The approach to treating substance use disorder (SUD) has been changing to be more recovery-oriented. There is a shift from treatment and control of symptoms to treatment focused on approaches that empower the client to maintain long-term recovery.  Peer recovery supporters (PRS), trained individuals with their own recovery experience, are thought to provide significant advocacy and support for individuals struggling with addiction. PRS support and advocate for their clients as they navigate the successes and setbacks of the recovery process.

Some of the advantages of using PRS are that clients paired with PRS:

• Formed better relationships with their treatment providers and greater utilization of social supports
• Stayed in treatment longer and reported higher satisfaction with treatment
• Had reduced substance use and were less likely to relapse

Peer Recovery Supporters, in turn, express that having the opportunity to share their lived experience with addiction and recovery with others helps them to:

• gain better insight into their own symptoms
• increase social engagement and
• improve their sense of life satisfaction

The use of PRS as a component of a recovery-oriented treatment model is showing promise for promoting long-term recovery. It is expected that the use of PRS in SUD recovery will continue to grow, and agencies may need to make additional adjustments to support PRS. Cultivating agency culture to embrace and promote the inclusion of peers in SUD treatment is vital to having a successful PRS program. Further, agencies should consider the expansion of peer occupational growth opportunities as well as professional development efforts that allow PRS to qualify for advanced positions. Considering the PRS as a valued professional member of the SUD treatment team will help maximize their ability to help clients engage in treatment and work toward long-term sobriety.

References:

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. Frontiers in Psychology, 10(JUN), 1–12. doi:10.3389/fpsyg.2019.01052

Ahmed, A. O., Hunter, K. M., Mabe, A. P., Tucker, S. J., & Buckley, P. F. (2015). The Professional Experiences of Peer Specialists in the Georgia Mental Health Consumer Network. Community Mental Health Journal, 51(4), 424–436. doi:10.1007/s10597-015-9854-8

Chapman, S. A., Blash, L. K., Mayer, K., & Spetz, J. (2018). Emerging Roles for Peer Providers in Mental Health and Substance Use Disorders. American Journal of Preventive Medicine, 54(6S3), S267–S274. doi:10.1016/j.amepre.2018.02.019

Research from the U.S. Census Bureau has found that states with higher opioid prescribing rates have higher numbers of grandparents raising grandchildren, even after taking into account other socio-economic factors such as poverty. Data from the 2012-2016 American Community Survey allowed researchers to study the relationship between opioid prescription rates at the state and county level and the number of grandparents raising grandchildren. The study found that opioid misuse was involved in 46% of cases where grandparents are caring for grandchildren in rural areas, compared to 32% in urban areas. Nationally, 32% of children in foster care are being raised by relatives with many more are being raised by relatives outside of the foster care system. Currently, 2.7 million grandparents are raising grandchildren. According to the Public Children Services Association of Ohio, about 100,000 grandparents are currently raising their grandchildren in Ohio.

Ohio is making progress in reducing its opioid prescribing rates, but rates are still high. Since 2010, Ohio’s overall opioid prescribing rate has dropped from 102.4 to 63.5 per 100 persons, which is still higher than the national rate of 58.7. Cuyahoga is the only urban county, at 50.1 per 100 persons, have an opioid prescribing rate lower than the national rate. In rural counties, the prescribing rate ranges from Nobel the lowest (17.8) to Jackson the highest (112.5). Ohio continues to be challenged by the misuse of opioids with the second-highest opioid overdose death rate of 39.2 deaths per 100,000 persons.

Grandparents raising grandchildren face many special challenges including mental health concerns for themselves and their grandchildren due to the death or temporary loss of their grandchild’s parent (their son or daughter), financial obligations, navigating the school system, and building networks of social and other supports. To respond to the impact of the opioid crisis on grandparents, the federal government enacted The Supporting Grandparents Raising Grandchildren Act in July of 2019. The act created a federal task force to identify and share information to help grandparents raising grandchildren.

