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Castedo de Martell S, Wilkerson JM, Howell J, Brown HS, Ranjit N, Holleran Steiker L, McCurdy SA. The peer to career pipeline: An observational study of peer worker trainee characteristics and training completion likelihood. J Subst Use Addict Treat 2024; 159:209287. [PMID: 38160878 PMCID: PMC10947928 DOI: 10.1016/j.josat.2023.209287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 11/06/2023] [Accepted: 12/25/2023] [Indexed: 01/03/2024]
Abstract
INTRODUCTION Peer recovery support services (PRSS) for substance use disorder (SUD) are a flexible and evidence-based intervention employed across multiple settings and for a variety of populations. These services have expanded over the past two decades, but there is little research on recruitment and training of prospective peer workers - the peer to career pipeline. This study observed training outcomes for applicants to a peer worker scholarship program in Texas. METHODS A total of 448 participants provided baseline personal history information, and a subset of participants (n = 239) completed optional psychosocial surveys. Logistic regression analysis tested associations of personal history and psychosocial variables with three training stage completion outcomes: classroom training completion, placement at an internship site, and full certification. RESULTS The greatest decline in advancement between stages occurred in the transition between classroom training (78.1 % of participants completed) and internship placement (43.3 % of participants completed). Participants were diverse in terms of race/ethnicity and life experiences salient to the peer worker role, but Hispanic/Latinx peer workers were under-represented. Past work with a SUD peer worker, age, and having a bachelor's degree were each positively associated with training stage completion across multiple models, while having basic technological access, being a woman, and veteran status were each positively associated with training stage completion in only one model. Years since recovery initiation date, non-monosexual orientation, White race, and quality of life were each negatively associated with training stage completion in only one model. CONCLUSIONS The existing peer workforce may be a key source of recruitment for new peer workers; thus retention of existing workers is key to ensuring continued expansion of these services. Additional support may be required to recruit and retain younger peer worker trainees, men trainees, Hispanic/Latinx trainees, trainees who lack basic technological access, or trainees without bachelor's degrees. Unanswered questions about the peer workforce remain and must be addressed to ensure that an appropriately diverse workforce is recruited, that disparities in training outcomes are minimized or prevented, and that existing peer workers are well-supported.
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Affiliation(s)
- Sierra Castedo de Martell
- The University of Texas Health Science Center at Houston, School of Public Health, 7000 Fannin, Suite 1880, Houston, TX 77030, USA; Chestnut Health Systems, 1003 Martin Luther King Jr. Dr., Bloomington, IL 61701, USA.
| | - J Michael Wilkerson
- The University of Texas Health Science Center at Houston, School of Public Health, 7000 Fannin, Suite 1880, Houston, TX 77030, USA.
| | | | - H Shelton Brown
- The University of Texas Health Science Center at Houston, School of Public Health, 7000 Fannin, Suite 1880, Houston, TX 77030, USA.
| | - Nalini Ranjit
- The University of Texas Health Science Center at Houston, School of Public Health, 7000 Fannin, Suite 1880, Houston, TX 77030, USA.
| | - Lori Holleran Steiker
- The University of Texas at Austin, Steve Hicks School of Social Work and School of Undergraduate Studies, 110 Inner Campus Drive, Austin, TX 78705, USA.
| | - Sheryl A McCurdy
- The University of Texas Health Science Center at Houston, School of Public Health, 7000 Fannin, Suite 1880, Houston, TX 77030, USA.
