‘Disruptive’ approach to peer support training sparks curiosity, concern among Minnesota addiction recovery leaders

Daniel Larson was born into a multigenerational household where addiction was part of the DNA. 

It began with his grandfather, who Larson said developed a drinking problem after coming over from Norway. “He thought that part of being an American was to drink,” Larson said.

When Larson was 10, tragedy struck: His grandfather and uncle took off on a drinking binge, and both died on the same night. 

Decades later, in 2019, Larson worried his own drinking was growing problematic and called an addiction hotline. He ended up at Minnesota Adult and Teen Challenge, a residential treatment program based in Minneapolis. There, in a room filled with people waiting hours to be seen, an intake worker took the time to slow down and ask Larson about his goals for recovery: What did he want to do with his life? 

That personal connection helped to kickstart his recovery, he said, and throughout his journey he’d come to appreciate the power of peers in the recovery process. 

That appreciation led Larson in 2021 to start a nonprofit he called Refocus Recovery that he hoped would dramatically increase the ranks of certified peer recovery specialists — people with a history of substance use disorder who provide support for others during the recovery process. 

Despite being new to the peer recovery space, Refocus Recovery has quickly become the leading recipient of state Medicaid dollars going toward peer addiction recovery support. In 2022, the Minnesota Department of Human Services reimbursed Refocus for about $4.2 million in services, while the next largest reimbursed amount made to Mankato-based WEcovery was roughly $1.1 million.

But that rapid growth has also raised red flags among some of the major players in Minnesota’s recovery community. Besides raising eyebrows over Refocus Recovery’s reimbursement levels, some leaders of other organizations who also train and deploy certified peer recovery specialists question whether those being recruited for the jobs are far enough along in their own recovery to be able to help others.

“Right now, peer recovery support services in Minnesota are the Wild West,” said Wendy Jones, executive director of Minnesota Recovery Connection, a statewide provider of peer support and advocacy and the first Minnesota organization to train certified peer recovery specialists. “It was rolled out fast. It’s a new service. Not a lot of people understand it. It is different.”

Disrupting the model

After finishing treatment, Larson moved in with his brother, who had also recently completed residential addiction treatment. Though they lived happily together for a time, Larson’s brother slipped back into drug use. 

“He left in the middle of the night and left behind his two dogs and all of his stuff,” Larson said. His brother later died of an overdose. 

Larson said the experience made him want to create a way to train people and to get them quickly out in the world to help others, so that people like his brother could get the support they so desperately needed.  

Refocus Recovery could fulfill that, but it needed technology to help with the complicated administration required to recruit and train peer support specialists, match them with organizations carrying out addiction treatment and handle billing. With a professional background in workforce development and technical staffing, Larson then started Kyros, a for-profit technology company that works in tandem with Refocus and operates the administrative infrastructure for treatment organizations. Kyros received financial support from angel investor Bob Naegele III.

Larson entered the peer recovery space as the nationwide opioid crisis continued and overdose deaths spiked. Peers helping peers has long been a centerpiece of addiction recovery and treatment programs like Alcoholics Anonymous, so it seemed like a natural extension in 2017 when the state decided to add certified peer recovery specialists to Minnesota’s Medicaid subset, making their services eligible for reimbursements, which started in 2019. This move was in line with other states that, inspired by the worsening addiction crisis, had professionalized the role of certified peer recovery specialists.  

With that came a need for training and certification, and now a number of Minnesota organizations offer multi-day training programs for individuals interested in becoming certified peer recovery specialists. These programs cost anywhere from $700-$1,000, and graduates earn a certification that qualifies them to work for a range of employers. Some recovery community organizations offer scholarships for individuals who do volunteer service to help build their skills. 

Part of what is different — and controversial — about Refocus Recovery’s trainings is the fact that they are offered for free. Larson explained that for many people, especially those who’d just been through the recovery process, the cost of the trainings was prohibitive, so he developed a way to offer it at no cost.  

In December 2021, he and his colleagues at Kyros debuted a “model that partnered with  Minnesota health care providers to allow us to charge a fee to manage their fee-for-service business.” Kyros, Larson explained, “takes a percentage of what nonprofits bill insurance companies,” allowing the company to offer its trainings for free.

That approach upsets some existing organizations that have relied on an established model of charging for their certified peer recovery specialist trainings.  Kyros and Refocus, Larson said, “launched to the dismay of a lot of for-profit training entities.” 

This approach quickly gained momentum: By the end of 2022, Larson said that his company had trained 637 new certified peer recovery specialists (CPRS) and onboarded some 280 providers to their management platform. That year, Larson said, Kyros and Refocus “were the largest employers of CPRS in the state of Minnesota. One out of three CPRS in the state works in our program.” 

Kyros grads are employed by a number of the state’s recovery organizations. “We’re partnering with close to 144 homeless shelters, reentry programs, community based support groups like Catholic Charities, Dorothy Day and Salvation Army,” Larson said.  The company,  headquartered in Minneapolis across from Target Field, has close to 45 employees and nearly 340 network providers, including certified peer recovery specialists and licensed alcohol and drug counselors, Larson said. 

