(170) From Crisis to Connection: Insights From the THRIVE Peer Recovery Program

Background & Introduction: Peer recovery services are increasingly used to support individuals living with substance use disorders (SUD) and have been linked to positive SUD treatment outcomes [1,2]. Less is known about how peer recovery programs are integrated within safety-net healthcare settings, and how patients and healthcare teams in these settings experience these services. The Transforming Health by Reducing Inequities for the Vulnerable (THRIVE) program, launched in June 2024, integrates certified peer recovery specialists (PRS) into the SUD care continuum within a vertically integrated, urban safety-net health system in Denver, Colorado. THRIVE serves patients with SUDs who have significant unmet health and social needs. Patients are referred to the program from acute and crisis care settings (i.e., during hospitalizations, emergency or detoxification visits, or from the outpatient setting to support initial treatment engagement or following a treatment lapse). The deployable team of PRS provide short-term, intensive support focused on building recovery capital and supporting linkage to and engagement in SUD treatment. This evaluation aimed to describe how peer recovery services were integrated and delivered across the SUD care continuum and assess their acceptability and impact from the perspective of patients, PRS, program leaders, and healthcare partners to inform program improvement, sustainability, and scalability.

Methods: We conducted a mixed-methods evaluation of the THRIVE peer recovery program. Our primary focus used qualitative data from semi-structured key informant (KI) interviews with patients, and focus groups with PRS, referring partners, and program leaders. Patient interviews included individuals who actively engaged with the program and those who had engagement challenges, to explore both facilitators and barriers to engagement. Interviews and focus groups utilized semi-structured guides to elicit multiple perspectives on program implementation, acceptability, impact, and opportunities for improvement. Patients were recruited via purposive sampling from a program list. They received a gift card for participation in an interview. Qualitative data were analyzed using a pragmatic, rapid matrix approach informed by the Practical Implementation and Sustainability Model (PRISM) domains to identify emerging themes [3]. Quantitatively, we analyzed electronic health record data for patients on or after October 1, 2024, when the program was fully operationalized. Descriptors included referral source, patient sociodemographic and clinical characteristics, healthcare utilization, and patterns of engagement with peer recovery services and will support future outcome analysis. The study protocol was reviewed and approved by the Quality Improvement Review Committee, which is authorized by the Colorado Multiple Institutional Review Board to make non-human subjects research determinations.

Results: To date, 782 patients were referred across multiple care settings, including the main hospital and emergency department (ED), detoxification center, outpatient behavioral health services, and community health clinics. Preliminary qualitative results are based on 14 KI patient interviews completed as of January 2026 and three focus groups with PRS, referral partners, and program leaders. Among the 14 patients interviewed, mean age was 47 years (31-63). Eight were female. Five identified as Non-Hispanic White, 6 as Hispanic/Latinx, 2 as Black/African American, and 1 as American Indian/Alaskan Native. One was referred from the ED, 8 from outpatient behavioral health services, and 5 from Inpatient. They had a median of 12 (2-14) peer encounters. Five themes were identified in patient interviews: 1) Quality of relationships with PRS (consistently perceived as a positive, helpful, non-judgmental, comfortable, and safe relationship distinct from prior healthcare experiences which did not feel personalized or make patients feel valued, consistency and follow through by PRS is central to satisfaction); 2) Perceived impact on recovery (PRS increase hope and optimism for recovery through shared lived challenges, reduce the emotional and cognitive burdens of navigating complex healthcare and social systems, unconditional support and encouragement increase self-worth and reduce shame especially after relapse, PRS increase motivation, confidence and perceived self-efficacy, ability to meet basic needs for housing, food and safety alongside linkage to SUD treatment critical); 3) Barriers to engagement (significant socioeconomic disadvantage especially homelessness and housing instability, lack of income/employment, lack of insurance, and transportation and communication challenges, physical disabilities, acuity of health conditions); 4) Facilitators of recovery (early introduction with rapid response and proactive outreach with “hands-on” support during crises, PRS creativity, adaptiveness and flexibility to meet patient needs, PRS practical knowledge of resources and navigating systems, provide continuity across care settings and during high risk care transitions, ability to meet in informal spaces); 5) Suggestions for program improvement (expectations about program timeline and communication, extend duration of peer support, additional resources for housing and food insecurity, improved coordination during care transitions). Focus groups highlighted the broader impact of peer recovery services, noting that peers humanize care, fill critical gaps in services, and extend support beyond what clinical teams could provide. At the same time, they identified the need for clearer role boundaries, expanded education on peer roles, and greater structural support for peers' well-being and professional development.

Conclusion & Discussion: This program evaluation utilized rapid qualitative methods and the PRISM framework to describe the implementation of peer recovery services within the SUD care continuum in a safety-net healthcare institution, and to assess the acceptability and impact of these services from the perspective of patients, PRS, healthcare partners, and program leaders. Our preliminary findings provide important insights into how the program is working during its early implementation and identifies potential targets to improve, sustain and scale the program. Our evaluation may inform other health systems seeking to implement similar peer support programs to support individuals living with SUD.

References: 1. Reif S, Braude L, Lyman DR, Dougherty RH, Daniels AS, Ghose SS, Salim O, Delphin-Rittmon ME. Peer recovery support for individuals with substance use disorders: assessing the evidence. Psychiatr Serv. 2014 Jul;65(7):853-61. doi: 10.1176/appi.ps.201400047. PMID: 24838535.

2. Gillard S, Foster R, White S, Bhattacharya R, Binfield P, Eborall R, Gibson SL, Harnett D, Simpson A, Lucock M, Marks J, Repper J, Rinaldi M, Salla A, Worner J. Implementing peer support into practice in mental health services: a qualitative comparative case study. BMC Health Serv Res. 2024 Sep 11;24(1):1050. doi: 10.1186/s12913-024-11447-5. PMID: 39261915; PMCID: PMC11391751.

3. McCreight MS, Rabin BA, Glasgow RE, Ayele RA, Leonard CA, Gilmartin HM, Frank JW, Hess PL, Burke RE, Battaglia CT. Using the Practical, Robust Implementation and Sustainability Model (PRISM) to qualitatively assess multilevel contextual factors to help plan, implement, evaluate, and disseminate health services programs. Transl Behav Med. 2019 Nov 25;9(6):1002-1011. doi: 10.1093/tbm/ibz085. PMID: 31170296.