C4 Innovations

Peer Support Workforce: Status and Future

An episode of “Changing the Conversation” podcast

Cheryl Gagne and host Steven Samra share why peer support is important and what peer workers need to provide the best services.

October 17, 2022


Steven Samra, Host (00:05): Hi everyone. Welcome to Changing the Conversation. I’m your host today, Steven Samra. I’m a senior associate with C4 Innovations, and today’s topic is going to focus on the status of the peer workforce and where we go from here. My guest today is Dr. Cheryl Gagne, a senior associate with C4 Innovations. Welcome, Cheryl.

Cheryl Gagne, Guest (00:25): Thank you, Steven. I’m happy to be here.

Steven (00:28): It’s great to have you. I just have to say, I remember back when you and I first started working together, some of the most incredible work that you did when you first joined C4, and you developed the core competencies for peer workers for SAMHSA. Do you remember the amount of work you put into that effort?

Cheryl (00:48): I’ll never forget it. It was an enormous effort, not just on my part. And indeed there were dozens of people who helped with that product. But I had come to C4 after 20 years at Boston University (BU) Center for Psychiatric Rehabilitation. And way back in the early 1990s, we were talking about peer support. Many organizations used the term “consumer providers” back then in mental health. So it was in early days. And then many of our colleagues at BU, people like Sherry Mead and Judy Chamberlain and others wrote really important articles about the principles, the philosophy, the basics of peer support, what it was, what it wasn’t, and how it could really make changes in the mental health and substance use disorder treatment systems.

Steven (01:55): Well, Cheryl, I can remember there was a Pillars of Peer Support conference back in 2012, and during that conference there were national experts there that pretty much anybody would recognize, and they were there on workforce development issues. And that group essentially concluded that to ensure that peer support didn’t become a dead-end path, we had to find a way forward to professionalize the service, but at the same time maintain the spirit of peer support as being non-professional. Can you give us a sense of any progress that you’ve seen since 2012, and have we begun to develop a real pathway for peers to advance? And then finally, where do you see the landscape right now today?

Cheryl (02:49): Well, thank you Steven. Really, to take a step back, it’s hard to report on kind of where things are going kind on a system level, but I think most people who enter the peer support workforce do so for one of two reasons, and sometimes both of them, in many ways, and this is very true of recovery from trauma, mental illness, substance use disorder, reaching out to someone else who is experiencing some of the same distress and difficulty is very healing for us. There is something about being human that helping somebody with something that we’ve grappled with that we may be even continuing to grapple with. The depth of that connection is very healing. And I think a lot of people get in to continue their healing, which is wonderful, wonderful other people get in and maybe some of the same people to make things right, change the system.

(04:00): I don’t want people to go through the same hardship that I went through when I was coming out of prison or when I went into treatment for addiction or when I encountered DCF [department of] children and family services. I don’t want people to have to do what I went through. So I think there is this yearning for personal healing as well as sort of changing the system. And that often motivates people who enter as peer support specialists, parent peer support workers, reentry specialists, whatever label we want to give. And I think those motivations are really important. That is how healing happens, is through that kind of connection. That is how change happens is through highly motivated people to speak their truth and motivate change. I think keeping people in the field is really different from that. It’s so different from that. And so when we think about what needs to happen to really keep people engaged in that healing and change is first of all, a living wage.

(05:25): Something that is a living wage to recognize the expertise even the very difficult work that you do in this job, to really pay honor to that. These are difficult jobs and peer support specialists, all of the… but I’m also speaking about home health aides and community health workers and paraprofessionals. Everybody who’s doing kind of that entry level, those jobs require such skills and commitment and compassion and that people are being paid lower than they would earn at a retail store is really a shame. It really is. These skill sets are really impressive. So I think that’s kind of a foundational thing. That’s something we haven’t seen any movement on, Steven, in terms of there are some like, oh, we’ll hear exciting things about what’s happening in Denver, Colorado, and Milwaukee, Wisconsin. But then, you know what I mean? There’s nothing systemic that really gives a higher wage.

