Interviewing and Partnering with Peer Support Providers to Build Peer Support Practice in Exploring and Addressing Substance Use Among Young People with First-Episode Psychosis in Community-Based Mental Health Care

Background and Purpose: Substance use (SU), in particular cannabis use, is common among adolescents and young adults, including those experiencing early psychosis (EP). Cannabis is linked to psychosis onset and severity. Despite this, there are not empirically validated practices to address SU among young people experiencing EP. Coordinated Specialty Care (CSC), a community-based multidisciplinary team-based service model, is increasingly used to address early psychosis. In addition to prescribers, clinicians and vocational specialists, CSC includes Peer Support Specialists (PSSs) who use their own living/lived experience with mental health and treatment to engage and support young people with their recovery goals. Peer Support is also foundational in SU recovery. Some CSC Peer Specialists co-identify as individuals in recovery from both serious mental health and substance use disorders. However, little is known about how PSSs navigate client SU in CSC. A better understanding of current Peer Support practice regarding SU is important for informing intervention design in CSC to decrease SU among young people with EP.

Methods: As part of a national NIH initiative in early psychosis (EPINET), University of Texas at Austin research team embarked on a participatory action research process to study CSC Peer Support to inform CSC Peer Support SU practice. A PhD- level qualitative researcher and a former Peer Support Specialist with lived experience with mental health and SU co-conducted virtual interviews with 20 CSC PSSs. Study participants were recruited through the EPINET-TX Learning Healthcare System that has 15 community-based mental health agencies representing 29 CSC teams. The lived experience co-researcher cleaned and coded Zoom transcripts, and kept a running memo related to study analytic questions: “How do CSC PSSs respond to SU? What factors appear to influence their responses?” The PhD level researcher then led a multidisciplinary team, including researchers with lived mental health experiences, to thematically coded interview transcripts to further unpack how and why CSC PSSs responded to CSC participant SU.

Findings: A spectrum of CSC PSS SU responses emerged: 1) leverages lived SU experiences, 2) does not explore SU with clients, 3) shares client SU information with CSC team, 4) educates, mentors, and advocates, 5) shares SU consequences and/or challenges substance use 6) non-judgmental, non-directive SU exploration, 7) promotes harm reduction. CSC PSS SU practice is influenced by several contextual tensions. For example, between clinical versus peer support understandings and approaches to SU as well as SU being related to mental health (e.g., coping with trauma) versus being deviant, non-compliant, and one’s fault.

Conclusions and Implications: The research team translated these findings into presentations for EPINET researchers, EPINET early psychosis provider sites, and the EPINET-TX LHS consortium. Then, the research team recruited two more CSC PSSs to consult on the development of a CSC PSS SU practice manual and associated (a) 2-hour training for CSC tams, and (b) one-day training for CSC PSSs. This resulted the development of the Peer Approaches to Substances in Early Psychosis Programs (PAS-EPP) intervention that is currently being studied across 15 CSC provider sites within the EPINET-TX Learning Health System.