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Lessons learned in peer workforce development

February 2, 2012
by Lori Ashcraft, PhD, and William A. Anthony, PhD
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While peer employees can make a powerful contribution, adding them can pose unique challenges.

“When we first began adding peers to our workforce 12 years ago, other behavioral health agencies thought we had lost our minds. Today, if an organization doesn’t have any peer employees, they are seen as being behind the times.” This is a quote from Lisa St. George, who is an executive and a peer at Recovery Innovations (Phoenix) and has supervised large peer programs for the past 12 years.

We agree with Lisa—adding peers to the workforce these days is a common practice and is often a requirement in state and federal grant applications. Yes, peers have proven their worth and have been adding depth and breadth to the services offered by behavioral health programs. They have helped for many years in substance use treatment programs, and have more recently come to assist in serving those with mental health challenges.

Let’s take a closer look at what’s actually happening when peers begin working in our programs. For the most part, peers have proven their worth to even the most cynical bystanders. But it hasn’t all been a glorious experience—not for them, for other staff, or for the larger organization.

In this column we want to take an honest look at what’s working and why, so we can replicate our successes and have even better outcomes. We also want to examine the mistakes that have been made so we can correct our course and avoid future disappointments for all involved.

What peers can bring to service delivery

Let’s first look at how the abilities and qualities of peers can enrich service delivery when things are working well. Often, the service improvements that they bring occur by virtue of their lived experience with mental illness and with navigating service systems. Generally, well-trained peers offer:

  • Dedication and commitment to work.
  • Ability to create an immediate connection with the people they serve.
  • Ability to use their stories and lived experiences to inspire hope.
  • Ability to build bridges that engage other providers on the treatment team.
  • Ability to guide people in accessing community resources and services.
  • Ability to model healthy relationships that others can replicate in the community by being trustworthy and supportive in an intentional relationship.
  • Ability to demonstrate to family members and other supporters that people like their loved one can recover.

Systems that have the courage to add peer support workers demonstrate a commitment to working with peers that helps the system to transform old ways of thinking and being. For example, the presence of peers:

  • brings a different perspective to other treatment team members during team meetings;
  • supports the use of recovery language by reminding organizations to minimize the use of labels and diagnoses that are impersonal or demeaning to those seeking help; and
  • provides living proof that people recover on treatment teams.

Where peer employment may go wrong

The success stories shared by many organizations who have added peers to their workforces have caused others to rush out and hire peers, only to see later that they did not contribute as expected.

There are a lot of things that can “go wrong;” the good news is that most problems can be avoided through proper training and follow up. Here are some “must haves” for peer training:

  • Peers must understand the importance of their work or they might fail to take it seriously, leading them to be unreliable about completing work and maintaining work hours.
  • Peers must be able to complete required documentation or paperwork—or get help as needed. Otherwise, they’ll create problems for the treatment team.
  • They must know and exercise responsibility for using wellness tools to maintain their own recovery and stability. Sometimes peers who feel great when they go to work stop doing the very things that help keep them well.
  • They must be enabled and empowered to work from their strengths so that they can “let go” of the status of “mental patient,” shift into a “helping role” for others, manage personal feelings and challenges that arise at work, and maintain good attendance.
  • They must be able to use their own story in a healing, inspiring way that supports and guides the people they serve and contributes to the treatment team.
  • They must know why and how to maintain a “recovery environment” by reacting positively and avoiding gossip and negativity.
  • They must be challenged to grow into their potential, rather than feeling they are entitled to special treatment. This compromises their effectiveness.

Tips for keeping peer employees on track

Now, because many of these problems can occur with all employees, let’s not be too quick to judge peer employees or to see them as being more problematic than other staff members. In fact, let’s not blame anyone: Let’s just figure out how to get it right to begin with!

If an organization takes the following steps when they add peers to their workforce, their outcomes will be much better and the results of the peer contribution will be stronger and more effective:




I am interested in finding out if other behavioral health agencies have revised their Dual Relationship policies in light of the employment of peers in the workforce. We have found that our current Dual Relationship policy does not adequately address the evolving relationships with peers who step into the role of co-worker with other clinical staff. I would love to hear from others about their experiences in this area and would really appreciate it if anyone would be willing to share their policy.

Ginger Bandeen, Quality Improvement Manager
Columbia Community Mental Health

Do a search for:

Developing a Mental Health Peer Specialist Workforce in Massachusetts.

They seem to have the only strong focus dual relationship issues.

We have found that globally peer support is recognized as an evidence-based practice which gets the attention of legislative bodies.

Clifford Thurston
Founder, Worldbridgers
Western State Hospital
Washington State

Hmmm it sounds convincing what you say,,,,,BUT

"There's hardly anything worse for company morale than leaders who practice the "Do as I say, not as I do" philosophy. When this happens, you can almost see the loss of enthusiasm and goodwill among the staff. It's like watching the air go out of a balloon – and cynicism and disappointment usually take its place.

No matter what the situation is, double standards – witnessing people say one thing, and then doing another – always feel like betrayals. They can be very destructive. If this ever happened to you, you can probably remember that sense of disappointment and letdown.

If you're in a leadership position, then you know that you have a responsibility to your team. They look to you for guidance and strength; that's part of what being a leader is. And a big part of your responsibility is to lead them with your own actions.