The Peer Specialist Workforce: Results of a National Survey

Presenters:

E. Sally Rogers, ScDDirector of Research and Research Professor

Center for Psychiatric Rehabilitation, Boston University

Andy Bernstein, PhD, CPRPClinical Director, Camp Wellness, University of Arizona

Co-Authors:

Rita Cronise, MS, ALWFDirector of Operations, iNAPS

and Adjunct Faculty, Rutgers University

Carina Teixeira, PhDPost-Doctoral Research Fellow, Boston University

Steve Harrington, MS, JD Founder, International Association of Peer Supporters

(iNAPS)

Brief History of Human Helping (part 1)

Before professionals◦ Mutual help: natural, organic, evolutionary◦ Experiential Knowledge—sociologist Thomasina Borkman

Industrial Revolution and Class System◦ Formal training and purported expertise◦ “Professional” knowledge◦ Accountability to third parties

◦ society (educators, certifiers, geographic regions)

◦ payers (insurers)

◦ professions (guild system, interdisciplinary competition)

◦ Techniques and the standardization of helping◦ Emergence of “best practices”◦ Objectification of helpees, and helpers◦ Commodification of the helping “industry”

Brief History of Human Helping (part 2)

Consumer Empowerment• Naturopathic, “alternative” medicine

• Whole person approach

• Self-help movement

• “Nothing about us without us!”

• Challenging big pharm and big psych

• Recovery and psychosocial rehabilitation

• Consumer providers, peer workforce

Peer Support as a Profession

Two Helping Paradigms

Professional

book knowledge

expertise defined by formal education and credentials

provided in exchange for money

uni-directional accountability

clear boundaries and generally fixed roles

power rigidly defined a priori

externally regulated

Mutual Help

experiential knowledge

expertise defined by lived experience

no money involved

bi-directional accountability

flexible boundaries and complementary roles

power situationally defined

un-regulated

What is iNAPS?

Our mission is to grow the [peer support workforce] profession by promoting the inclusion of peer supporters throughout mental and behavioral health systems worldwide.

Mission

Background

• Compensation / Satisfaction Survey in 2007• National Practice Guidelines in 2013

• 1000 (200 focus group / 800 survey) responses• 98% agreement on 12 core values

• Comparison Survey (similar to 2007) in 2014 • Compensation• Satisfaction

• New questions about education and training

Methods

• Online survey (SurveyMonkey) • Purpose to better serve the iNAPS membership

(organizational development tool)• Data collected between July and December 2014• Distributed link and request to participate in:

• iNAPS newsletter • Mental Health Consumers’ Self-Help Clearinghouse

• 608 responses from 44 states

Working with the datan=597 usable responses after cleaning

Data required very significant collapsing of categories and recoding

For example, training topic, job tasks, and other questions had dozens of responses needing to be categorized

Collapsing and re-coding was done in a very careful, iterative way and with consensus

