Lessons learned in peer workforce development
February 2, 2012 by Lori Ashcraft, PhD, and William A. Anthony, PhD Posted on Behavioral Healthcare (http://www.behavioral.net)
Original article here.

While peer employees can make a powerful contribution, adding them can pose unique challenges.

 “When we first began adding peers to our workforce 12 years ago, other behavioral health agencies thought we had lost our minds. Today, if an organization doesn’t have any peer employees, they are seen as being behind the times.” This is a quote from Lisa St. George, who is an executive and a peer at Recovery Innovations (Phoenix) and has supervised large peer programs for the past 12 years.

We agree with Lisa—adding peers to the workforce these days is a common practice and is often a requirement in state and federal grant applications. Yes, peers have proven their worth and have been adding depth and breadth to the services offered by behavioral health programs. They have helped for many years in substance use treatment programs, and have more recently come to assist in serving those with mental health challenges.

Let’s take a closer look at what’s actually happening when peers begin working in our programs. For the most part, peers have proven their worth to even the most cynical bystanders. But it hasn’t all been a glorious experience—not for them, for other staff, or for the larger organization.

In this column we want to take an honest look at what’s working and why, so we can replicate our successes and have even better outcomes. We also want to examine the mistakes that have been made so we can correct our course and avoid future disappointments for all involved.

What peers can bring to service delivery

Let’s first look at how the abilities and qualities of peers can enrich service delivery when things are working well. Often, the service improvements that they bring occur by virtue of their lived experience with mental illness and with navigating service systems. Generally, well-trained peers offer:

• Dedication and commitment to work.
• Ability to create an immediate connection with the people they serve.
• Ability to use their stories and lived experiences to inspire hope.
• Ability to build bridges that engage other providers on the treatment team.
• Ability to guide people in accessing community resources and services.
• Ability to model healthy relationships that others can replicate in the community by being trustworthy and supportive in an intentional relationship.
• Ability to demonstrate to family members and other supporters that people like their loved one can recover.

Systems that have the courage to add peer support workers demonstrate a commitment to working with peers that helps the system to transform old ways of thinking and being. For example, the presence of peers:

• brings a different perspective to other treatment team members during team meetings;
• supports the use of recovery language by reminding organizations to minimize the use of labels and diagnoses that are impersonal or demeaning to those seeking help; and
• provides living proof that people recover on treatment teams.

Where peer employment may go wrong

The success stories shared by many organizations who have added peers to their workforces have caused others to rush out and hire peers, only to see later that they did not contribute as expected.

There are a lot of things that can “go wrong;” the good news is that most problems can be avoided through proper training and follow up. Here are some “must haves” for peer training:

• Peers must understand the importance of their work or they might fail to take it seriously, leading them to be unreliable about completing work and maintaining work hours.
• Peers must be able to complete required documentation or paperwork—or get help as needed. Otherwise, they’ll create problems for the treatment team.
• They must know and exercise responsibility for using wellness tools to maintain their own recovery and stability. Sometimes peers who feel great when they go to work stop doing the very things that help keep them well.
• They must be enabled and empowered to work from their strengths so that they can “let go” of the status of “mental patient,” shift into a “helping role” for others, manage personal feelings and challenges that arise at work, and maintain good attendance.
• They must be able to use their own story in a healing, inspiring way that supports and guides the people they serve and contributes to the treatment team.
• They must know why and how to maintain a “recovery environment” by reacting positively and avoiding gossip and negativity.
• They must be challenged to grow into their potential, rather than feeling they are entitled to special treatment. This compromises their effectiveness.

Tips for keeping peer employees on track

Now, because many of these problems can occur with all employees, let’s not be too quick to judge peer employees or to see them as being more problematic than other staff members. In fact, let’s not blame anyone: Let’s just figure out how to get it right to begin with!

If an organization takes the following steps when they add peers to their workforce, their outcomes will be much better and the results of the peer contribution will be stronger and more effective:

1. Involve staff in the decision to employ peers. It is essential for top management to involve staff who will be supervising and coaching peers as well as the staff who will be working beside them. These individuals must “buy in” to the concept of employing peers. If they don’t have a voice, they’ll have no choice but to resent and resist. Peers tell us that this resistance is among the hardest challenges they face when entering the workforce.
2. Recruit potential peers. Once all are “on board” with the concept (staff don’t have to love it, but most must be willing to try it), step two is to recruit peers who are interested in the possibility of contributing, making a difference, and wanting to work. There are several ways to recruit peers. Often, staff can recommend people; you can reach out to potential peer groups; or offer meetings where potential peers can stop in and learn about the possibilities or hear peers from other locations tell their stories, explain what successful peer work is like, and identify the qualities peers need to be successful.
3. Provide peers with great training before they go to work. This is very important! There are a couple of training groups that do an excellent job with peer training. And, we promise if you make this investment, you will have many fewer problems as your peer employment process moves ahead.\
4. Ensure that trained peers have good coaching and supervision. You don’t have to micromanage peers, but you must be clear about expectations and supportive in their efforts to do the best work. Some examples: Offer clear job descriptions. Give peers meaningful assignments that really use their strengths and skills—not just driving, straightening the waiting room, or ordering/delivering lunches.
5. Provide ongoing peer training. Ongoing peer training need not be clinical. It can focus on sharpening skills in engagement, recovery, wellness, and resilience.
6. Challenge peers to perform and enforce accountability. Build an atmosphere in which all staff members who work with peers know that peers must not be treated differently than other employees. All supervisors of peer staff—even if they are peers themselves—must understand that every employee is held to the same level of accountability. Peer staff must be held to this standard or resentment and disharmony will result.

