Peer PLUS: A Client-Centered Digital Intervention for Addressing the Needs of Individuals with Substance Use Disorder
The use of the Peer PLUS (People Leveraging Urgent Support) platform is expected to enhance the connection between those with substance use disorder and peer recovery coaches, assisting in the goal of long-term recovery for these individuals so that they may progress along the four dimensions of recovery (i.e., home, health, community, and purpose).
Project Details -
Ongoing
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Grant NumberR21 HS028880
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AHRQ Funded Amount$990,015
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Principal Investigator(s)
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Organization
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LocationFort WayneIndiana
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Project Dates04/01/2023 - 03/31/2028
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Technology
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Medical Condition
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Type of Care
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Health Care Theme
Substance use disorder (SUD) is a major public health crisis, with over 70 percent of overdose deaths occurring with a synthetic opioid. SUD is often a chronic condition, requires early and consistent treatment to meet the goal of long-term recovery, and has a relapse rate of 40-60 percent. SUD disproportionally impacts those from rural and medically underserved areas. Peer recovery coaches (PRCs)—trained certified coaches that frequently are in recovery themselves—engage with their clients regularly, allowing treatment to extend beyond in-person clinical settings and providing nonclinical support. However, coaches today rely on simple communication methods such as in person meetings, text messaging, paper mail, and voice calls. These methods are neither secure nor efficient. They also limit the range of topics that can be discussed and require the use of manual tracking methods. The use of secure technology could overcome each of these shortfalls.
The researchers previously developed a prototype mobile app called Peer PLUS (People Leveraging Urgent Support), a HIPAA-compliant app that supports secure communication between PRCs and their clients, facilitates community resource referrals, allows for the transfer of information, tracks communication, and provides additional functionality that supports SUD recovery. Peer PLUS has a companion website that allows teams of PRCs to manage pools of clients, allowing for more comprehensive coverage.
This research will begin with a small pilot at Parkview Health, the largest hospital system in Northeast Indiana, with iterative evaluation leading to user-centered refinements of the app and creation of an implementation toolkit. Parkview’s PRC network is embedded in four different community settings: emergency departments; Parkview’s medication assisted treatment (MAT) clinic; with local police detectives, as part of a mobile overdose response; and in rural health centers. If, during the pilot, Peer PLUS is found to be usable and has the potential to be sustainable, the team will conduct a randomized controlled trial (RCT) at Parkview Health. The team will also run a pilot at Vanderbilt University Medical Center to demonstrate the feasibility of scaling the solution to another organization.
The specific aims of the research are as follows:
- Determine if Peer PLUS is perceived as usable and has sustained use by PRCs and their clients.
- Evaluate the potential impact of Peer PLUS on recovery, quality of care, and therapeutic alliance between clients and their PRC during care for SUD.
- Test the effect of Peer PLUS on recovery, quality of care, and therapeutic alliance between clients and their PRC during care for SUD.
- Evaluate Peer PLUS implementation at a second site.
For the pilot phase, workflows and process requirements will be documented from PRCs; this work will inform the implementation toolkit. The Peer PLUS platform will be deployed incrementally at Parkview Health in two phases. User-centered design (UCD) methods, including user-experience surveys and direct observation of PRCs, will be used to inform updates to the app, companion website, and toolkit. This initial iterative design, deploy, and refine phase will continue for a total of 12 months, with application improvements being made based on input from users. In the second year, PRCs will be selected to pilot the app with new clients, again using UCD methods to inform continued refinement of the app and toolkit.
Researchers will then decide whether or not to proceed with the RCT based on usability and feasibility findings from the initial phase. If the initial pilot is successful, the initial Peer PLUS evaluation and implementation toolkit will serve as the foundation for the RCT. The primary outcome of the RCT will be self-reported recovery outcomes, assessed using the Substance Use Recovery Evaluator (SURE) scale. The researchers hypothesize that those using the app will have higher SURE scores compared to a control group. Importantly, both the app and website are not tied to any specific care provider, and the modular software design and implementation toolkit will allow it to be readily taken up by any peer recovery support service organization.