Employees • Community Peer Support • Jails

  18. Future of peer support as a profession • Best practice development for peer support • Data collection to indicate effectiveness • Create efficient pathways between engagement and access to MAT

  19. Challenges for Peer Supporters and Case Management of OUD/SUD • Homelessness • Inability to contact peer after discharge from hospital • Sober housing restrictions • Uninsured • Stigma • Medical and mental health co-morbidities

  20. How we can help • Advocate for more residential treatment accepting MAT • Make referrals to Peer Support • Choose prescriptions that are not easily abused when appropriate*

  21. References Center for Disease Control and Prevention. (2018). Opioid overdoses treated in emergency departments. Retrieved from https://www.cdc.gov/vitalsigns/opioid-overdoses/index.html Center for Substance Abuse Treatment, What are Peer Recovery Support Services? HHS Publication No. (SMA) 09-4454. Rockville, MD: Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services, 2009. Herring. A. (2016). Emergency department medication assisted treatment of opioid use disorder. P.1-73. Richardson, J. and Rosenberg, L. (2017). Peer support workers in emergency departments : Engaging individuals surviving opioid overdoses-Qualitative assessment. National Council Mentl Health First Aid. P1-11. Retrieved from http://www.TheNationalCouncil.org Rubin, R. (2018). As overdoses climb, emergency departments begin treating opioid use disorder. JAMA, 119(21), 2158-2160.

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