Department of Medicine, Oregon Health & Science University, Portland, Oregon, USA.
Mental Health & Addiction Association of Oregon, Portland, Oregon, USA.
Subst Abus. 2020;41(4):419-424. doi: 10.1080/08897077.2019.1635968. Epub 2019 Sep 6.
Legislators and health systems have recently begun to explore the use of peer mentors as part of hospital-based addiction teams. Integrating peers into hospitals is a complex undertaking still in its infancy. Peers' lived experience of addiction and its consequences, combined with their distance from medical culture and hierarchy, is at the core of their power - and creates inherent challenges in integrating peers into hospital settings. Successful integration of peers in hospitals has unique challenges for individual providers, health systems, and the peers themselves. We have included peers as part of a hospital-based addiction medicine team at our hospital since 2015. In this article, we outline some unique challenges, share lessons learned, and provide recommendations for integrating peers into hospital-based SUD care. Challenges include the rigid professional hierarchy of hospitals which contrasts with peers' role, which is built on shared life experience and relationship; different expectations regarding professional boundaries and sharing personal information; the intensity of the hospital environment; and, illness severity of hospitalized people which can be emotionally draining and increase peers' own risk for relapse. Recommendations focus on establishing a way to finance the peer program, clearly defining the peer role, creating a home base within hospital settings, creating a collaborative and structured process for hiring and retaining peers, identifying peers who are likely to succeed, providing initial and ongoing training to peers that extends beyond typical peer certification, ways to introduce peer program to hospital staff, and providing regular, meaningful supervision. We hope that our recommendations help other hospital systems capitalize on the practical lessons learned from our experience.
立法者和卫生系统最近开始探索将同伴导师用作医院成瘾治疗小组的一部分。将同伴纳入医院是一项复杂的工作，仍处于起步阶段。同伴对成瘾及其后果的亲身经历，加上他们与医疗文化和等级制度的距离，是他们力量的核心——这在将同伴融入医院环境方面带来了固有的挑战。将同伴成功融入医院对个别提供者、卫生系统和同伴本身都带来了独特的挑战。自 2015 年以来，我们一直在我们的医院将同伴纳入医院成瘾医学团队。在本文中，我们概述了一些独特的挑战，分享了经验教训，并为将同伴纳入医院基于 SUD 的护理提供了建议。挑战包括医院僵化的专业等级制度与同伴的角色形成鲜明对比，同伴的角色是建立在共同的生活经验和关系之上的；对专业界限和分享个人信息的期望不同；医院环境的强度；以及住院患者病情的严重程度，这可能会让人情绪疲惫，并增加同伴自身复发的风险。建议侧重于建立一种为同伴计划提供资金的方式，明确界定同伴的角色，在医院环境中创建一个大本营，创建一个招聘和保留同伴的协作和结构化流程，确定可能成功的同伴，为同伴提供超出典型同伴认证的初始和持续培训，向医院工作人员介绍同伴计划的方法，以及提供定期、有意义的监督。我们希望我们的建议能帮助其他医院系统从我们的经验中吸取实际教训。