Steven (06:48): Cheryl, that’s exactly why I began to do this work. It was both a facilitator for advancing my recovery. I felt that I owed that giving back to my brothers and sisters that were still struggling. And honestly, it became a spiritual quest for me as well. I can remember sitting in the penitentiary writing some really dark poetry, talking to grandfather about the fact that I had a felony and I don’t — What do I do now? And the message to me was just keep writing. Just keep writing.

(07:30): And I moved through, entered recovery ,and moved through the recovery process. And as I was doing that, all of the employment that I had at that time was pretty low level, low paying. It took a ton of skill. It took a lot of lived-experience brain power to make the connections and make things happen. And ultimately there was no place left for me to go in terms of career growth. And as I became, I think more solid and grounded in my recovery and understood what that meant, that became much more valuable to people who wanted to know more about how to do recovery. And I think watching the maturation of peer support since, really since 2005 when I became familiar with it, we’ve come a long way in many things, but in the few things that really matter like those livable wages we’re really stuck and stagnating.

Cheryl (08:44): Yeah, exactly, Steven. And again, we’re not alone. It kind of cuts across a larger workforce that really expands beyond the peer workforce. And I’m hoping over time there may be some connections or that can be made and advocacy for higher wages. But the other piece that I haven’t seen a lot of change, though some, again, is in having people with lived experience in leadership positions in many of these behavioral health organizations, we still see that most people in leadership positions have credentials like LICSW, licensed social worker or even you know, CEO or MBA.

(09:39): And so seeing ourselves in leadership positions, and that’s really important. I think if we can remember any kind of civil rights movement, it became very important to see ourselves in leadership. And that was true for people of color. It was true for women. It wasn’t just enough to hire women, but really employ women in leadership positions, employ people of color in leadership, employ people with disabilities, employ people with lived experience of mental illness, substance use disorder in leadership positions. So that’s something I think when we see that change, we’ll see some rippling effect in terms of how services are delivered and financed.

Steven (10:29): Cheryl, what you’re saying about being in position of leadership, I think about that often in the role that I find myself in the work I do every day. And I can remember having conversations with you with other, frankly leaders of recovery about how challenging and honestly how lonely it can be at this level because we aren’t connected, we don’t have, there isn’t a network or a guild to join and be part of. And while it’s fantastic that we are able to have some leadership in the work that we do, providing technical assistance and training and the things that we do, it’s not the same as having somebody in a leadership role at a behavioral health organization. It just isn’t. And we’re modeling it. We’re proving that we can lead, and we can do it well. But that message, as you said earlier, it’s only hit pockets, right? It’s only entered pockets. And I think we do have a long way to go.

Cheryl (11:40): And again, there are some really shining examples of people’s lived experience stepping into leadership positions, but it is not very far reaching. And when we think about career ladders, certainly I know — although, Steven, you and I both have lived experience of many things. We also have a lot of education under our belts. We pursued, I always pursued education as a way to get rid of psychiatric labels. I thought once I get a doctorate, it would kind of erase a psychiatric label or something, I don’t know. But there was something all kind of confabulated, you know, confounded in all of that. But not everybody has had the opportunities that we’ve had in terms of education and thinking about ways people can gain competencies without having to return to school.

Steven (12:45): Yeah. For me, it was that master’s degree will overcome that felony conviction. It did. But at the same time, that was the rationale I used, and it drove me to go to school. And I, grateful that I was able to accomplish it and that it actually did that. But I think today too, my felony was a cannabis felony. So it doesn’t hold a lot of weight with a lot of folks anymore, which I think is a really good thing. But let me jump into question two here, Cheryl, because it feels like we are stagnated. And can you share what you know about some of the barriers and challenges that face this fledgling workforce that we have to find their place alongside the other pros in behavioral health, folks who have similar career paths? We would like those. We would like opportunities for advancement. And we certainly would like parity with the pay of some of the professionals that we’re working alongside. So thoughts on any of this?

