Across the U.S., Coordinated Specialty Care (CSC) for a recent onset of psychosis providers are increasingly integrating Peer Support (SAMHSA, 2019). This trend is promising for improving care experiences and outcomes among those with a recent onset of psychosis– and providing meaningful employment opportunities for those in recovery from an onset of psychosis. Peers importantly bring a non-clinical, alternative perspective that disrupts team language, practice, and systems rooted in the more traditional medical model (Deegan, 2017). However, recent research summarized empirically established peer workforce issues in community mental health (e.g., Jones et al., 2020; Mancini, 2018). These include on-the-job stigma and discrimination, low pay and no benefits, isolation, unclear work roles, burnout, limited professional development opportunities, and high turnover. With the proliferation of Peer Support integration into CSC, providers are becoming acquainted with these challenges in building and sustaining a peer workforce. Our presentation compares: (1) the vision for peer support integration into CSC with the (2) current reality facing peers on CSC teams. We propose innovative solutions from CSC Models OnTrackNY and EASA as well as emerging approaches from across the country that target organizational and systemic reforms to improve peer workforce experiences and outcomes.
The Vision: Peer Specialists will work successfully within multidisciplinary teams, support service engagement, influence team culture to be more responsive to young person lived experiences, strategically share their story, document services, maintain wellness and professionalism, role model and coach, provide community support, host groups and social activities and build strong working alliances with CSC participants.
The Reality: The dominant narrative within CSC, and where CSC is implemented, is clinical and does not embrace (and arguably rejects) core Peer Support principles, including mutuality and "nothing about us without us." Most CSC teams operate within adult community mental health or university-based clinics, not peer-run or youth-centric organizations. Other disciplines on CSC teams (e.g., psychiatrists, social workers) are taught to limit self-disclosure and use evidence-based methods that inherently reject alternative illness and healing narratives. Compared to other CSC team members, peers tend to be lower paid, younger, and individuals of color. In a recent study with 25 CSC teams with peers, 84% had only one peer and most were part-time (SAMHSA, 2019). Thus, peers, who are the lowest paid and who have the least power (and presence) on CSC teams, must educate colleagues on the value of their role, challenge the dominant clinical narrative, and speak up "appropriately" when colleagues make discriminatory, racist, sexist, classist, and/or ablest remarks. Peers are subject to tokenism, microaggressions, being ignored, and feeling pressured to advocate or answer uncomfortable questions – and later regretting their responses. Particularly during COVID-19, peers have been leveraged as self-care and virtual technologist experts – educating their colleagues on how to maintain health and wellness when stressed and facing adversity as well as how to best use smartphones and computers to engage CSC participants creatively through video chat platforms.
The Solution: Peers need equitable roles on CSC teams in regards to pay, benefits, responsibilities, support and professional growth opportunities. Peers cannot be solely responsible to be the culture carriers and engagement specialists on CSC teams. CSC Models must value and centralize peer support principles and practices to the extent that they do other treatment modalities. CSC teams must support peers in connecting to national and local peer networks, and professional development opportunities. Team-, program-, and system-level strategies aiming to build and retain peers in CSC must be evaluated.