Top 5 Mistakes Clinical Providers/Administrators Make Working with Peer Support Specialists: #4 Failing to Embrace the Advocacy Role of Peer Support Specialists

The inclusion of Peer Support Specialists into clinical care has the potential to radically change the quality of that care.  One of the most important dynamics is that Peers are natural advocates for those that the team serves.  Peers are patients, they have experience in using treatment, and they see clinical care through the eyes of patients.  They see how interventions designed by clinicians are helpful and how they miss the mark.  They see how behaviors and statements by clinicians are experienced by patients, and can point out those behaviors and communications that undermine the therapeutic alliance and clinical success.  Peers have “fresh eyes”, unsocialized by years of graduate training and professional indoctrination, that see clinical care in new ways that create opportunities for important improvements.

It is important to recognize that it only reasonable that clinical team members would be ambivalent about the inclusion of Peers on their team.  This means having staff member whose routine role includes advocacy for the clients that the team serves.  Situations will come up in which the Peer is advocating with their own team to achieve a change in care for one of the clients discussed in team meetings – changes that will mean more work and uncomfortable changes for team members.

Power is a common dynamic in all groups and all work settings.  In clinical settings, clinicians traditionally have a powerful role in which they have been seen as the experts on what happens and they use a variety of subtle, and not-so-subtle tools to maintain control.  Given the unique perspective and role of Peer Support Specialists, including Peers on the clinical team can be seen as a direct threat to that power. 

That is exactly why clinicians should include them into clinical teams.  Having the advocates inside the clinical team means that the team incorporates the Peer voice inside itself.  The team gives up power that has shielded it from seeing important ways that it fails to serve its clients.  Peers as advocates have the potential to prompt important changes in how care is provided and how clinicians see their role. 

 At one point in my career, I was responsible for the mental health programming at a large healthcare service, involving 20+ programs and 200+ employees.  As part of my duties, I had a monthly meeting with a group of volunteer Peer Support Specialist patient advocates who were very experienced in their role.  They also were past and current patients, receiving their care in the programs they were advocating for. 

I remember feeling very ambivalent about starting to work with this group because I knew they were going to be strong advocates.  They were going to point out problems that needed changing, and they were going to hold me accountable for fixing those problems.  They were not going to accept excuses from me for not getting things done.  They made it clear that they were going to track the issues they raised and expect action on my part, including monthly updates on my progress to fix those problems.

They increased my work and my stress.  There were times I did not want to go to that meeting.

Over time, their pressure forced me to fix important problems in the programs I was responsible for.  Many of these problems were things that clinicians did not see as important, but that patients saw as very important.  Many were about small things that made it harder for patients to be successful, or ways that patients felt that clinicians were limiting their choice or communicating disrespect. 

These problems were not easy for me to fix.  Many required extended efforts to change programs and re-educate staff. Fortunately, the constant pressure of these advocates forced me to persevere and get things done that I would have neglected, and so we did fix those things.  Over time, by working with these advocates I was able to make big changes in what we were doing – changes that helped patients feel like full partners in their care. 

I worked with those advocates for 9 years, and during that time, we were able to accomplish more than I ever thought we could change.  I eventually looked forward to going to those meetings, knowing that they produced real results.  I grew to appreciate the value of having to work closely with advocates.  Their pressure and perspective forced me to do a better job.  They made me uncomfortable, but that was part of why they had such a valuable impact.

 This is the same dynamic with clinicians and Peer Support Specialists.  Clinicians have stressful jobs.  Embracing the advocacy role of Peer Support Specialists will make their jobs even more challenging in the short run.  In the long run, it will help them do their jobs in a way that truly improves quality and builds better success for their patients. 

To help clinicians and clinical administrators recognize the value of Peer Support Specialists as advocates, and integrate that role within clinical teams, Peers and clinicians need to take a few steps:

1.      Speak openly about the natural role of advocacy for Peers, and the value it brings to clinical care.

2.      Make sure that all Peer Support Specialists are well trained in how to be effective advocates and how to avoid some of the common pitfalls that can make advocates unhelpful.  This cannot be over-emphasized. Clinical teams will only accept Peers as advocates if they do this work effectively and professionally.

3.      Include Peer Support Specialists in administrative roles related to advocacy and quality improvement.  These would include committees working on quality improvement, roles that provide ongoing leadership to clinical programs, and committees focused on patient safety, ethics, etc.

4.      Draw attention to the successes created by effective advocacy by Peers.  Clinicians need to see the practical benefits of this work in order to move further to embrace this role.

5.      Talk openly about the productive value of ongoing collaboration with advocates.  This should include a clear recognition of the hard work involved, the natural experience of discomfort when advocates point out challenging problems, and the shift in power involved in truly including advocates on clinical teams.

The inclusion of Peer Support Specialists on clinical teams changes the power structure of those teams.  We need to ensure that those changes are positive and that they result in real benefits for patients in terms of improvements in the care that those teams provide.