Experience from a peer-operated organization

The above lists are meant to help you avoid problems when hiring and coaching peers. We think this is good information for you to have, but it doesn’t really tell you about the heart of peer work. For that, we’ll talk again to Lisa, but first let’s look at the amazing work that is going on at the Baltic Street program (Brooklyn, NY).

Baltic Street is a peer-operated organization funded by New York City Dept of Mental Health. Baltic Street’s CEO, Isaac Brown and its Director of Employment Services, Steve Duke, offer a story that speaks to the power and effectiveness of peer-professional collaboration. And, they’ve got the outcomes to prove it.

Since 1996, Baltic Street has grown from a group of five peers who served 400 people to an organization in which 100 peers serve some 5,000 people annually. One of the largest peer-run organizations in the country, Baltic Street operates 13 programs in four of the five NYC boroughs.

Through comprehensive advocacy, self-help, bridger, housing, employment services, and a new Resource and Wellness Center, Baltic Street helps people develop a life in the community and achieve goals: an apartment, a job, a support system, an education, or a skill, for example. Participants can identify and strive for any goals that will increase their satisfaction with life.

All Baltic Street services are delivered through a partnership of a person diagnosed with mental illness and a professional peer who is dedicated to empowering and helping that person to achieve recovery goals. This concept—peer-to-peer service delivery—is what Baltic Street is all about.
When we asked Isaac and Steve, “what’s your secret to having an effective peer workforce?” here’s what they had to say:

“We find that relationships are the key to successful outcomes in peer organizations. Good relationships depend on positive attitudes, good skills, and core competencies. One way to protect good relationships is to include everyone in the process of positive change regardless of titles or credentials. Each person in the agency needs to be respected for their strengths and what they have to offer.

“We find that peers are particularly talented at engaging people by using shared experiences for connecting and gaining trust. They are also adept at helping people navigate systems that tend to be frustrating to deal with due to bureaucratic regulations. Like other employees, peers really shine when given high-quality training and supervision.

“Collectively, we all need to have positive attitudes and provide unyielding support to the people we serve. We try to stay focused on strengths and look for what people can do as opposed to what they cannot do. We look for capabilities instead of focusing on disabilities. We maintain flexible boundaries whereby we try our best to relate as people first as opposed to relating through our roles and job descriptions.”
That’s very inspiring Isaac and Steve. Thanks for sharing your approach.

Opening pathways to recovery

Now let’s get back to Lisa and see what she can add. When I asked Lisa “how can you tell you have a great peer workforce?” here is what she had to say:

“We’ve talked about a lot of the keys to success above, but there is a very important aspect of peer support that is harder to put into words. At Recovery Innovations we call it ‘the magic.’

“At one meeting early in our peer workforce development process (FYI-RI employs the largest peer workforce in the world), several leaders, peers, and non-peers started to talk about what was happening in our organization: We saw that significant numbers of people were doing well, that their relationships with their treatment teams were improving, that they were coming to classes even when their attendance was not required. And, rather than waiting months or years to see the ‘light’ return to someone’s eyes, we were seeing it occur every single day.

“We knew that Mary Ellen Copeland’s WRAP was a wonderful tool and was helping people take charge of their lives. We knew that our WELL (Wellness and Empowerment in Life and Living) class was helping to strengthen individual recoveries. We knew about and saw wonderful relationships built on hope, but there was something else the peers brought to their work: When peers work, they lead with their heart! They lead with compassion, kindness, understanding, and treasure the uniqueness of each individual.

“We thought about it, and suddenly we understood that peers bring love to their work. Without this agape love, service brought by peers was still special but it was not magnificent. Once we identified that love was a key ingredient, we asked the people we served what other things we did that helped advance their recovery. This question led people to describe what we now call “recovery pathways”:

• Hope
• Choice
• Empowerment
• Recovery Culture
• Spirituality/Meaning and Purpose.

“As important as these pathways are, we call Love the key to opening them. The love that peers bring is coming from the deepest part of their heart, the part that truly and deeply understands that inside every person is a treasure of strength, courage, and hope for what is possible. Effective peers know this because someone once saw the same things in them and dared to lead from the heart and love them in the same selfless and spiritual way, a way that believes all things are possible. Imagine what could happen if everyone that works in mental health and addiction services led with their hearts.”

Well there you have it folks! The experts have given us the scoop on how to have a great peer workforce! What are your thoughts? Let us know if you have questions, need information, or wish to talk further.

Lori Ashcraft, PhD, is executive director of Recovery Innovations’ Recovery Opportunity Center in Phoenix, Ariz. and is a member of the Behavioral Healthcare Editorial Board. William A. Anthony, PhD, is a professor at Boston University and vice chairman of the Foundation for Excellence in Mental Health Care.