Developing Peer Approaches to Substances for Early Psychosis Programs (PAS-EPP): A Harm Reduction-Oriented Practice Framework for Peer Support Specialists

Background: Substance use (SU) is common and developmentally normative during adolescence and young adulthood, the same period in which most psychotic disorders emerge. Among individuals experiencing early psychosis (EP), approximately half meet criteria for a co-occurring substance use disorder, contributing to poorer clinical and recovery outcomes. Coordinated Specialty Care (CSC), the most widely implemented model for EP in the United States, integrates multidisciplinary supports including psychiatry, therapy, employment/education services, and peer support. Despite high rates of SU among CSC participants, programs lack consistent, developmentally appropriate, substance use-specific practices. Peer Support Specialists (PSSs), who draw on lived experience to support engagement and recovery, are uniquely positioned to engage young people in conversations about SU; however, structured guidance tailored to the peer role is limited. This study describes the development of a harm reduction–oriented practice approach “Peer Approaches to Substances for Early Psychosis Programs” (PAS-EPP) designed specifically for CSC PSSs.

Methods: Practice development occurred within the Advancing Early Psychosis Intervention Network in Texas (EPINET-TX), a university-affiliated Learning Health System comprising 15 public mental health agencies and 29 CSC teams. A multidisciplinary development team included a study coordinator with lived peer experience, a practicing CSC PSS consultant, community mental health researchers, and intervention development experts. The team employed evidence-informed intervention development strategies, including conceptual mapping, literature review, integration of prior EPINET-TX qualitative findings with CSC clients and PSSs, and expert consultation. Development activities produced a conceptual model, guiding principles, practice domains, and a structured toolkit and training curriculum for CSC teams and PSSs.

Results: The PAS-EPP framework consists of eight guiding principles and four core practice domains designed to support harm reduction–oriented engagement around SU among young people with EP. Guiding principles emphasize early exploration of SU, moral neutrality, curiosity-driven dialogue, intentional sharing of lived experience, collaborative teamwork, harm reduction planning, and community connection. The four practice domains include: (1) exploration and understanding of young people’s perspectives and experiences with substances; (2) support for goal setting and harm reduction strategies; (3) promotion of social connection and substance-free community engagement; and (4) multidisciplinary collaboration to support coordinated care. The PAS-EPP toolkit includes self-reflection exercises, practical peer strategies, harm reduction tools, and educational materials addressing substance-related risks, including cannabis and psychosis. Training materials were developed for both CSC teams (90-minute overview) and PSSs (six-hour immersive training), emphasizing bias awareness, nonjudgmental exploration, and peer-led harm reduction strategies.

Conclusions: PAS-EPP represents a novel, developmentally informed, peer-delivered practice approach addressing a critical gap in substance use practices within CSC programs. By centering harm reduction principles, lived experience, and team collaboration, PAS-EPP supports PSS capacity to engage young people in meaningful exploration of substance use and risk reduction. Ongoing mixed-methods evaluation, including a randomized controlled feasibility trial across EPINET-TX sites, will assess the feasibility, acceptability, and preliminary impact of PAS-EPP. Findings will inform future large-scale testing and dissemination of peer-delivered substance use practices in early psychosis care.