Anderson, L. (2019). The opioid prescribing rate and grandparents raising grandchildren: State and county-level analysis. Retrieved from https://www.census.gov/content/dam/Census/library/working-papers/2019/demo/sehsd-wp2019-04.pdf

Centers for Disease Control and Prevention. (2017). U.S. Opioid Prescribing Rate Maps | Drug Overdose | CDC Injury Center. Retrieved May 31, 2019, from https://www.cdc.gov/drugoverdose/maps/rxrate-maps.html

Cole, P. E., Clausen, K. A., Cook, L., Johanson, M., Cunliffe, J., Associate, R., Rostan, M. (2016). 2016 state of poverty: A portrait of Ohio families. Retrieved from www.oacaa.orgwww.researchpartners.org

National Institute on Drug Abuse (NIDA). (2019). Opioid summaries by state. Retrieved May 31, 2019, from https://www.drugabuse.gov/drugs-abuse/opioids/opioid-summaries-by-state

Public Children Services Association of Ohio. (2019). PCSAO – Factbook. Retrieved May 31, 2019, from http://www.pcsao.org/factbook

Good Samaritan laws are meant to protect someone from legal liability when providing help to a person in distress. Ohio has had a Good Samaritan Law since 1977 to protect people from malpractice lawsuits when providing emergency medical and non-medical care to someone in need. This protection is not just for off-duty medical professionals but also for any citizen. This law does not protect someone who deliberately acts in a way that they know can cause further harm, or who accepts money, gifts, or any form or payment for helping.

Do you have to help someone in distress? Ohio does have a “duty to rescue” rule and requires you to help someone in distress if:

• You are responsible for the welfare of a child. This includes parents, guardians, teachers, and any adult responsible for the child.
• Your actions caused the danger.
• You started to help – you must continue to help unless the situation changes to put you in danger.

In 2016, Ohio revised its Good Samaritan laws (Ohio Revised Code Section 2925.11) to encourage people to call 911 when they see someone who overdoses. What this law does is provide immunity for minor drug possession, amounts considered to be a misdemeanor or fifth-degree felony, to individuals who seek emergency help for themselves or another person during a drug overdose. The 911 operator receiving the overdose call can help explain this immunity if asked. You cannot be arrested or prosecuted if:

• Law enforcement found the drugs as a result of seeking medical assistance for a drug overdose.
• The person has a drug test and receives referral for treatment from an accredited addiction treatment program or professional within 30 days.
• The person provides documentation, when requested by a prosecutor, verifying the date and time of the drug test and receiving the referral.

This immunity can be used twice and people on parole or probation are not eligible. The immunity is limited to possession of controlled substances. House Bill 205 is currently in the Ohio Legislature and, if approved, it will expand immunity to include drug paraphernalia.

Parents involved with child welfare that have substance use (SUD) are often engaged with multiple systems including child welfare, SUD treatment, and the courts. To help families navigate these services and requirements, they can be assigned a Family Peer Mentor (FPMs). What is an FPM, what do they do, and are they helping families with parental SUD stay together?

An FPM is someone in long-term SUD recovery¹ who also has experience with the child welfare system. They also complete a certification training program¹ to learn how to apply their own experiences to help other families. The FPM is the family advocate, connecting the family to needed services and as emotional support promoting sober parenting. The relationship between the FPM and the family is collaborative with the shared goal of achieving parental sobriety and family safety and stability. FPMs are uniquely positioned not only to help families navigate the child welfare system, but also to provide the hope and motivation needed to achieve and maintain sobriety.

To better understand how FPMs help child welfare involved families, a study² was conducted of the services and outcomes of 28 FPMs involved in the Sobriety Treatment and Recovery Teams (START) in Kentucky. Each FPM was partnered with one child welfare caseworker, and this FPM/caseworker team served 12-15 families. This study shows the importance of FPMs in promoting family unification and parent sobriety:

The study also highlights the importance of supporting FPMs’ own sobriety as they transition from child welfare client to an employee supporting families through a very stressful situation. Of the 28 FPMs, 10 had a relapse or other ethical/policy violation that resulted in their removal; however, the remaining 18 FPMs realized stability and growth either with the child welfare agency or with other, more advanced positions.

With the goal of parental sobriety and family unification, the use of FPMs shows excellent promise. Kentucky START and programs using FPMs or peer supporters are not only helping families; these programs are keeping more children from entering out-of-home care while also giving individuals in recovery an opportunity for steady, full-time employment that appreciates their child welfare and SUD experience to help others.

¹Click here for more information on The Ohio Department of Mental Health and Addiction Services (OhioMHAS) certification for Peer Recovery Supporters in Ohio: (https://workforce.mha.ohio.gov/Workforce-Development/Job-Seekers/Peer-Supporter-Certification).

²Huebner, R. A., Hall, M. T., Smead, E., Willauer, T., & Posze, L. (2018). Peer mentoring services opportunities and outcomes Huebner 2018.pdf. Children & Society, 84, 239–246.