(59) Disability Rights Training for Peer Support Specialists: A Prospective Survey Study

Background & Introduction: Of the estimated 6.3 million people in the United States with an opioid use disorder (OUD), (1) only 1 in 5 people receive medication for opioid use disorder (MOUD), despite it being the most effective form of treatment. (2) The Americans with Disabilities Act (ADA), protects people with OUD, including those taking MOUD, against discrimination in many settings, including hospitals, carceral settings, skilled nursing facilities, and places of employment. (3) Peer Support Specialists (PSSs) work closely with individuals with OUD and are uniquely positioned to advocate for MOUD rights under the ADA, but PSS training often lacks critical legal education. (4) Advocacy and continued education on the ADA for PSSs may help decrease discrimination against people with OUD and increase access to MOUD. This prospective survey study piloted a didactic training for PSSs and evaluates baseline understanding and changes in knowledge about the ADA for people with OUD, as well as self-report of advocacy efforts to combat potential discriminatory practices within three months after the training.

Methods: PSSs from community peer support organizations in Kentucky were invited to attend one of three 1-hour virtual training sessions and to complete a pre-training, post-training, and 3-month follow-up survey. The interactive session was developed by addiction medicine physicians and civil rights lawyers based on feedback from a 1-hour focus group for individuals with OUD. Topics in the training session included case discussions on recognizing potential ADA violations, advocacy resources, and reporting mechanisms. Surveys assessed knowledge about and confidence in recognizing potential ADA violations for MOUD. Participants received $30 in gift cards on completion of all surveys. All knowledge items were scored on a 1-5 Likert-type scale from “definitely false” to “definitely true”; higher scores indicated greater knowledge. Knowledge composite scores were calculated as a mean score across nine items pre- and post-session after evaluating for internal consistency. A Wilcoxon signed-rank test was used to compare responses to individual knowledge-related items and for overall knowledge before and after training. Primary outcomes were changes in knowledge on the ADA for people with OUD and how to report violations. The study was approved by the University of Kentucky Institutional Review Board.

Results: A total of 118 participants attended a training, though not all participants were PSSs. Seventy-three PSSs completed the pre-training survey, 72 completed the post-training survey, and 65 completed both. Forty participants completed the 3-month follow-up survey. Participants were predominately 30-49 years old, White (88%), female (80%), living with OUD (71%), and receiving MOUD (75%). Internal consistency across the nine items was deemed acceptable for using composite scores to measure overall knowledge (Cronbach’s ɑ>0.8). Participants showed improved overall knowledge of ADA rights for OUD post-session, with the median knowledge composite score increasing from 4.22 (IQR = 3.89 – 4.89) to 5.00 (IQR = 4.67 – 5.00) (P < 0.001, n=65). Understanding that “It is a violation of the Americans with Disabilities Act to deny medical care for people being on medication for opioid use disorder (naltrexone, buprenorphine products, methadone)” increased after training, shown by a shift in the distribution of responses though the median remained the same at 5.00 (IQR = 5.00 – 5.00) compared to 5.00 (IQR = 4.00 – 5.00) (P = 0.003). Knowledge on how to file a report for a potential ADA violation also improved post-session, with the median score increasing from 2.00 (IQR = 2.00 – 3.00) to 5.00 (IQR = 4.00 – 5.00) (P < 0.001). After the training, 92% agreed that the presentation was relevant for their work as a PSS and 89% reported that they intend to file complaints about potential ADA violations for people with OUD. In the 3-month follow-up survey, 97% reported sharing the training information with others on MOUD, 70% reported using the information to advocate for themselves or their clients, and 36% reported using the training information to help a client on MOUD report a potential ADA violation (n=40).

Conclusion & Discussion: This pilot training significantly improved PSS overall knowledge and confidence in recognizing and reporting ADA violations related to OUD. These findings indicate that targeted ADA education for PSSs is effective and may strengthen legal advocacy for individuals on MOUD. Further research is needed to determine if similar trainings could be expanded to increase ADA violation reporting on a larger scale.

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2. Jones CM, Han B, Baldwin GT, Einstein EB, Compton WM. Use of Medication for Opioid Use Disorder Among Adults With Past-Year Opioid Use Disorder in the US, 2021. JAMA Netw Open. 2023;6(8):e2327488. doi:10.1001/jamanetworkopen.2023.27488

3. Whaley BA, Williamson P. The Americans with Disabilities Act, addiction, and recovery. Journal of Vocational Rehabilitation. 2023;58(3):299-305. doi:10.3233/JVR-230018

4. Stack E, Hildebran C, Leichtling G, et al. Peer Recovery Support Services Across the Continuum: In Community, Hospital, Corrections, and Treatment and Recovery Agency Settings - A Narrative Review. J Addict Med. 2022;16(1):93-100. doi:10.1097/ADM.0000000000000810