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By Sarah C. Threnhauser, MPA

Last week, we provided an update on the current state of credentialing of peer support specialists (PSS) and changes in reimbursement for their services (see Bringing Peer Support To Scale In Service Delivery). For most organizations, the question is not whether to add PSS to their service delivery team—but how. And how to bring those services to scale across a service location.

Sue Bergeson

The article brought some interesting comments from my colleague and OPEN MINDS Senior Associate Sue Bergeson. She noted:

Provider organizations should leverage peers in the areas of activation, engagement, reduction of isolation/increase support, communication, and education. Involve peers as you would other staff in the organization’s decision-making process. Peers will see things differently and can give you feedback, and insights others will not see that can positively impact the effectiveness of your programs. Effectively on-board peers into the organization, supervise, and promote them as a part of the overall treatment team. Pay them a fair wage and offer them access to continuing education so they can continue to build skills and serve your clients.

Done right, she observed that this approach can improve consumer outcomes, including increased consumer empowerment, increased sense that treatment is responsive, and increased social support and social functioning (see Bringing Recovery Supports To Scale: Peer Support and Developing A Value-Based Care Model With Peer Support-Two Case Studies). But she noted that there are six key issues that consistently diminish the effectiveness of peers in the workforce—role confusion, lack of integration, performance measures, management training, career paths, and specialties of focus.

Role confusion—Often job descriptions are unclear, and staff does not know what to do with peer staff. This can lead to peers used simply as extra hands to drive a bus, to do filing, or to clean. Its fine if peers are hired to do these roles specifically but they are not peer roles – they do not used the skills or leverage the experience of trained and certified peer specialists. It’s no more appropriate for peer specialists to drive the bus than it is for clinicians to drive the bus. Peer job descriptions and roles need to align with the core competencies or the system employing them is missing out on the benefits of adding peer support to the system of care – in short, they will not achieve the very benefits they were hoping to achieve by adding peers to the workforce (see Certified Recovery Specialist and Peer Specialist—Job Description)

Being treated as separate from the rest of the workforce—Because the staff team has usually not had any orientation to the work of peers, often peers are not invited to the table, not involved in committees, not involved in meetings, not informed or asked about organizational changes. Because peers have different experiences and can see things differently, the system misses important feedback if they do not involve peers as they create and implement new policies, programs and systems (see Emerging Roles for Peer Providers in Mental Health and Substance Use Disorders and Best Practices For Effectively Integrating Peer Staff In The Workplace).

Not being held to the same standard—Peers are sometimes treated as fragile and the company might make special allowance for behavior not acceptable in other staff. This does the peer a disservice. Peers need to be held accountable for the same kind of professional behavior as other staff members. Sometimes hired peers are new to the workforce and so a mentor that helps them acclimate can be a great addition to the onboarding process (see Developing A Value-Based Care Model With Peer Support-Two Case Studies and Bringing Recovery Supports To Scale: Peer Support).

Training for supervisors—Because the role is often new to a system, supervisors often need additional support in learning how to effectively supervise this new role. It is not unusual for the peer to mistakenly be supervised as a “mini therapist” or “junior social worker” because that is the field the supervisor knows best. This diminishes the effectiveness of the peer worker (see Peer Workers in the Behavioral and Integrated Health Workforce: Opportunities and Future Directions and Peer Support Toolkit).

Career paths—Hiring peers as supervisors is an effective way to ensure peer roles remain peer and are optimized for success. Successful peers should also be considered for other leadership and administrative roles as they demonstrate their effectiveness (see Expanding the Role of Peer Support Services In Mental Health Systems of Care and Recovery and Peer Support Programs—Sustaining Peer Supporters).

Areas of focus—We are seeing additional areas of focus emerging within the field, each with its with corresponding training. For example, peer support within later life populations, within transition age youth, within co-occurring health conditions like diabetes and depression (see Building Peer Support Programs To Manage Chronic Disease: Seven Models For Success and Peer Support Roles In Mental Health Services).

Like any change in the service delivery system, planning for incorporating PSS demands planning. Managers of health and human service organizations will need to make this a priority to remain competitive in the coming years.

For more, be sure to join us at The 2019 OPEN MINDS Performance Management Institute in Clearwater, Florida on Thursday February 14 for the session “Optimizing Productivity: A Guide To New Performance-Based Compensation Models”, led by John F. Talbot, Ph.D., Chief Strategy Officer, Jefferson Center for Mental Health, & Advisory Board Member, OPEN MINDS.

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