Top 5 Mistakes Peer Support Specialists Have Made in Working in Healthcare: #3 Not Recognizing and Working to Compensate for the Relative Limitations in Their Training and Credentialling Process

Clinical settings are supposedly designed around the goal of meeting clients’ needs.  Critics have pointed out that they are also designed to protect the financial and professional interests of the organization and the clinical staff.  From that perspective, these organizations are settings in which a variety of professions collaborate – and compete. The competition usually focuses on power and money.  Professional groups have been collaborating and competing with each other for many years.  Peer Support Specialists are the new arrivals to the work and to the competition.

In any competitive situation, it is crucial that we know our strengths and our weaknesses.  Ideally, we want to maximize the influence of our strengths and minimize the impact of our weaknesses. 

By joining a clinical work setting, Peers must be aware of the dimension in which professional groups are competing.  They must realize how clinicians see them within that competition.  Clinicians see their own authority as being based on their years of graduate training, passing a clinical licensing exam, and their years of experience as a clinician.  Peers are a radical departure from this viewpoint --- the authority of Peer Support Specialists is based primarily on their personal experience with illness and recovery.

Salaries and reimbursement are closely tied to years of training and to supply and demand factors.  In this area, Peer Support Specialists’ reimbursement is not a departure from the usual system.  They have the least formal training and they are typically paid less than most clinicians, often much less.  Peers need to be paid salaries that reflect the importance of their work and that allow them to sustain long-term employment.

It is important for Peer Support Specialists to compete for more influence/power and better reimbursement.  For clinicians and administrators who truly understand the value of Peer Support Specialists, the difference in Peers training and background is a great strength that ensures that Peers bring a different and needed perspective to the work. 

For clinicians and administrators who don’t fully understand the value of Peer Support Specialists, the difference in Peers’ training and background is a cause for skepticism about what value they bring.  This is a group who will need to be persuaded that Peers bring unique value to the clinical organization and that it is in the interest of the organization to give them positions of influence and better funding.  Unfortunately, clinical communities often see power and funding along traditional lines.

Clinicians have had to pass a number of steps that function to screen out people who would like to be clinicians but who are not bright enough or conscientious enough to do the work.  These include:

1.        Getting accepted to a graduate program.

2.        Passing graduate classes and earning the required degree.  These programs range from 2 to 8 years in length and involve a great deal of work.

3.        Being closely supervised as a clinical trainee and having supervisors agree that they are competent.

4.        Passing the licensing exams and the supervised work requirements to earn a government-issued clinical license.

Compare that with steps required to become a Peer Support Specialist:

1.        Having personal experience of illness and recovery.

2.        Passing classes required for Peer Certification.  The amount of time in class varies by state, ranging from 40-120 hours in length.

3.        Passing a certification exam required to earn a state-issued certification.

NOTE: a few states are now requiring evidence of hours of supervised work experience.

Whether it is fair or justified, the discrepancy between the training of Peers and clinicians sets up barriers to the acceptance of Peers as full members of clinical teams. 

I have talked to many Peers about this challenge.  I have also talked to many clinicians about the reason for the difference and the unique value of Peers and their background.  The reality is that despite education and advocacy, the difference in training continues to be a barrier to the full influence of Peer Support Specialists. 

Peers who do not recognize this as a reality of the healthcare setting and don’t actively work to compensate for this reality have lost an opportunity to be more influential.  The unique value of Peers will always be their personal experience and status as people who have recovered.  Smart clinicians will understand that.  Others may not. 

Again, Peer Support Specialists need to promote and champion their strengths, but they also need to minimize the impact of their “weaknesses”.  In a competitive area, their lack of formal training represents a perceived weakness that they want to address.  The following strategies are likely to gain more credibility and rapport with clinicians and more respect for individual Peers, while actually enriching the work of the Peers.

1.        Continue to champion and spotlight the unique expertise of Peer Support Specialists in the experience of illness and recovery.  This can’t be based on formal training, and so as clinicians accept that lived experience is truly valuable, then they have to accept that power and funding based on formal training is inadequate and must change.

 2.        Support the development and maintenance of a strong professional organization for Peer Support Specialists.  Many of these battles for power and funding are waged at the national level and involve lobbying with the government and with quality assurance agencies.  Peers need an effective professional organization that knows how to stand up for them with the right organizations.

 3.        Aggressively pursue additional education in topics related to clinical care including: illness, treatment, recovery, prevention, clinical research methods, and health systems.  Knowledge is power and more knowledge will increase Peers influence.  It is important that Peers don’t allow educational experiences to undermine their unique role in the clinical setting by socializing them to act or think like clinicians.  They need to develop their own education and training that supports their unique view and skill set, while also participating in existing education available to any profession working in clinical settings

 4.        Pursue ongoing clinical supervision in their work.  All clinicians went through years of this oversight process, and Peers will genuinely benefit from additional supervision by competent supervisors.  I feel that my own skills were developed mostly through clinical supervision.  This is where you meet on a weekly basis with a more skilled person who looks very closely at your work and gives you direct feedback about what you are doing right and what you are doing wrong.  It is a very vulnerable process to have someone see you do the work, but it is very influential in building real skills!

 Ideally, those supervisors should be experienced Peer Support Specialists who have real expertise to share.  In some situations, knowledgeable clinicians who understand the Peer role, and fill in as supervisors, can play this role.  Again, Peers must be careful to avoid any subtle influences that could undermine their role.

 5.        Completion of formal training programs in clinical and related topics, resulting in learning and credentials that add to the credibility of individual Peers.  Examples would be trainings with certification in specific skills such as Motivational Interviewing.  Peers have a wonderful tool box of interventions they can use to help their clients.  Formal trainings are available that include other interventions suitable for Peers – interventions that will make their tool box larger and more helpful to clients.

 6.        Pursuit of graduate degrees in related fields.  For example, I have seen Peer Support Specialists who have completed master’s degrees in counseling or in couples and family therapy as a means of building their skills for their work as Peer Support Specialists.  While this strategy has a danger of turning Peers into clinicians, many Peers have done this, and done it successfully.  Their degree has increased their skills in a way that makes them an even more influential and effective Peer. 

Competition is a reality in clinical settings.  Peers need to accept that reality and become effective at competing in ways that increase their influence, their perceived value among clinicians, and their support in the form of salary and benefits.  In this way, they will increase their ability to change the system and amplify their voice in these settings.