Can peer-workers help those leaving residential addiction treatment improve their recovery by planning and setting goals based on recovery strengths and weaknesses?

Description of intervention Intervention title: Peer Facilitated REC-CAP Continuing Care Overview The intervention is a model of continuing care for people discharged from inpatient addiction treatment. The intervention uses a validated assessment tool to assess recovery capital called REC-CAP (short for RECovery CAPital), which highlights participants' recovery strengths and weaknesses. The REC-CAP output will be used by Lived Experience Workers (LEWs) to plan goals that aim to build recovery capital. Goals follow the SMART goal format. Materials REC-CAP: This tool is a battery of questionnaires. It includes; 1. Assessment of Recovery Capital (ARC; Groshkova et al., 2013) 2. Quality of Life: World Health Organisation’s quality of life assessment (WHOQL-BREF; Skevington, Lofty, O’Connell, 2004) 3. Barriers to recovery: Five ‘Barriers to recovery’ adapted from the TOP (Delgadillo et al., 2013): (1) Accommodation risk, assessed by a composite of perceived risk of eviction and acute housing problems in the last three months; (2) any substance use in the past 90 days; (3) any risk taking i.e. drug injecting; (4) any involvement with the criminal justice system (offending); (5) lack of meaningful activities (training or employment) 4. Meaningful activities: Meaningful activities, adapted from the Treatment Outcome Profile (TOP; Delgadillo et al., 2013): 1) Are you currently working?, 2) Are you currently volunteering? 5. Recovery Group Participation Scale (RGPS; Groshkova et al., 2011) 6. Commitment to Sobriety Scale (CSS; Kelly and Green 2014) 7. Social Support Scale (Jetten et al., 2011) 8. Service involvement needs: Developed for the REC-CAP that asks “Do you need help or additional help with:” 1) AOD treatment Yes/No 2) Mental health Yes/No 3) Housing support Yes/No 4) Employment Yes/No 5) Primary healthcare (GP, medical services) Yes/No 6) Family relationships Yes/No 7) Other specialist help/support (please specify) Yes/No Training/support materials to aid LEWs in delivering the intervention: a) Information handout on what to do with each barrier, b) information on the intervention process, c) information on SMART goals, d) information on available services for referral, e) training day slide pack. Procedures Training and support – LEWs attended a 5 hour workshop prior to beginning the intervention, covering several topics (background in recovery capital, introduction to REC-CAP including questions and interpretation of output, goal setting, what to do with different REC-CAP profiles, role play, the role of peers, follow-up sessions, and the intervention process). Take home materials are provided (see materials). In addition to initial training, LEWs attend fortnightly check-ins (between 10 to 30 minutes) with the research team that aim to ensure the LEWs are completing the intervention properly. LEWs also complete a spreadsheet with details of client interactions (attendance, session length, cancelations) that can be checked by the research team before team check-in calls to ensure LEWs are adhering to the intervention process. During the LEW check-in calls, the facilitator will ask LEWs about various aspects of the intervention including translating REC-CAP output to SMART goals. LEWs will be reminded of the take home materials especially : a) What to do with each barrier, and b) intervention process. Intervention Baseline (between 45 and 90 minutes) - LEWs meet with participants in person to conduct the baseline session. This involves 1) building rapport, 2) completing the REC-CAP, 3) goal setting, 4) arranging the follow-up sessions. Participant fortnightly check-in calls (between 5 and 30 minutes) – This involves short calls to the participants made by LEWs. The call is aimed at 1) reminding participants of their goals, 2) seeing how participants are going with recovery and their goals. Follow-up (between 30 to 60 minutes) – A 4-week follow up session is conducted in-person by an LEW. This involves 1) maintaining rapport, 2) completing the REC-CAP, 3) reflecting on REC-CAP scores now compared to baseline, 4) reflecting on goal progress, 5) updating goals. Fortnightly calls continue aimed at 1) reminding participants of their goals, 2) seeing how participants are going with recovery and their goals, 3) updating goals where necessary. The final fortnightly call (at 12-weeks - 10 to 60 minutes) will be focused on 1) reflect and review, 2) celebrate achievements, 3) closure. A 12-week follow-up session is completed by a researcher to collect REC-CAP only (approx. 30 min). Six month and 12-month follow-ups are also completed by a researcher. (approx. 30 min) These follow-ups are not part of the intervention. Goal setting will often include linkage to services, groups, or activities that are identified as a barrier during the REC-CAP assessment and/or issues that the participant wishes to address. For example, linkage to Alcoholics Anonymous, financial support services, or employment services. The process of linking participants to services involves identifying the service, providing details (e.g. phone number/address), and creating SMART goals (e.g. attending a particular alcoholics anonymous meeting a particular number of times). Who, when and how The intervention will be delivered by Lived Experience Workers (LEWs), defined in this project as people who have personal experience of recovery from addiction, and training, and have been hired into formal “lived experience” roles. The intervention will begin with a baseline session (see intervention procedures) delivered to patients in residential addiction treatment during their stay, in-person (face-to-face), at the residential facility, after the participant has been in the program for at least 5 days. Fortnightly calls will be made to the participant by the LEWs over the phone between baseline and 12-week follow up. The 4-week follow-up is conducted by LEWs, in-person, in a building located near the residential treatment facility. The intervention finishes after 12-weeks and the 12 week follow up is not part of the intervention (this will be done by a researcher and only involves data collection – no goal setting ). Six and 12-month follow-ups are also completed by a researcher.