An aggressive approach

While he readily acknowledges that his organization’s rapid growth has raised red flags among  some of the major players in Minnesota’s recovery community, Larson said some of that controversy was expected. Most days he welcomes it as part and parcel of taking what he sees as a bold, new approach.

Even though Kyros uses technology to grow and manage its business, Larson said that his company’s focus remains human-centered. “From the beginning,” he explained, “I’ve always said, ‘We are not going to focus on technology. We are going to focus on people. We are going to build an army of people who can help others so no one has to worry about getting the help they need.’” 

His brother’s overdose death, Larson explained, “made me not be not as pragmatic or diplomatic as I should have been. Coming in with a new, disruptive mode made me a lot less patient. And it makes some people angry.” 

The emergence of Kyros as a certified peer recovery specialist powerhouse has created some level of distress for people who’ve been offering this type of training for years. Some, including Randy Anderson, founder and principal of Bold North Recovery, a provider of peer recovery curriculum and training, continuing education, and technical assistance, claim that Kyros’ aggressive approach could lead to situations where certified peer recovery specialists trained by the company may not always be far enough along in their own recovery to responsibly provide support for others.

“I would move 10 times as fast if I could,” he said. 

Some leaders of Minnesota’s recovery establishment express concern that it’s aggressive to the point of being at risk for misuse. 

Jones, of Minnesota Recovery Connection, said the move to qualify certified peer recovery specialists for Medicaid reimbursement created “a financial incentive” that was different from the way peer support worked in the past. While Jones said that she and her colleagues have seen a lot of encouraging advancements in the field, “like more partnerships between RCOs, emergency departments and community paramedics, we’ve also seen some confusion.” 

Refocus Recovery’s DHS reimbursement numbers, Jones said, “do make me raise my eyebrows. It’s is a lot. I’m always going to come from the perspective that we are providing a community service.” 

Hurley agrees with Larson that the state’s addiction crisis calls for a serious response, but she also has some concern about Kyros’ and Refocus Recovery’s approach. 

“Nobody knows how they are doing this,” Hurley said. “They are billing a lot. They are deploying the people they train into the community to get their own people to support and then they submit for their billing. It is a very different model than anyone has used here before. Maybe it is brilliant and innovative. Maybe it’s what we need. I just don’t know.”  

Strife among competitors

To say that Anderson, of Bold North Recovery, is concerned about Kyros and its approach peer recovery training is putting it lightly. 

“They are going after vulnerable people,” Anderson said of recruitment strategies used by Kyros and Refocus. “I see a problem here. I’m committed to fixing it. I want to be part of the solution.”

Larson said he’s not surprised by Anderson’s accusations. What does surprise Larson is how slow he says other organizations have been at training and deploying certified peer recovery specialists into the community after Medicaid reimbursement became available in 2019.

“They had more than enough time before we got here to figure this out,” he said. “Three people a day are dying in our state.”

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Anderson’s concerns about training peer recovery specialists before they’re ready were echoed by John Curtiss, president and CEO of The Retreat, a Twin Cities-based provider of programs and support for people with substance use disorder. With a rush to build up the specialists’ ranks comes the risk that some may be under-qualified for the job, Curtiss said: “I’m a little worried about the long-term impact of this.” 

‘I want to run into the burning house’

Debating the motivations of a recovery entrepreneur may get in the way of understanding the true motivations of the very people who choose to earn their peer recovery certification. 

Take Rolando Ruiz. He met Larson back in 2019 when they were both enrolled in Minnesota Adult and Teen Challenge’s residential treatment program. Ruiz later completed training at Minnesota Adult and Teen Challenge to become a certified peer recovering specialist, and Larson approached him to find out if he’d be interested in working with Refocus Recovery. 

Ruiz had just received a college scholarship, and he’d already started worrying about how he’d be able to juggle school and keep the regular job he needed to pay his bills. When Larson explained that certified peer recovery specialists are free to set their own hours, he was in.  

“Daniel explained how peer support works and how you can work on your own schedule,” Ruiz said. “I realized, ‘That is perfect for me.’” 

At first, Ruiz said that he struggled to feel comfortable in the role of supporting other people through their recovery, but with time the job began to feel natural. “Once I was able to push past that newbie phase of, ‘What am I doing here? How does that work?’ I realized it was me taking my own personal experience and walking alongside someone to help them out,” he said. 

Ruiz now feels uniquely qualified to provide peer support, and he finds real meaning in his work: “It empowers me to realize all of the things I went through weren’t a waste. I can turn this into something where I can help people.” 

Though his role at Kyros has expanded from certified peer recovery specialist to supervisor, Ruiz said that helping individual peers on the path to recovery remains at the center of his work. He feels like he is doing his part in one small way to fight the addiction epidemic.  

“I can’t help everybody,” Ruiz said. “I want to. I see the value in peer recovery support. I want to run into the burning house. The more people we can train, the more people we can help. For me, it’s more than a job.” 

Editor’s note: An earlier version of this story contained an extra zero on the number of network providers Kyros has that was inserted inadvertently during the editing process. The story has been updated. This story has also been updated to clarify that Ruiz received training from another organization before joining Refocus Recovery.