Cheryl (13:59): I have a lot of thoughts about this, and they change as the winds flow in terms of the behavioral health workforce. And one thing I’m seeing now, and particularly since the COVID pandemic and quarantines is really just a weakening of the behavioral health workforce across the board. There are so many people have left the field. There are so many openings, programs, beds have been closed down because they can’t get workers. And that’s true not just for peer support specialists, but across the board. And so that is an issue. I think each program is grappling with survival issues and the idea of making dramatic changes in policies, procedures, the way we do business may be too daunting right now. I have seen a lot of organizations hiring peer workers, pretty large numbers of them. I feel concerned when I think about peer workers just responding to the kind of overall behavioral healthcare workforce shortage.

(15:23): I think there are some real potential issues for exploitation and really having peer support workers fill the gap. But we’ll see. I think it’s right now, there are opportunities for people who want to do peer support and want a specialization, maybe are really excited about health and wellness. There are some states that are offering health and wellness ambassadors certification that really focuses on kind of community health. Others are really working with people around reentry, following incarceration. So if that is your passion. So there are a lot of opportunities in terms, back in the day in the 90s, peer support worker could work in a day treatment program or it wasn’t all that exciting. But these are really great opportunities for people who might want to have that opportunity to give back, have that opportunity to make some changes.

Steven (16:37): That’s fantastic, Cheryl, because it reminds me just of how much the work that we do sort of at that entry level, not only often strengthens recovery, and in many ways it made me examine pieces of my own recovery, and that made it a lot stronger. But as a person’s skill grows, I think we get pulled away. If you are competent and capable of doing peer supervision, some heavy administrative work, and these are things that sometimes those of us who’ve had spotty employment histories or we haven’t done a lot of that type of work and had exposure to that work culture, it becomes a real challenge. So I think that there’s definitely potential, but I think we need data that is then reviewed and has been verified that really pushes the idea of the value of peer support. And I just don’t think we’ve gotten that yet.

Cheryl (17:43): I think the data are there. It is not as well organized and as compelling, but what we do know is that peer support really makes a difference for those folks who are most marginalized, for those folks who are most disadvantaged, right? So people experiencing homelessness, people experiencing prejudiced discrimination on a routine basis, and people with mental illness, serious mental illness, serious substance use disorders, we know that peer support helps those folks the most. And they’re the folks who need the most help. I mean, I think it’s really kind of a lovely thing. The way that the data come together on that, there is a lot more to know. And truthfully, yes, we have more questions and answers, but there are pockets of real promise, engaging peer support specialists as navigators and support after somebody comes out of a crisis, right? Whether it’s a psych hospitalization or an opioid overdose like that has been proven to work really well, to reduce re-hospitalization, to reduce overdose, to reduce suicide. So that might make sense for a system to put something like that in place.

Steven (19:07): You’d certainly hope. You’d certainly hope.

Cheryl (19:11): And there are dozens of other examples, and I think as states are now kind of rolling out their crisis response, the peer workforce is really a vital element of that and can respond in really helpful ways. So my hope is that states will really rely on the workforce to deliver high quality services that every citizen deserves. So thank you, Steven for having me.

Steven (19:41): Cheryl Gagne, thank you so much for just joining me today. And thank you for everything that you’ve done for the field, for our brothers and sisters who are still struggling, for me as a mentor and a coach. Can’t tell you how valuable it’s been, and it’s just such a pleasure to work alongside of you. And to our listeners, join us next time on Changing the Conversation.

Erika Simon, Producer (20:06): Visit c4innovates.com and follow us on Twitter, Facebook, LinkedIn, and YouTube for more resources to grow your impact. Thank you for joining us. This episode was produced by Erika Simon and Christina Murphy. Our theme song was written and performed by Peter Hanlon. Join us next time on Changing the Conversation.


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