Adapting peer-delivered behavioral activation for mothers with substance use disorder histories: A peer support...

Behavioral Activation (BA) is an evidence-based treatment for depression that researchers have adapted for peer delivery to improve access to maternal mental health care. However, little research has examined how peer-delivered BA should be adapted for mothers with substance use disorder (SUD) histories. Building on prior qualitative work with mothers in recovery, this study used Experience-Based Co-Design (EBCD) to adapt the peer-delivered BA intervention Alma in partnership with peer support specialists (PSS) with lived recovery experience.

Using an EBCD framework, the study team conducted a two-phase adaptation study. In Phase 1, four PSS completed all six Alma meetings as participants and engaged in structured co-design meetings after each meeting. In Phase 2, five additional PSS completed Alma training and provided feedback on the proposed adaptations. Analyses used reflexive thematic analysis to examine co-design meeting transcripts, facilitator field notes, and open-ended survey responses.

Six themes emerged. PSS recommended tailoring recovery-specific language according to stage of recovery, integrating recovery concepts into existing BA tools, incorporating mid-week accountability check-ins, expanding opportunities for peer connection, emphasizing participant choice and consent, and providing structured supervision for PSS. Participants consistently viewed Alma as acceptable and relevant for mothers navigating SUD and recovery.

Findings provide an empirically grounded framework for adapting peer-delivered BA interventions for mothers with SUD histories and highlight the value of engaging PSS as co-design partners. A subsequent pilot study of the adapted Alma program will evaluate these adaptations.