Turning Crisis Moments Into Recovery Pathways
Healthcare leaders gathered to explore one of the most urgent challenges facing rural communities today, connecting patients with substance use disorder (SUD) and behavioral health needs to timely, compassionate support. The session highlighted the Peer Recovery Expansion Project (PREP), a Pennsylvania-based initiative embedding Certified Recovery Specialists (CRS) directly into emergency departments.
The goal is simple but transformative: meet patients where they already are and connect them to recovery resources in real time.
Substance use and mental health crises often surface first in emergency settings, yet hospitals frequently lack the dedicated behavioral health support needed to intervene effectively. PREP aims to close that gap.
Why Peer Support in the ED Matters
Certified Recovery Specialists bring something no textbook can teach, their lived experience.
They serve as mentors, advocates, and navigators for patients who may be scared, overwhelmed, or unsure where to turn.
When embedded in emergency departments, CRSs help:
- Reduce repeat ED visits and readmissions
- Improve patient trust and engagement
- Strengthen connections to treatment and community resources
- Reduce stigma among staff and patients
- Support families during crisis moments
How the PREP Program Works
PREP is a regional collaboration funded through HRSA’s ARCOR grant and facilitated by the Rural Health Redesign Center. The program partners hospitals with local Single County Authorities (SCAs) to embed CRSs into EDs across five Pennsylvania counties.
The PREP model includes:
- Full-time or part-time CRSs embedded in participating hospitals
- Technical assistance from ARMOT (Addiction Recovery Mobile Outreach Team)
- Education and stigma-reduction training from Pitt PERU
- Ongoing data collection and evaluation
- Strong collaboration between hospitals, SCAs, and community partners
Program Development: From Concept to Implementation
Year 1: Strategic Development
- Built relationships between hospitals and SCAs
- Conducted county-level gap analyses
- Developed educational offerings
- Began hiring and training CRSs
Year 2: Implementation & Integration
- All five counties launched CRS services
- Strengthened workflows and communication pathways
- Expanded community outreach
Year 3: Execution & Monitoring
- Faced workforce shortages and CRS vacancies
- Continued data collection and partner support
- Identified sustainability challenges
Year 4: Sustainability & Scaling
- Focused on long-term funding strategies
- Continued education and technical assistance
- Developed partner-specific training and toolkits
Education: Building Behavioral Health Capacity in Rural Hospitals
PREP developed three major educational offerings to support hospitals and communities:
1. Mental Health First Aid (MHFA)
Teaches participants how to identify and respond to mental health or substance use crises. Offered free of charge to partners.
2. Stigma Reduction Modules
Asynchronous online training covering:
- Trauma
- Stigma and language
- Recovery pathways
- Engagement strategies
CE/CME credits available
3. Customized Training for Hospital Staff
Based on partner needs, topics include:
- Trauma-informed care
- Motivational interviewing in the ED
- SUD attitudes and perceptions
Key Takeaways for Rural Leaders
- Peer support works. CRSs bridge the gap between physical and behavioral health.
- Alcohol remains a major driver of ED visits, even in programs focused on opioid use.
- Education reduces stigma and improves patient interactions.
- Collaboration is essential. Hospitals, SCAs, EMS, and community partners all play a role.
- Sustainability planning must start early, especially in rural settings with workforce shortages.
Closing Thought
The PREP program shows what’s possible when rural hospitals, community partners, and peer specialists come together with a shared mission: to meet patients with compassion, reduce stigma, and turn crisis moments into opportunities for recovery.
By embedding lived experience into emergency care, PREP is not just improving outcomes, it’s restoring hope.