National Recovery Month | Exploring the World of Peer Recovery Specialists

September is National Recovery Month. In this blog we dive into the world of peer recovery specialists. Peer recovery specialists, often referred to as "peers," are individuals with lived experience of substance use, mental health, or co-occurring disorders who provide support to those who are coping with similar diagnoses. Relationships between peer supporters and the individuals who receive peer services are based on mutuality, agency, and empowerment. In line with this framework, peers often refer to those they work with as "consumers" or simply "individuals," rather than the more traditional terms "client" or "patient."

Over the past two years, OMNI has assisted the Virginia Department of Behavioral Health and Developmental Services to learn about various aspects of peer work, providing guidelines and procedure recommendations to revamp Virginia's peer training and evaluation systems.

Through our research, we’ve learned the fundamentals of the peer role and its origins in recovery-oriented behavioral health in the U.S. Peers have been widely documented to improve the lives of those in or working toward recovery, which has led national agencies, community organizations, and private health providers to call for their support in a variety of behavioral health and other settings. By sharing their own lived experience, peers guide those they support to develop and achieve recovery goals, create strategies for self-empowerment, and build fulfilling, self-determined lives in recovery.

Peer recovery support services have proven to be consistently effective at improving outcomes such as:

• Reduced inpatient service use

• Improved consumer relationships with providers

• Better consumer engagement with care

• Higher levels of consumer empowerment

• Higher levels of consumer activation (willingness/ability to independently manage their health and care)

• Higher levels of consumer hopefulness for recovery

However, peers are still relatively new to the behavioral health scene, and there isn't yet a clear roadmap for how to effectively integrate peers into existing provider organizations. It is often left up to the  behavioral health administrators to determine how peers should be trained, what the extent of their role should be for a given setting, how to navigate common challenges that occur, and how to evaluate the effectiveness of peers' work.

Below are important takeaways and lessons for those interested in the role of peers in recovery services.

1. Peers can work anywhere- OMNI found that peers work in a variety of settings, including but not limited to hospitals and emergency departments, community centers, criminal justice settings, colleges and universities, federally qualified health centers, and more. The services peers provide include providing education on behavioral health disorders, emotional support, teaching problem-solving skills, and supporting or leading crisis intervention services. Peers also serve as part of interdisciplinary care teams, offering case management and referral to various support services. Peers also may be there to connect individuals with daily supplies, accompany someone on a smoke break, or provide a sounding board for challenges or worries.

2. One size doesn't fit all- Peers are as diverse as the people they serve. A core component of what makes peers effective is the relationships they build with individuals in recovery. These relationships are based on a mutual sharing of lived experiences with a disorder and are most often fostered organically. Thus, although we can glean best practices, agencies should remain flexible and not overly prescriptive when applying them.

3. Peers are the personification of the recovery orientation- Researchers have found that the traditional, "top down" medical model used in behavioral health care doesn’t always work well for consumers. It stifles consumer autonomy, is focused on symptoms rather than wellness, and many national health organizations are calling for change. Recovery orientations in mental health and substance use disorder services are fundamentally based on respect, empowerment, and supportive relationships with social networks and communities, all of which is evident in the work that peers do.

4. The main threats to the effectiveness of peers are due to poor implementation of their role– Administrators, clinicians, and other traditionally educated or trained staff can be wary of peers in their organization, since peers, though trained for their role, often don’t have the same professional education or naturally fit in with established organizational hierarchies. This can be confusing for traditionally trained staff and might make for bumpy transitions of peers onto teams. Peers and clinical staff come from different worlds and use different terminology which can result in barriers to respectful communication between the two groups.

5. Peers both experience and help to fight stigma- Peers experience the same prejudice and discrimination the people they serve do: the negative stigma associated with a substance use or mental health disorder diagnosis. People often hold on to prejudices that peers can't get the job done, or that they oppose the use of prescribed medication in recovery, Others worry that adding peers to the team will take up too many already scarce resources. Even clinicians and administrators are not immune to holding these thoughts. Peers persevere though, and their presence in health settings is a step in the right direction of leaving this stigma in the past. Peers are living, breathing reminders that not only is recovery possible, but that those in recovery are capable of effectively changing lives by working in behavioral health services settings of all kinds.

Download the full literature review