In recent years, peer recovery support services (PRSS) have become essential resources to help persons with an opioid or other substance use disorder (SUD) find a stable path to recovery. Peer specialists—individuals who have the lived experience of recovery from SUD—usually meet people where they are, face-to-face at program locations, or in community spaces where participants live, work, or hang out.
Stay-at-home and social-distancing orders have changed how PRSS programs are supporting participants during their most vulnerable moments. Some programs have extended and enhanced their existing technology-assisted peer support (TAPS) to continue making personal and timely connections.
TAPS are any support or service provided by persons with lived recovery from substance use and /or mental health disorders and that uses technology to promote recovery outcomes. TAPS enhance and extend the value and reach of peer supports, combining in-person, telephone, and online approaches.
We conducted an informal review of PRSS programs across the country to learn how their use of TAPS has changed. Five key practices emerged.
1. Pick up the phone as your central tool. Most PRSS programs have increased their use of the smartphone and traditional telephone to keep in touch with participants in real-time (synchronous support) and for recovery-supportive messaging (asynchronous support). Peer recovery coaches are using phone calls to do recovery check-ins and follow-up with individual participants, and messaging to let them know about virtual resources such as online 12-Step meetings or video conferencing-based All Recovery Meetings, family support meetings, and sober active classes.
Programs also are augmenting warmlines that receive incoming calls from people with an SUD concern who are not in crisis. For example, the Georgia Council on Substance Abuse, Faces and Voices of Recovery in Greenville, and HOPE Inc. have increased staffing of their warmlines to accommodate increases in calls since the outbreak. In many cases, they are moving peer specialists to these warmlines who previously made in-person connections.
They also are establishing new emergency phone numbers for people usually supported through outreach so they can easily get in touch with peer workers. And they are conducting assertive telephone outreach to support individuals at risk of disengaging from supports and services.
2. Use communication platforms preferred by participants. Although Zoom receives a lot of media attention, the specific platform has not mattered as much as the ease of use for participants (as long as it has sufficient security protections). PRSS programs are using the platforms their participants prefer, especially for one-on-one video chats, such as Apple’s FaceTime and Google Hangouts. Programs are moving to messaging apps like Signal, which offers end-to-end encryption, as more participants become comfortable with them.
3. Engage people in new ways using virtual peer-led support groups. Nearly all PRSS programs we spoke with are using a video conferencing platform to host peer-led support groups. They reported that initially, peer specialists and participants struggled with the technology, but after a few meetings the number of people joining and engaging in the meetings increased. Many programs report seeing new participants that they had not seen in face-to-face meetings; the virtual setting has reduced geographic, transportation, and other barriers to participation.
The Jefferson County, Alabama, District Court has transitioned problem-solving court appearances to online sessions that court staff and participants attend just as they would during regular, in-person ones. The peer specialists assigned to the court host daily virtual support groups for court participants. USARA (Utah Support Advocates for Recovery Awareness) has transitioned from face-to-face to virtual meetings for its family support meetings; its peer recovery specialists offer support, education, and guidance for families of persons with substance use or mental health disorders.
Online peer recovery group meetings can have advantages, such as purposeful multitasking via text chat, where facilitators and participants can ask clarifying questions and share information and resources that enhance the discussion. At the same time, attention spans for online meetings are shorter. Programs are adapting sessions to fit the context and audience.
4. Provide clear guidelines for technology use. Peer specialists are taking on the roles of moderating virtual meetings, setting group agreements and managing group dynamics. Often, they are adapting in-the-room guidelines for the virtual world, with an added emphasis on communication etiquette and confidentiality.
PRSS programs are concerned with online security and privacy. Even if they are not subject to the regulations of telehealth, the programs use encrypted forms of technology when possible. They are reviewing and revising guidelines to ensure staff take care when posting in public forums to protect participant privacy.
Their guidelines help peer specialists set and maintain boundaries for their health and well-being, along with participant protection. For example, PRO-ACT, a recovery community organization in Pennsylvania, provides guidelines for its certified peer specialists to use their work cell phone for interactions with members, and to turn off their phone when they are not working. They encourage peer specialists to let members know when they are working and to stick to those hours.
5. Promote TAPS through online resource pages and social media. For people who are new to recovery, finding out where and how to access TAPS may be challenging. PRSS programs are getting the word out through a variety of means: creating resources pages on their websites, putting links on their social media feeds, working with community partners to advertise phone lines, publishing blog posts, and posting self-directed learning courses to address information needs. These one-way, on-demand communications from programs to participants (extrachronous supports) offer crucial information to get and keep people connected.
For example, Connecticut Community for Addiction Recovery (CCAR) created a webpage for all online recovery meetings. Plymouth County Outreach, a collaboration of 27 police departments in the Boston area, is promoting its remote services on Twitter with the hashtag #RecoveryatHome.
Overall, the experience with the unexpected shift to peer support primarily through TAPS has been a positive one. Even after this pandemic, many programs anticipate seeing more virtual supports offered alongside in-person supports. As we have greater clarity in the weeks ahead about the ongoing risks of COVID-19, we’ll have a better idea of how to begin safely offering in-person supports once again.
Elizabeth Burden is a technical assistance director in Altarum’s Center for Behavioral Health, where she helps community organizations implement peer recovery support services through the Bureau of Justice Assistance’s Comprehensive Opioid, Stimulant, and Substance Abuse Program.