(46) Race and Ethnicity Concordance in Recovery Coaching

Background: We implemented a Recovery Coach program across a large, integrated health system which provides individuals with substance use disorder (SUD) with coaching from peers with lived experience. As recovery coaching is a relatively new intervention there is a need to evaluate predictors of successful engagement of participants with coaches, as well as understand how we can most equitably serve diverse patient populations. Our aim was to assess the impacts of race and ethnicity of peer recovery coaches on enrollment and engagement of diverse participants.

Methods: This was a retrospective study which included all participants who had been referred to a recovery coach since program implementation. Chi-Squared tests were used to examine the association between participant-provider concordance and enrollment for Black, White, Hispanic, and non-Hispanic participants and coaches. Wilcoxon Rank-Sum tests were used to evaluate differences in average number of months participants were active in the program and average engagement rate (visits per active month) between concordant and nonconcordant participants. Due to privacy concerns, analyses were run at a system-wide level and not broken down by site.

Results: Black participants with Black coaches (n=118) were more likely to enroll in recovery coaching than Black participants with non-Black coaches (n = 391) (OR: 4.88, 95% CI 2.07-11.49, p<.001). Among Black and White participants, 94.9% of Black participants with Black coaches enrolled versus 79.3% of Black participants with non-Black coaches, while 84.7% of White participants with White coaches (n = 3908) enrolled versus 91.4% of White participants with non-White coaches (n = 1145). Enrollment among concordant participants was not significantly different from enrollment among nonconcordant participants for both Hispanic and Non-Hispanic participant groups. However, the mean and median number of months in which participants were active in the program was longer among Hispanic participants with Hispanic coaches (n = 150, mean = 4.4, median = 2) than among Hispanic participants with Non-Hispanic coaches (n = 4050, mean = 3.4, median = 1)(p < 0.05). Although Black participants with Black coaches (mean = 4.6, median = 2) tended to be engaged longer than Black participants with non-Black coaches (mean = 3.7, median =1), it was not significantly different (p>0.05). Also, the engagement rate for concordant participants was not significantly different from the engagement rate for nonconcordant participants in Black and Hispanic groups. An important limitation of this study is the small size of Black and Hispanic populations among recovery coaches, which may have affected the results.

Conclusions: In a health system-wide recovery coach program, Black participants with Black recovery coaches had higher enrollment, and Hispanic participants engaged longer with Hispanic coaches. These findings suggest that racial and ethnicity concordance between coaches and participants may be an important factor in promoting engagement and retention in this model of support. This supports the need for diversity in hiring in peer recovery coaching, which may involve adaptations like reevaluating how job descriptions are written and where they are posted, what requirements are for the job, partnering with community agencies to source talent, and ensuring an inclusive interviewing panel.

References: 1. Bluthenthal, R.N.; Jacobson, J.O.; and Robinson, P.L. Are racial disparities in alcohol treatment completion associated with racial differences in treatment modality entry? Comparison of outpatient treatment and residential treatment in Los Angeles County, 1998 to 2000. Alcoholism: Clinical and Experimental Research 31(11):1920– 1926, 2007
2. Lagisetty PA, Ross R, Bohnert A, Clay M, Maust DT JAMA Psychiatry. 2019;76(9):979-981.
3. Ma A, Sanchez A, Ma M. The Impact of Patient-Provider Race/Ethnicity Concordance on Provider Visits: Updated Evidence from the Medical Expenditure Panel Survey. J Racial Ethn Health Disparities. 2019 Oct;6(5):1011-1020. doi: 10.1007/s40615-019-00602-y. Epub 2019 Jun 24. PMID: 31236800.
4. Blanchard, J., Nayar, S., & Lurie, N. (2007). Patient–provider and patient–staff racial concordance and perceptions of mistreatment in the health care setting. Journal of general internal medicine, 22(8), 1184-1189.

Diversity, Equity, and Inclusion: Black and Latinx individuals do not have equal access to substance use disorder treatment. Prior studies show enrollment with a recovery coach impacts engagement in outpatient medical and behavioral health treatment. Additional investment is key to increasing the diversity and size of the Recovery Coach program. It is also essential to provide a clear social justice and anti-racism framework including focus on educating staff around implicit bias, making discussions around race and ethnicity a normal part of the workplace, having clear supports in place for diverse talent, and educating staff on the discrimination that minoritized communities may have faced in seeking treatment. However, there also needs to be equal emphasis on systemic change and atonement for past history. Ensuring healthcare systems are engaging Black and Latinx patients and referring them to SUD support services like recovery coaching while understanding that race and ethnicity are not a monolith is vital to enrollment of diverse participants. The nuances of each community and culture require all SUD programs to continue to partner with community agencies, remain open, compassionate, and welcoming to all participants, and educate themselves on bias and cultural humility.