Top 5 Mistakes Peer Support Specialists Have Made In Working in Healthcare: #1 Not Recognizing the Political, Financial, and Bureaucratic Dimensions of Healthcare and Using Their Power Effectively to Promote Their Role and Work.
Since entering the healthcare arena, Peer Support Specialists have often faced stiff resistance to their work. This has come in the form of clinicians voicing skepticism about their value, managers assigning them work that has nothing to do with their role, and administrators failing to hire more than a token number of Peers.
Many Peers have expressed surprise, disillusionment, and anger that this resistance has slowed their influence. From one perspective, that resistance is not at all surprising. Consider the following:
1. Like all work settings, healthcare is governed by a complex array of legal, political and financial interests that key stakeholders use to influence what happens. The stated mission of healthcare is the healing and recovery of patients, and so there is a large and longstanding set of laws/guidelines that govern almost everything that happens in clinical settings. Healthcare in the US has a profit motive, and there is a second layer of power and influence organized around ensuring healthcare is profitable for those stakeholders who are interested in profit. Healthcare is also a venue in which a variety of professions work, and so there is a third layer of power and influence organized around ensuring each profession can practice and has influence over what their members do. Healthcare organizations are vulnerable to lawsuits and legal actions, and so there is a fourth layer of power and influence organized around ensuring that healthcare organizations are protected from legal liability.
2. Peer Support Specialists are the newcomers to this complex array of power and process. While there is a growing research base documenting the positive ways that Peer Support Specialists contribute to healthcare, there are limited guidelines and procedures governing their use. It will take time and effort to build the bureaucratic resources that fully support the Peer role.
3. Peer Support Specialists have the least amount of organized professional support and smallest lobbying resources relative to all other professions working in healthcare. Physicians have the AMA, social workers have the NASW, nurses have the ANA, psychologists have the APA…. All of these organizations are well-funded, and have a long history of using professional advocates and lobbyists to press the healthcare system to protect and promote that professional group. The National Association of Peer Supporters was the only national organization advocating for Peer Support Specialists, and it closed 2 years ago. Even when it was active, it was by far, the smallest professional organization, the least experienced, the most poorly funded, and the least influential. There are new organizations trying to provide training and support for Peers, but they have not yet been national advocates for the profession.
4. Peer Support Specialists have the least formal training of all healthcare provider professions. Working in the complex world of healthcare, that limited training is often seen as putting them at risk for mistakes. In healthcare, mistakes result in liability and public failure --- consequences that healthcare organizations work hard to avoid.
5. The healthcare reimbursement systems, including government programs like Medicare, and private health insurance programs, have been slow to set up reimbursement systems for the work done by Peer Support Specialists. Without clear ways that Peers contribute to the financial success of healthcare organizations, the stakeholders who focus on money are not likely to push strongly for Peers to be hired.
This pattern of challenges is not new. As new professions have moved into healthcare, this same scenario has occurred. In each case, the profession had to find concrete reasons why they must be allowed to work and to gain support in the system. Sometimes it is the uniqueness and value of the services they provide (very true for Peers). Sometimes it is political pressures created by the lobbying of their professional organization (not currently true for Peers). Sometimes it is their ability to earn funds that contribute to the financial welfare of the healthcare organization (Direct funding is not currently an easy argument for Peers, though indirect benefits to the bottom line are clear and persuasive).
Peer Support Specialists have been present in significant numbers in healthcare for less than 20 years. It will likely take another 20 years before many of the initial political issues related to their role are resolved. Success will depend on Peer Support Specialists focusing on several key strategies:
A. BUILDING A WELL-ORGANIZED AND ASSERTIVE PROFESSIONAL ORGANIZATION AND SUPPORTING ITS ONGOING EFFORTS TO ADVOCATE FOR THE PROFESSION
Peer Support Specialists must have an effective professional organization that brings pressure on the healthcare world and the government in the service of Peer Support Specialists. This group needs to be funded well enough to hire competent staff who know how to exert real pressure. The group needs to serve the profession by actively creating guidelines that build a successful constituency. It must be a national voice for Peer Support Specialists that can explain the unique value of Peer Support Specialists to the field and the public
B. ADVOCATING FOR ADVANCES IN REIMBURSEMENT STRUCTURES FOR PEER SUPPORT SPECIALISTS, INCLUDING MEDICARE AND PRIVATE HEALTH INSURANCE.
