Evaluating the Success of the Certified Recovery Peer Advocate (CRPA) Training and Hospital-based Care Intervention Model
Research Spotlight
Evaluating the Success of the Certified Recovery Peer Advocate (CRPA) Training and Hospital-based Care Intervention Model
Overview
One way to improve patient engagement and value-based care performance outcomes for hard-to-reach populations is to employ a peer support worker, someone who uses their own lived experience and specialized training to engage patients struggling with a similar health challenge. Peers have been part of the healthcare workforce for decades, but the workforce has largely been disconnected from standard healthcare staffing models. Services have largely been paid for by grants or other short-term funding in lieu of insurance, while the impacts and value of the work were unknown or unclear to other health professionals on a care team (such as a primary care provider).
Excitingly, in 2015, the New York State Office of Alcoholism and Substance Abuse Services (OASAS) announced new statewide certification and educational criteria for peers who work with those with a substance use diagnosis, Certified Recovery Peer Advocates (CRPA). Shortly thereafter, CRPA services became reimbursable by New York State (NYS) Medicaid at an increased rate. Jumping on this opportunity, NYACH and its employer and educational partners created what became the first comprehensive training model for the CRPA role in NYS. Learn more about the CRPA training program on page 31.
Many graduates of this training program were hired by NYC Health + Hospitals (NYC H+H), which also provided input into the training program’s creation, as the hospital system was in the middle of designing an emergency department-based pilot program for the incorporation of CRPAs into patient care. Each year, over 13,000 individuals arrive at NYC H+H emergency departments with a substance use diagnosis (SUD), accounting for nearly 40,000 annual visits and necessitating new ways of working with patients to serve this growing need.
NYACH believes that CRPAs can play a key role in patient care, and importantly, that the CRPA occupation can also provide an entry point into the healthcare workforce for individuals with nontraditional employment histories, many of whom have a personal history of substance use and/or former interactions with the criminal justice system. If the comprehensive training program and new staffing model implemented by NYC H+H proved to be effective, we wanted to make sure that that information was evaluated and shared broadly with the industry. With this goal in mind, NYACH partnered with NYC H+H to fund an academic study with researchers at New York University’s Steinhardt School to evaluate the impact of the model.
NYC Health + Hospitals ED Peer Pilot Program and Academic Evaluation
CRPAs in this NYC H+H pilot provided services in its emergency department (ED) and served as an introductory bridge from the ED to the SUD treatment clinic. Successful implementation involved not only recruiting well-trained staff, but also considering how staff would be incorporated into existing staffing models and workflows. This included considerations about the physical workspace, shifts, supervision/training, and integration into preexisting ED workflows. The academic evaluation included in-depth interviews with CRPAs, supervisory staff, ED staff and administrators, as well as an analysis of Medicaid claims data to evaluate patient outcomes pre- and post-implementation of the pilot program. The evaluation found many implementation lessons learned and best practices to share with the field around implementation and impact, especially around patient experience and engagement. As reflected in the patient quote that serves as the title of the resulting article–“if it wasn’t for him, then I wouldn’t have talked to them”–CRPAs were able to reach patients who would otherwise have been disinclined to engage with healthcare providers. The evaluation also found the program had modest, yet measurable positive impacts on patient outcomes, particularly for patients with no history of substance use treatment in the last 12 months.
Key patient outcome findings from the early stages of implementation
(For the period covered during the research):
The likelihood of patients with no history of treatment in the last 12 months entering rehab/detox treatment within the first two months post-ED visit increased from 4.2% to 8.1%.
The proportion of patients attending counseling sessions also substantially increased, from 9.9% to 13.1% within two months and 11.5% to 17.4% within three–six months, post-ED visit.
In comparing initiation of medications for addiction treatment (MAT), the program almost doubled the proportion of untreated patients who received MAT from 2.5% to 4.6% within three–six months post-ED visit.
The proportion of patients receiving methadone increased from .4% to .9% and .7% to 1.9% in months one–two and three–six months post-ED visit, respectively.
Learn more by reading a Summary Report released by NYACH and NYC H+H in 2021, and by reading the academic article published in the Journal of General Internal Medicine.
