West Virginia expanding peer recovery services

Cliff Massey, harm reduction coodinator for the Fayette County Health Department, displays the items in one of 200 Naloxone kits donated for use in the department's Harm Reduction Program.

The people in one of the hospital emergency rooms just wanted to get rid of him.

Others were more kind.

Cliff Massey had several overdoses in the region over the years. These days, he is in recovery and works at the Fayette County Health Department.

Part of his job now includes going to Plateau Medical Center, in Oak Hill, to meet with overdose survivors and offer help. He estimates he knows six out of ten of them, usually through his former drug use.

"These are my friends," he said.

Sometimes he's the only one who goes to see them. 

"It's like a flashback," he said. "I can remember laying there. I can remember just being helpless and not knowing what to do. Wanting something different but not knowing how to go about anything as far as how to get it. 

"So I show up," he said. 


Throughout West Virginia, people in recovery from drug addiction are taking jobs to help others reach that same goal.

Nearly 300 people interested in peer recovery services met at the Days Inn in Flatwoods Tuesday and Wednesday during a state Department of Health and Human Resources conference focused on training and networking for peer support workers. 

Among other topics, they discussed how to win over other health care workers who look down on them, as well as the importance of making those with substance use disorder and histories of traumatic experiences feel safe. 

Recovery Point provides peer support workers at four hospitals: two at Cabell Huntington Hospital, two at St. Mary's Medical Center, two at Charleston Area Medical Center and one at Thomas Memorial Hospital. 

Greg Perry, director of recovery support services at Recovery Point, said that overdose survivors are more likely to trust the recovery coaches than other hospital employees because they can identify with them.

"A year ago, those four emergency rooms were chaos," he said. "It's changed everything."

He said plans are in the works to employ the workers in several southern counties. One worker is scheduled to begin working out of Plateau Medical Center within a few months.

And Tina Rymer, spokeswoman for the West Virginia Hospital Association, said that many other hospitals in the state are in the process of implementing similar programs.

During a session at the conference focused on how emergency rooms can better respond to the overdose crisis in West Virginia, participants talked about how in some emergency rooms, hospital employees have negative attitudes about people who use drugs. 

West Virginia has had the highest drug overdose death rate in the country since 2010.

Last year, DHHR released an analysis of overdose deaths that found 81 percent of 830 people who died of an overdose in West Virginia in 2016 had interacted with at least one type of health care provider in the 12 months prior to their death, and 71 percent of those who died of overdose used emergency medical services within the 12 months prior to their death.

"This suggests that there are opportunities to offer screening, referral, and/or treatment to prevent overdose death and give people a chance to recover," the authors wrote.

Workers from St. Mary's Medical Center in Huntington and Christiana Care Health System in Delaware, which both have peer support emergency room programs, presented during the emergency room session. 

Taucha Miller, addiction medicine program coordinator at St. Mary's, said she has been a nurse for 17 years. When she got started, she said, nurses were taught to instruct the patient to stop using drugs – but not how to stop using drugs. 

"This is not something nurses dealt with 17 years ago," she said. "It's not something we were taught in nursing school."

But panelists said that peer recovery coaches can help change other workers' opinions about people who use drugs.

Christopher Rauhecker, who is employed by Recovery Point and has worked in the Cabell Huntington emergency room since late July, said that some nurses had treated him like he should stay out of their way.

He said that once health care workers saw he could relieve their stress, and stopped seeing the same people repeatedly, they changed their opinions.

One attendee asked how they respond if a patient is seen in the ER for an overdose for the third time in a week.

"The same way I did the first time," John Czartorijskij, of Christiana Care Health System, said, adding that means by showing them he is there to help. 

Taucha Miller said that at St. Mary's, hospital staff no longer simply hand overdose survivors a sheet of paper with services.

"I do as much as I can for them because I think that first step for them is very hard," she said. "If I make the appointment for him, part of that battle's over."