Only presenting a portion of the findings

Demographics

Gender N Percent

Female 380 65

Age

18-24 years 13 2

25-34 years 69 12

35-44 years 111 19

45-54 years 185 31

More than 55 211 36

DemographicsRace/Ethnicity N Percent

White (Caucasian) 437 74

Education

Bachelor's degree or beyond 233 39

Some college/Associate Degree 272 46

High School, GED, or Trade/Tech 83 14

Some High School 3 0.5

Job Titles

Job title N PERCENT

Peer Specialist/Peer Support

Specialist 367 62

Recovery Support Specialist 142 24

Peer Advocate 82 14

Recovery Coach 71 12

Recovery Educator/Recovery

Trainer 54 9

Peer Coach 50 8

Peer Bridger 17 3

Other Job Titles2 40 7

Work Tasks

WORK TASKS N Percent

Direct Peer Support Tasks 481 94

Clinical or Administrative Tasks 456 89

Teaching/Skill Development Tasks 441 86

Ancillary Tasks 389 76

Advocacy Tasks 323 63

Housing, Educational, and Vocational Assistance 232 45

Other Supportive Tasks 74 15

Work Settings

Community and/or Peer-Run Program Settings 388 66.3

Less Restrictive Mental Health and Substance Abuse

Treatment Settings 226 38.6

Restrictive Mental Health and Substance Abuse Treatment

Settings 160 27.4

Less Restrictive Residential Settings and Programs 139 23.8

Pre-Crisis or Crisis Settings 127 21.7

Restrictive Residential Settings and Programs 82 14.0

Employment or Educational Settings 75 12.8

Criminal Justice Settings 85 14

Other Settings 81 13.8

Years on Job

N PercentLess than one year 90 18

1-2 years 118 23

2-5 years 167 33

5-7 years 61 12

More than 7 years 78 15

N Percent

Less than 20 hours a week 134 23

From 20-36 hours a week 94 16

More than 36 hours a week 362 61

Number of hours working per week

Job LocationN Percent

Large Urban/Urban 373 64

Suburban 135 23

Rural/Frontier 143 25

Tribal 5 1

Training TopicsTRAINING TOPIC N Percent

Peer Relationship 531 97

Direct Peer Support 525 96

Policy, Legislation, Advocacy, and Rights Protection 520 95

Recovery Concepts 512 93

Traditional Mental Health Services 505 92

Administrative, supervision, and workplace-related 490 89

Alternative Healing and Wellness 419 76

Pre-crisis and Crisis Support 362 66

Compensation of peer support specialists

.

Total (N=162)1Full-time workers

(N=96)1,2

Part-time workers

(N=61)1,2

Hourly wages (in ranges) Frequency Percentage Frequency Percentage Frequency Percentage

$5.00-$10.00 per hour 20 12.3 11 11.5 7 11.5

$10.00-$15.00 per hour 98 60.5 47 49.0 48 78.7

$15.00-$20.00 per hour 32 19.8 26 27.1 6 9.8

$20.00-$25.00 per hour 10 6.2 10 10.4 0 0.0

0 0.0

Hourly wages

(continuous variable) Mean SD Mean3 SD Mean3 SD

13.87 4.37 14.96 5.05 12.42 2.33

Job Satisfaction55% report being very satisfied with job

33% report being somewhat satisfied

Primary source of satisfaction: helping others

Second most reported: helping in their own recovery

Most dissatisfaction reported about wages

What predicts satisfaction of Peer Providers?

Responsibility that reflects level of training and lived experience

Feeling respected by supervisors and colleagues

Feeling respected by the peers who receive the service

Perception of having sufficient training to do the job

Working in community settings and/or peer run programs

More hours of training to qualify as peer support provider

Perception that their peer support skills are utilized

Other findingsDifferences in wages by geography and by gender, even when controlling for factors such as education

78% of individuals feel that their job responsibilities reflect their training and lived experience

78% report that their skills are well utilized

Only 38% report being supervised by a peer

Other findings64% report working full time—higher than we expected based on other information

22-30% report feeling stigmatized or discriminated against by other professionals or the individuals with whom them worked

About half had other credentials (e.g., nursing)

LimitationsNot a random sample—purposive sampling

Difficult to know how representative these data are of the entire workforce of peer providers/specialists

All questions developed for survey itself—no standardized questions

Significant re-coding was needed

SummaryPeer support present in many areas of mental health arena and beyond

Individuals employed in a wide range of settings and perform a wide variety of tasks

Peer support specialists receive training in many areas, but training time and supervision time is not high

Salaries for peer support specialists remain quite low, on average

Important drivers of satisfaction include being respected by colleagues and others

Practice Guidelines National Practice Guidelines for Peer Supporters – 2013 1000 Responses Nationwide

Focus groups (n=200) Surveys (n=800)

Mental health Addiction / Co-occurring Veterans

Result = 98% (near consensus) on 12 core values

Peer Support Values

Comparison of ValuesHow do the Peer Support Values compare to the Principles and Values of Psychiatric Rehabilitation?

A comparison between the Core Values of Peer Support and the Core Principles of Psychiatric Rehabilitation is illustrated in a diagram by Andy Bernstein, Ph.D., CPRP who serves on the board of the Psychiatric Rehabilitation Association (PRA) and also serves on the board of the International Association of Peer Supporters (iNAPS).

Andy is a mental health professional who has been a champion of the peer support movement for many years and sees much commonality between the rehabilitation model of recovery and the recovery experience many in the peer support movement have described.

DiscussionBased on the core values and the reported levels of education, compensation, and satisfaction…

(1) Were there any real surprises or ‘aha’s?

(2) What do you see as the priorities for this emerging and rapidly growing workforce?

(3) Who are the allies that can be most helpful?