The financial infrastructure for the long-term health of Peer work in clinical settings must be set up. There is good research data to document the contribution Peers make to patient health – and so it is only reasonable that those who fund healthcare must fund the work of Peer Support Specialists. In particular, Medicare and private healthcare insurance must be persuaded to fully fund the work of Peers. The funding must be at levels that allow Peers to earn a respectable and sustainable salary. There needs to be opportunity for advancement, which include salary levels that encourage Peers to continue their work and advance in their skills. There need to be clear guidelines on the work of Peers to protect their unique work.
C. AT THE LOCAL LEVEL, PEER SUPPORT SPECIALISTS MUST COMPETE FOR INFLUENCE AND SPACE WITH OTHER PROFESSIONS.
Competition between professions is an everyday reality in healthcare settings. Peers have to accept that reality and join in the process. The unique value they bring to clinical work is the key selling point they must use to build their influence.
Areas of competition include:
1. Influence over the organization
2. Reimbursement
3. Roles in leadership
4. Funding and positions
5. Attention and recognition
6. New funding and new initiatives
7. Professionalism and competence
8. Staff education
9. Regulation and bureaucracy
D. USING THEIR FLEXIBILTY TO DEVELOP CREATIVE WAYS FOR PEERS TO CONTRIBUTE TO THE CARE PROVIDED
Clients need to know that a community of people in recovery exists, and that this community includes people who may be able to provide support for them. Clients often do not know about the existence of this community, or how to contact them and take advantage of the support they offer. Peer Support Specialists represent that community and can help clients feel connected to the large group of people living successfully through recovery. Peers tend to be creative in seeing ways to improve clinical care. They must be organized and assertive in their efforts to make those contributions.
E. ATTENDING TO SYMBOLIC WAYS THAT STATUS AND POWER ARE COMMUNICATED AND ENSURING THESE REFLECT THE VALUE AND INFLUENCE OF PEER SUPPORT SPECIALISTS
All industries and organizations use symbols to communicate status and value. Peer Support Specialists must be assertive to build symbolic processes that point to their worth and to the achievement of their worthy members. They also need to be acknowledged by the existing symbols in healthcare – symbols that include awards for high achievement and contribution. It is not enough to know that you are making a crucial contribution to your clients. The healthcare community needs to acknowledge the contribution in the ways that it routinely does for clinicians.
F. BUILDING CONNECTIONS WITH NATIONAL AND INTERNATIONAL ORGANIZATIONS AND RESEARCHERS THAT ARE ADVANCING HEALTHCARE
Efforts to grow the influence of Peer Support Specialists will depend on the ability of Peers to build partnerships with other influential players in healthcare. The unique value of Peers in advancing clinical outcomes suggests that many national and international organizations that promote health and healthcare outcomes, will be natural partners for Peer Support Specialists. For example:
· The World Health Organization (WHO) has already developed guidelines that promote the work of Peer Support Specialists. The Joint Commission for Accreditation and Hospitals (JC) has already developed guidelines for the work of Peer Support Specialists in healthcare settings.
· Hundreds of researchers publish research papers each year, documenting the clinical value of Peer Support Specialists. They are natural partners for Peer Support Specialists, helping them to develop new interventions and to document the benefits of their work.
· Other professional organizations like the American Psychological Association, can be partners in guiding and collaborating with Peers to develop new opportunities for Peer Support Specialists and clinicians to work together on new innovative services.
The history of professional peer support is young. Mistakes have been made, but there is plenty of time to recover the initiative and to better advance the field. The future success of Peer Support Specialists depends on their ability to organize and to promote their profession and their work. This is not a time to be humble and deferential. Healthcare is a competitive setting. Peers need to be more assertive in the service of their profession and their clients.