In another session, attendees learned how traumatic events in one's life, such as abuse, neglect, the death of a parent, or living with a parent who struggles with mental illness, can increase the risk a person becomes addicted to drugs later in life. They learned the importance of making sure that person feels safe.

Marianna Footo-Linz, chair of the psychology department at Marshall University, noted that post-traumatic stress disorder, which can sometimes occur after traumatic events, changes a person's central nervous system and brain function.

They can have low frustration tolerance – meaning they might have stronger reactions to emotional events. They also may have problems with attention, with memory and with regulating their emotions, she said. 

Footo-Linz, who is from McDowell County,  said she explains to her patients that "triggers" are things, such as sights or smells, that remind people of traumatic events and cause intense emotional reactions. – maybe the smell of what was cooking on the stove when a person was abused.

"You can almost see a light go off," she said. 

Once they learn that, she said, the trigger loses some of its power.

"There's a lot of strength in that," she said. 


Rebecca Roth, director of the DHHR's Bureau for Behavioral Health and Health Facilities Office of Planning, Compliance & Policy said the conference was funded with opioid-specific funding from Congress. She also noted that in 2017, the federal Centers for Medicare and Medicaid Services agreed to let West Virginia begin using Medicaid to pay peer support workers, to take effect July 2018.

"Our bureau has a history of funding peer recovery services because if you want a recovery-based system, you need to have people who've been there and know what the people who are trying to get in recovery themselves are going through," she said. 

In an email, Allison Adler, spokeswoman for DHHR, said DHHR, through West Virginia University, is funding peer support workers in emergency rooms at Pleasant Valley Hospital in Mason County, Plateau Medical Center in Fayette County, WVU Medicine – Camden Clark Medical Center in Wood County, and WVU Medicine – United Hospital Center in Harrison County.

"The Bureau for Behavioral Health is embracing peers," she wrote in an email. "As a result, these crucial workers are interwoven into many different programs and initiatives. This makes it harder to define how many individuals are funded, but we currently fund 45 partners across the state to support the work of peer recovery specialists.

"In 2018, more than 2,300 individuals were served by peers through our programs," she said. "At last count, Medicaid has approved 153 Peer Recovery Support Specialists to provide services."

She also said that peer support workers are already working or will be working at jail treatment programs, including treatment programs at Western Regional Jail in Barboursville, as well as for local LEAD (Law Enforcement Assisted Diversion) programs.

The 2018 analysis of 2016 overdose deaths found that more than half (56 percent) of all those who died of overdose had previously been incarcerated. 

Law Enforcement Assisted Diversion programs, which send low-level drug offenders to treatment and support services, rather than jail and prosecution, will serve 12 counties: Calhoun, Greenbrier, Jackson, McDowell, Mercer, Nicholas, Raleigh, Randolph, Roane, Wirt, Wood, and Wyoming, according to Adler.

Kanawha and Cabell counties have announced similar programs, the Charleston Gazette-Mail reported.

Also, DHHR and the Claude Benedum Foundation funds peer support workers as part of the West Virginia Perinatal Partnership's Drug Free Moms and Babies Project, which began in 2012, Adler said. 

"The program is a comprehensive and integrated medical and behavioral health program for pregnant and postpartum women," she wrote. "Peer support services are an important part of the programs.

Currently, the project is expanding with enhanced funding from DHHR. An additional 7 facilities were added in 2018 in Kanawha, Monongahela, Cabell, McDowell, Randolph, Ohio and Hancock counties, Adler said. There are 11 programs in 9 counties.

From May 1, 2017, to February 28 of this year, approximately 545 women were served, according to Adler. In April and May, two additional programs are scheduled to start, one in Logan County and one in Upshur County. Many of the programs are affiliated with a birthing facility. By June 2019, 13 programs should be operational in 11 counties.

Adler said peers must be employed by a licensed behavioral health center to be reimbursed by Medicaid and have to be certified by DHHR’s Bureau for Medical Services (BMS). 

Email: ebeck@register-herald.com and follow on Twitter @3littleredbones

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