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Castedo de Martell S, Holleran Steiker L, Springer A, Jones J, Eisenhart E, Brown Iii HS. The cost-effectiveness of collegiate recovery programs. J Am Coll Health 2024; 72:82-93. [PMID: 35080467 DOI: 10.1080/07448481.2021.2024206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 11/02/2021] [Accepted: 12/26/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To conduct a preliminary cost-effectiveness analysis of collegiate recovery programs in the United States and to create a tailorable cost-effectiveness calculator based on the preliminary cost-effectiveness model. METHODS Cost-effectiveness was assessed with a base case, one-way sensitivity analyses, and probabilistic sensitivity analyses for the societal and health systems (institutions of higher education) perspectives, comparing CRPs to treatment as usual. Models were estimated using secondary data sources. A cost-effectiveness calculator was constructed using the models developed for the cost-effectiveness analysis. RESULTS CRPs were found to be cost-effective across all models. Institutional and societal models were robust to changes in parameters. CONCLUSIONS CRPs are a cost-effective intervention and are cost-saving under certain conditions. A free online calculator developed form this analysis is available to estimate program-specific cost-effectiveness.
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Affiliation(s)
- Sierra Castedo de Martell
- School of Public Health, The University of Texas Health Science Center at Houston, Austin, Texas, USA
| | - Lori Holleran Steiker
- Steve Hicks School of Social Work and School of Undergraduate Studies, The University of Texas at Austin, Austin, Texas, USA
| | - Andrew Springer
- School of Public Health, The University of Texas Health Science Center at Houston, Austin, Texas, USA
| | - Jeffery Jones
- Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, Georgia, USA
| | - Emily Eisenhart
- Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, Georgia, USA
| | - H Shelton Brown Iii
- School of Public Health, The University of Texas Health Science Center at Houston, Austin, Texas, USA
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Claborn K, Samora J, McCormick K, Whittfield Q, Courtois F, Lozada K, Sledge D, Burwell A, Chavez S, Bailey J, Bailey C, Pederson CD, Zagorski C, Hill L, Conway FN, Steiker LH, Cance J, Potter J. "We do it ourselves": strengths and opportunities for improving the practice of harm reduction. Harm Reduct J 2023; 20:70. [PMID: 37296459 DOI: 10.1186/s12954-023-00809-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 06/06/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND Unprecedented increases in substance-related overdose fatalities have been observed in Texas and the U.S. since the onset of the COVID-19 pandemic and have made clear there is considerable need to reduce harms associated with drug use. At the federal level, initiatives have called for widespread dissemination and implementation of evidence-based harm reduction practices to reduce overdose deaths. Implementation of harm reduction strategies is challenging in Texas. There is a paucity of literature on understanding current harm reduction practices in Texas. As such, this qualitative study aims to understand harm reduction practices among people who use drugs (PWUD), harm reductionists, and emergency responders across four counties in Texas. This work would inform future efforts to scale and spread harm reduction in Texas. METHODS Semi-structured qualitative interviews were conducted with N = 69 key stakeholders (25 harm reductionists; 24 PWUD; 20 emergency responders). Interviews were transcribed verbatim, coded for emergent themes, and analyzed using Applied Thematic Analysis with Nvivo 12. A community advisory board defined the research questions, reviewed the emergent themes, and assisted with interpretation of the data. RESULTS Emergent themes highlighted barriers to harm reduction at micro and macro levels, from the individual experience of PWUD and harm reductionists to systemic issues in healthcare and the emergency medical response system. Specifically, (1) Texas has existing strengths in overdose prevention and response efforts on which to build, (2) PWUD are fearful of interacting with healthcare and 911 systems, (3) harm reductionists are in increasing need of support for reaching all PWUD communities, and (4) state-level policies may hinder widespread implementation and adoption of evidence-based harm reduction practices. CONCLUSIONS Perspectives from harm reduction stakeholders highlighted existing strengths, avenues for improvement, and specific barriers that currently exist to harm reduction practices in Texas.
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Affiliation(s)
- Kasey Claborn
- Steve Hicks School of Social Work, The University of Texas at Austin, Austin, TX, USA.
- Department of Psychiatry, Dell Medical School, The University of Texas at Austin, Austin, TX, USA.
