Journal of substance use and addiction treatment · 2026
Perspectives on peer recovery support for people experiencing homelessness: A qualitative study of key informants from national health care for the homeless programs.
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Fine Danielle R, Little Bailey, Ma Angela, Sporn Nora, Baggett Travis P, Kruse Gina R
Аннотация
INTRODUCTION: People experiencing homelessness face high rates of opioid use disorder (OUD) with substantial barriers to treatment. Peer recovery support-delivered by individuals with lived experience of substance use and recovery-has emerged as a promising strategy for improving OUD care. However, little is known about peer recovery support within Health Care for the Homeless (HCH) programs.
METHODS: We conducted semi-structured qualitative interviews with 18 key informants from six stand-alone HCH programs across the United States, including program leaders (n = 6), OUD clinicians (n = 6), and peer recovery support specialists (PRSSs; n = 6). Interviews explored perspectives on peer support roles, perceived impacts, implementation, and sustainability. We used an inductive approach for codebook development, and themes were developed iteratively, examining patterns within and across key informant groups.
RESULTS: Participants agreed that peer recovery support is highly valued and uniquely well-suited to the HCH context. PRSSs were viewed as critical to engaging individuals experiencing homelessness by building trust, addressing social needs, navigating fragmented systems, and providing harm-reduction-oriented, flexible support. Key implementation challenges included role ambiguity, training and supervision, workforce sustainability (risk of relapse and emotional burn out), structural constraints, and financing instability. Lack of sustainable funding was identified as a major threat to long-term program viability.
CONCLUSIONS: Key informants perceived that peer recovery support enhances OUD care in the HCH setting through rapport building and practical supports tailored to the needs of people experiencing homelessness. Strengthening workforce infrastructure, clarifying role expectations, and developing sustainable financing mechanisms are critical to realizing the full potential of peer support within HCH programs.
METHODS: We conducted semi-structured qualitative interviews with 18 key informants from six stand-alone HCH programs across the United States, including program leaders (n = 6), OUD clinicians (n = 6), and peer recovery support specialists (PRSSs; n = 6). Interviews explored perspectives on peer support roles, perceived impacts, implementation, and sustainability. We used an inductive approach for codebook development, and themes were developed iteratively, examining patterns within and across key informant groups.
RESULTS: Participants agreed that peer recovery support is highly valued and uniquely well-suited to the HCH context. PRSSs were viewed as critical to engaging individuals experiencing homelessness by building trust, addressing social needs, navigating fragmented systems, and providing harm-reduction-oriented, flexible support. Key implementation challenges included role ambiguity, training and supervision, workforce sustainability (risk of relapse and emotional burn out), structural constraints, and financing instability. Lack of sustainable funding was identified as a major threat to long-term program viability.
CONCLUSIONS: Key informants perceived that peer recovery support enhances OUD care in the HCH setting through rapport building and practical supports tailored to the needs of people experiencing homelessness. Strengthening workforce infrastructure, clarifying role expectations, and developing sustainable financing mechanisms are critical to realizing the full potential of peer support within HCH programs.