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Adding Peers to the Workforce

November 01, 2007

The 2003 report of the President's New Freedom Commission on Mental Health gave us a wonderful vision of recovery, and urged the strategic and systematic inclusion of peers and family members in the behavioral healthcare workforce. Since then training programs have cropped up across the country to prepare peers and family members, such as "parent partners" (see our June 2007 column), to work alongside professional staff members, adding their hard-won expertise to promoting recovery for those who use our services.

If your organization is about to take this step, we want to assure you that you can do a lot to maximize the effectiveness of peer/family training programs and guarantee positive outcomes. It just takes a little thought and planning before you jump into hiring trainers.

We've looked back over our collective successes, as well as our "unsuccesses," to give you the benefit of what we've learned about training peers and parent partners to join the behavioral healthcare workforce. This way you can avoid some of the potholes we've fallen into and can arrive at a successful outcome without breaking a sweat. Well, maybe you'll have to sweat a little, but less than you would if you hadn't read this column.

Choose a Solid Curriculum

One of the first decisions that you'll probably make is whether to use an existing training curriculum or develop your own. Several good training programs are on the market; they have been tested over and over and proven to be effective. We recommend that you review what's available and choose the training program that best fits your needs. This way you can save the energy you would have invested in curriculum development for your implementation phase.

When looking for a curriculum that best matches your needs, find one with a strong recovery focus that trains students in their unique role as peers, not as junior case managers or junior clinicians. The training material should help them understand and articulate their own experience of recovery and prepare them to share it in ways that help others recover. Avoid less creative, highly clinical curriculum packages. They reflect the mistake that peers need to know how to do the things professionals do, but not to do them. This can confuse peers and parent partners trying to understand their new roles.

If you're looking at a curriculum heavily laded with information on diagnostic criteria, medications and their side effects, symptoms, and so on, keep exploring your options. Peers and parent partners may need to know the basics of some of these factors, but most of their training should focus on the discipline of skillfully being in a mutual partnership.

Most of the tried-and-true curriculum packages take about 70 to 80 hours to complete. This provides enough time to cover the basics of recovery and peer support, as well as enough time to train students in the key areas of skill development. There is often flexibility in how the training can be scheduled so it is most absorbable. Also, since recovery has a strong focus on strengths and accomplishments, be sure the training includes a bang-up graduation party and suggests inviting everyone remotely connected to the training. This is a great way to acknowledge the students' successes.

Note: If you work for a civil service organization, with a lot of red tape and departments that need to get involved in writing job descriptions and so forth, you may want to consider a pilot peer employee program. Start by contracting with a training program that has a strong track record. This might allow you to skip bureaucratic barriers and get a peer employee training program off the ground. Once you have established your program, you can use it as evidence that this approach works, and then begin to replicate it in other locations if that is part of your long-term plan.

Consider Your Post-Training Plans

When behavioral healthcare organizations realize how effective peers and parent partners can be, and how they can complement the existing workforce, they usually rush into implementing training programs without thinking through some of the logistics. It's great to start with a lot of enthusiasm but, before you get too far down the road, give some thought to how peers and parent partners will work in your organization after they complete their training. Consider the following before you schedule the training:

  • Where will peers and parent partners be employed? For example, will they be used in your outpatient settings, crisis centers, and residential settings? How about at your administrative offices?

  • If peers and parent partners will have benefits, how will you address the issues that arise around this? For example, peer employees often need to start part time to preserve disability benefits.

  • Who will write peers' and parent partners' job descriptions?

  • How will the positions be funded?

  • How will peers advance in their new careers?

  • What training will you provide existing staff members about peers' and parent partners' roles?

  • Who will supervise peers and parent partners? What kind of training will you provide managers so they can supervise skillfully?

Planning ahead will enable you to hire peers and parent partners right after they graduate from training programs. This allows you to maintain momentum and not lose students due to long waits for jobs. Below we go into detail in a few of these areas.

Job descriptions. Job duties clearly spell out what this new workforce will be doing on a day-to-day basis. Defining job duties will save you a lot of confusion and conflict when employment begins (more on this in a minute). It also will help other staff members know what to expect from these employees.

Career advancement. Do you have a career ladder for peers and parent partners? We aren't suggesting that peers eventually become social workers or clinicians (unless they want to undergo the formal education involved). Yet within their own discipline there should be a way to grow their skills and advance. Ongoing training could allow peer employees to grow their skills and knowledge. This would not involve training in general mental health treatments but rather in peer work and recovery.

Training other staff members. Another key to successfully adding peers and parent partners to your workforce is to train the staff members they will be working with on how to integrate peers and parent partners into existing work teams in ways that respect and maximize peers' and parent partners' contributions. If existing staff members aren't trained in how to work with peers and parent partners, they tend to see them as case aides or errand runners, positions that do not draw on peers' and parent partners' valuable skills and gifts. Ideally, the trainers of peers and parent partners also will be able to train the rest of your staff in how to work with these new faces.

It's not unusual for existing staff members to resist adding peers and parent partners to the workforce. If existing staff members haven't been taught the role of these new employees, they often will jump to the conclusion that peers and parent partners eventually will take their jobs. This will set up an uncomfortable and tense dynamic hard to overcome if not addressed early.

Existing staff members also may be concerned that peers and parent partners are fragile and not equipped to deal with others' emotional needs, or that they will need extra support and can't function as full-fledged staff members. You can save yourself a heap of trouble by providing existing staff members a strong recovery-based training program on what peers and parent partners have to offer.

Resistance to new ideas often comes in many interesting and creative forms. Respond to existing staff members' resistance with kindness and confidence, and gently move through it. Don't let it throw your plans for peers and parent partners off track. Plan on resistance and make accommodations to handle it, but don't be derailed by it. Use resistance as an opportunity to define and clarify issues, and support all staff members in moving through the changes that will begin the transformation process.

Good supervision. Just as existing staff members need good supervision, peers and parent partners need it too. Good is the operative word here. We aren't suggesting that you micromanage peers and parent partners, and we aren't suggesting you ignore them either. Good recovery-based supervision involves putting peers' and parent partners' talents to work and helping them develop in areas that need to be strengthened.

We often ask organizational managers about the way they are supervising peers, and many tell us that they aren't sure. Many organizations haven't conducted performance evaluations of peer employees. Yet peers and parent partners, just like all other staff members, need regular and clear feedback on their performance, as well as help in moving through challenges.

Further Information

We hope you have found this information helpful, and we have more if you need it. We have compiled checklists of the minute details that contribute to a successful outcome for developing this special workforce, and we have created a list of the types of resistance often encountered and what works best to address each one. If you would like a copy of these free lists, please e-mail us at lori@recoveryopportunity.com.

Lori Ashcraft, PhD, directs the Recovery Opportunity Center at Recovery Innovations, Inc., in Phoenix. She is a member of Behavioral Healthcare's Editorial Board.
William A. Anthony, PhD, is Director of the Center for Psychiatric Rehabilitation at Boston University.
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