- Addictions Research Institute, The University of Texas at Austin, Austin, TX, USA.
| | - Jake Samora
- Steve Hicks School of Social Work, The University of Texas at Austin, Austin, TX, USA
- Addictions Research Institute, The University of Texas at Austin, Austin, TX, USA
| | - Katie McCormick
- Steve Hicks School of Social Work, The University of Texas at Austin, Austin, TX, USA
- Addictions Research Institute, The University of Texas at Austin, Austin, TX, USA
| | - Quanisha Whittfield
- Steve Hicks School of Social Work, The University of Texas at Austin, Austin, TX, USA
- Addictions Research Institute, The University of Texas at Austin, Austin, TX, USA
| | | | - Kyle Lozada
- The Center for Healthcare Services, San Antonio, TX, USA
| | - Daniel Sledge
- Round Rock Fire Department Crisis Response Unit, Round Rock, TX, USA
| | - Annie Burwell
- Round Rock Fire Department Crisis Response Unit, Round Rock, TX, USA
| | | | | | | | - Chelsea Dalton Pederson
- Steve Hicks School of Social Work, The University of Texas at Austin, Austin, TX, USA
- Addictions Research Institute, The University of Texas at Austin, Austin, TX, USA
| | - Claire Zagorski
- College of Pharmacy, The University of Texas at Austin, Austin, TX, USA
| | - Lucas Hill
- College of Pharmacy, The University of Texas at Austin, Austin, TX, USA
| | - Fiona N Conway
- Steve Hicks School of Social Work, The University of Texas at Austin, Austin, TX, USA
- Addictions Research Institute, The University of Texas at Austin, Austin, TX, USA
| | - Lori Holleran Steiker
- Steve Hicks School of Social Work, The University of Texas at Austin, Austin, TX, USA
- Addictions Research Institute, The University of Texas at Austin, Austin, TX, USA
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Xuan Z, Choi J, Lobrutto L, Cunningham T, de Martell SC, Cance J, Silverstein M, Yule AM, Botticelli M, Steiker LH. Support Services for Young Adults With Substance Use Disorders. Pediatrics 2021; 147:S220-S228. [PMID: 33386325 PMCID: PMC9034746 DOI: 10.1542/peds.2020-023523e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/23/2020] [Indexed: 11/24/2022] Open
Abstract
In summarizing the proceedings of a longitudinal meeting of experts in substance use disorders (SUDs) among young adults, this special article reviews principles of care concerning recovery support services for this population. Young adults in recovery from SUDs can benefit from a variety of support services throughout the process of recovery. These services take place in both traditional clinical settings and settings outside the health system, and they can be delivered by a wide variety of nonprofessional and paraprofessional individuals. In this article, we communicate fundamental points related to guidance, evidence, and clinical considerations about 3 basic principles for recovery support services: (1) given their developmental needs, young adults affected by SUDs should have access to a wide variety of recovery support services regardless of the levels of care they need, which could range from early intervention services to medically managed intensive inpatient services; (2) the workforce for addiction services for young adults benefits from the inclusion of individuals with lived experience in addiction; and (3) recovery support services should be integrated to promote recovery most effectively and provide the strongest possible social support.
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Affiliation(s)
- Ziming Xuan
- Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts;
| | - Jasmin Choi
- Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts
| | - Lara Lobrutto
- Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts
| | - Tiffany Cunningham
- Steve Hicks School of Social Work, The University of Texas at Austin, Austin, Texas
| | | | - Jessica Cance
- RTI International, Research Triangle Park, North Carolina
| | - Michael Silverstein
- Department of Pediatrics, Boston Medical Center, Boston, Massachusetts.,Grayken Center for Addiction Medicine, Boston Medical Center, Boston, Massachusetts
| | - Amy M Yule
- Department of Psychiatry, Boston Medical Center and Boston University School of Medicine, Boston, Massachusetts
| | - Michael Botticelli
- Grayken Center for Addiction Medicine, Boston Medical Center, Boston, Massachusetts
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