Peer recovery support services (PRSS) are non-clinical services that support individuals with mental health conditions or substance use issues. They are often developed, designed and delivered by persons with lived experience in recovery. Although it can be traced back to the 1700s, new audiences have become aware of peer support over the last decade as peer workforce roles, such as peer specialist, have formalized and PRSS have expanded across a range of settings. The peer specialist role rose from peer-run organizations, such as recovery community organizations (RCOs), however the versatility of the role allows the peer specialist to meet individuals and families “where they are” within a recovery-oriented system of care. For example, peer specialists help build resilience and protective factors, promote access to clinical services, and facilitate person-driven recovery plans. peer specialists conduct outreach into homes, schools and libraries, the criminal justice system, and homeless service centers.
While PRSS complement clinical services, they should not be viewed as a replacement for clinical services. Today, the majority of states have a formal process for training and certifying peer specialists and see them as vital members of the behavioral health workforce. In some states, peer support is billable under Medicaid, and both federal and state grants support training peer workers and delivering PRSS. Texas, for example, passed House Bill 1486 in 2017, and during 2019 rolled out peer specialist training curricula and certification processes that allow eligible individuals to further specialize as substance use disorder or mental health peer specialists.
This new source of funding and certification process is timely. Texas has one of the greatest shortages of behavioral health providers in the nation, with over 80% of Texas counties designated by the U.S. Health Resources and Services Administration (HRSA) as Mental Health Professional Shortage Areas.1 This shortage is expected to worsen; many existing behavioral health professionals are nearing retirement age, and recruitment of new clinicians is low.2,3 Peer workers can address this shortage. Peer-delivered recovery support services cost-efficiently improve recovery outcomes and engagement satisfaction across a variety of settings.4
From a workforce perspective, there are several challenges that impede the wider use of PRSS, and little research has been done to understand the gaps and attrition rates across the peer specialist career path. This leaves strategic plans – such as SAMHSA’s FY2019-2023 Strategic Plan, which calls for the greater adoption of peer recovery support services to address several of its priority areas – somewhat short-sighted for several reasons:
- Rural and other underserved communities lack peer specialist training opportunities. While decentralized approaches, such as train-the-trainer, create local instructors, they raise barriers to coordinated data collection, evaluation and quality assurance.
- A lack of field experience opportunities limits available internship placements where newly trained peer workers can build skills and document hours required by certification.
- Interns and peer specialists lack access to performance support from a certified peer specialist supervisor.
- Certified peer specialists lack employment and career path opportunities that pay competitive wages.
RecoveryPeople and researchers from the University of Texas Health Science Center at Houston (UTHealth) School of Public Health received funding from HRSA to better understand the aforementioned gaps and career path planning and support for peer specialists. Together, RecoveryPeople and UTHealth are piloting a peer-to-peer specialist solution that centralizes recruitment, knowledge assessments, and evaluation support towards certification and job placement while establishing a network of local partners to provide peer specialist training, field experience, and employment opportunities.
RecoveryPeople’s approach cultivates local workforce development while offering a comprehensive view across peer-to-career milestones, settings and regions. In this partnership, UTHealth will analyze quantitative data collected through the centralized system and qualitative data collected from an advisory committee composed of participants and partners. The findings will be used to inform rapid-cycle quality improvement at the partner and system level as well as shape comprehensive workforce development strategic plans. The joint project will train 210 peer workers over three years, focusing on high-need regions along the Texas-Mexico border, Hurricane Harvey-affected areas, and rural parts of the state.
Since the passing of House Bill 1486 in Texas, peer workers trained under this initiative are among the first to receive the new curriculum and will soon be delivering PRSS reimbursable by Medicaid. As RecoveryPeople and UTHealth work to close the gap in the behavioral healthcare workforce in Texas, addiction professionals are encouraged to learn more about integrating peer workers into their own workplaces, and to provide opportunities for peer worker trainees to gain on-the-ground experience and future employment in order to further develop this valuable workforce.
Sierra Castedo de Martell, Sheryl A. McCurdy and J. Michael Wilkerson represent the University of Texas Health Science Center at Houston. Jason Howell and Pace Lawson represent RecoveryPeople in Elgin, Texas.
1. Vestal C. How severe is the shortage of substance abuse specialists? Pew Trusts. Published 2015. Accessed October 12, 2019. http://bit.ly/19GbMZ1
2. Hogg Foundation for Mental Health. Crisis Point: Mental Health Workforce Shortage in Texas.; 2011.
3. Department of State Health Services. The Mental Health Workforce Shortage in Texas. Department of State Health Services; 2014. https://www.dshs.texas.gov/legislative/2014/Attachment1-HB1023-MH-Workforce-Report-HHSC.pdf
4. Eddie D, Hoffman L, Vilsaint C, et al. Lived Experience in New Models of Care for Substance Use Disorder: A Systematic Review of Peer Recovery Support Services and Recovery Coaching. Front Psychol. 2019;10. doi:10.3389/fpsyg.2019.01052