Integrating Peers into Clinical Teams

Background   Peers’ unique skills, roles and perspectives on treatment teams challenge recruitment, retention and performance, with implications for successful dissemination of peer support.  Peers offer credible, embodied evidence of recovery for individuals in crises and their networks: their biographically-rooted ways of connecting are unavailable to people without lived experience.

 Methods Parachute hired 64 FTE peers, one of the largest efforts nationally to integrate peers into the delivery of Mental Health services. Using extensive,  ethnographically based field observation and key informant interviews over 3 years in Parachute’s implementation evaluation, we documented peer involvement in trainings, staff meetings, clinical supervisions or co-supervisions, observations of integrated teams at work, key informant interviews, and focus groups with teams and with peer staff only. 

 Results Issues that challenged peers’ working on clinical teams and providing respite services in Parachute included: attitudes toward peer co-workers; hiring challenges/benefits counseling; poorly defined jobs/role conflict including definition and perceived value of peer work, focus on lived experience of illness than recovery; few support opportunities in supervision and commodifying lived experience.

 Implications Besides informed supervision, peers need peer-specific supervision and practice communities to share their particular concerns. Organizations must develop peer-informed personnel policies; broader diffusion of recovery language is needed in mental health services and clinical training; co workers should consider more flexibility in sharing practice challenges. As Medicaid increasingly funds Peer services and certification standards emerge it is critical to develop, test and disseminate strategies that address structural and personal challenges in peer integration to exploit its potential in transforming MH services.