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‘I Know What It Feels Like’: Program Embeds Peer Supporters In N.C. Emergency Rooms

Alex Olgin / WFAE
Peer support specialist Rick Witherspoon in front of the Emergency Department at Novant Health Presbyterian Medical Center.

When a patient is brought into the emergency room for a drug overdose, there will now be someone at a few hospitals to help. Called a “peer support specialist,” this person isn’t a doctor or a nurse, but has personally dealt with addiction, mental illness or both.

As part of a pilot program, six North Carolina hospitals will have these positions to help people struggling with addiction and mental illness. 

Rick Witherspoon starts his mornings by looking at details of patients who’ve come into the emergency room the night before.  

“I go through and look for red flags,” he said. “Such as drug or alcohol use and mental illness. Because I, too, still cope with a mental health disorder. And so I usually go to an emergency room. I talk to the nurse and/or doctor about the particular patient.”

Witherspoon then talks to the patient about how he struggled with an addiction to heroin, lived on the streets and bounced in and out of emergency rooms and treatment centers for years. For his job as a peer support specialist for Novant Health in Charlotte – those are qualifications. He also has to complete 60 hours of training to get licensed by the state. There are more than 3,300 certified peer support specialists in North Carolina. A little less than half are working in the field.

To be a good peer supporter, Witherspoon said it requires total engagement with patients.

“I am a specialist. Been there and done that. I know what it feels like,” Witherspoon said. “I know what it smells like. I know how you are feeling. I know what the withdrawals feel like. I can empathize with that trauma-induced stuff because I believe that’s what set the stage for me.”

The most important thing he can share with patients, as someone who has gone through treatment, is that there is hope. Witherspoon felt it after talking to a peer support specialist after his tenth trip to a hospital. 

”After he shared his story a little bit, I felt encouraged. I felt like there is hope,” he said. “I remember wanting to be like him. He’s one of my good friends today.”

Witherspoon sort of acts as a sponsor. He can help get patients into treatment. He gives them his phone number and follows up with them after they leave the hospital. It’s part of a year pilot project the state’s funding with recently awarded federal opioid treatment dollars.

Participating hospitals must track how many people return within a month, and what kind of services and referrals the peer support specialists provide. In 2017, more than 5,000 people came into North Carolina emergency rooms with overdoses. So, Novant Health’s Director of Nursing for the Emergency Department Lina Varela-Gonzalez in Charlotte said there’s a need.

“We need to be able to connect with our patients and provide them with hope and support,” she said. “That is difficult at times for nurses and providers to provide in such a short visit.”

Novant and other health systems, like Atrium, have had peer support specialists in behavioral health facilities and in other capacities, but not in the emergency department. The idea is these peer support specialists could help get people into recovery and keep them out of the hospital — which could help reduce costs for both hospitals and insurers.

A study by Optum, a part of insurer United Health Group, which is a WFAE sponsor, found when it funded peer support services in a few places like Washington State, Wisconsin and New York — hospitalizations decreased and people used fewer inpatient services. One Atrium hospital in Concord also hired peer support specialists as part of a pilot. Lisa McCanna with Atrium’s Behavioral Health hospital in Davidson hopes peer support specialists prove to be as successful here. 

“If we can demonstrate to payers that there is a return on this investment, I think that’s the path to funding,” McCanna said.

41 states and Washington D.C. bill Medicaid for the care peer support specialists provide. But, as of now, North Carolina doesn’t. Back at Novant’s hospital in Charlotte, Lina Varela-Gonzalez said she’s already learned some lessons from working with Witherspoon.  One is — stop referring to patients with substance abuse disorders as addicts. 

“That immediately pulls a wall between patient and I. So, we are not going to connect at a level we should be connecting,” Varela-Gonzalez said. “The power of words. The language that we use.”

Clarification: This story has been updated to reflect that peer support specialists are certified by the state and not licensed and that the pilot is one year.