The Certified Recovery Peer Advocate (CRPA) and Community Health Worker (CHW) are two emerging workforce roles in health care. A CRPA is a person who uses lived experience with substance use disorder (SUD) and who have been certified to provide peer support services including non-clinical coaching, support, information, guidance and motivation to those seeking or sustaining recovery from a substance use disorder. A Community Health Worker is a front-line public health worker who helps individuals and families to connect to healthcare and social service resources that will further support their wellness.
Across New York State and other parts of the country that are experiencing an opioid and other substance misuse epidemic, there is an increasing need for peer support professionals. This is especially true for CRPAs who can provide billable services in licensed substance use disorder treatment programs, particularly outpatient clinics licensed under the Office of Alcoholism and Substance Abuse Services (OASAS). Similarly, there is a growing need for community health workers who can work in clinical and community-based settings to assist individuals to better navigate the healthcare system and access appropriate health and social services. Such high demand of these two emerging workforce roles requires innovative models to develop and expand the workforce effectively. The Delivery System Reform Incentive Payment Program (DSRIP) is a federal program under the MRT 1115 Waiver that aims to fundamentally restructure the health care delivery system by reinvesting in the Medicaid program and reducing avoidable hospital use by 25% over 5 years. The Staten Island Performing Provider System (SI PPS) has utilized an enhanced model for CRPA and CHW workforce development and expansion. This innovative model focuses on these four phases:
Phase 1: Workforce & Training Needs Assessment: In 2015 to early 2016, there were two Certified Recovery Peer Advocates on Staten Island, one of five boroughs in New York City. At that time, Staten Island was in the midst of an opioid epidemic with the highest per capita mortality rate in NYC. Alcohol and other substance use disorders also remain concerning in this community. In order to tackle the crisis, new DSRIP funded initiatives were developed which required the integration of peer support professionals in the emergency department, criminal justice system as well as in outpatient clinics, residential programs, and other clinical and community-based settings.
Addressing social determinants of health and clinical needs have become an increasingly important focus within key DSRIP-funded initiatives to support Medicaid recipient. This is especially true for people with behavioral health needs who overutilize preventable hospital inpatient and/or emergency services or have difficulty accessing healthcare services due to cultural, language, and/or socioeconomic barriers. CHWs are trained to extend the reach of providers into underserved communities, reducing health disparities, enhancing communication, and improving health outcomes.
Initiating and sustaining these initiatives required more certified recovery peer advocates and community health workers on Staten Island. The first challenge to address the lack of CHWs and CRPA was to determine what curriculum/skills were needed by partners and create a common curriculum which partners would accept. A common curriculum would break the old single employer, silo approach to employee learning and development. The SI PPS in partnership with the College of Staten Island (CSI), Staten Island Partnership for Community Wellness (SIPCW), and other community partners joined forces to develop robust CRPA and CHW training and workforce programs using the four-phase model. The model begins with conducting a current state analysis and needs assessment of the Peer Advocate and CHW workforce. During this phase, SI PPS community partners share information on their projected demand for CRPA and CHW staff. SI PPS with the CSI use this information to develop target goals for each training program including class size, funding, and job placement resources.
Phase 2: Curriculum Development: The second phase involves creating a new curriculum or leveraging an existing curriculum, reviewing and gathering feedback from community partners/employers during structured discussions to develop the training curriculum. Based on real workplace needs and CRPA/CHW roles and responsibilities, community partners/employers share input on their expectations of what the training should entail.
Certified Recovery Peer Advocate (CRPA) Training Program: SI PPS and CSI adapted the NYACH and Queensborough Community College curriculum and incorporated additional elements from community partners to establish the CRPA training program. The CRPA training curriculum includes Advocacy, Mentoring/Education, and Recovery/Wellness Support and Ethical Responsibility as well as other professional and soft skills development. The program’s key objectives for students are to: Learn the standard skills and knowledge needed to succeed in the CRPA role; Receive personalized support from the program’s dedicated student advisor; Prepare to sit for the peer recovery certification exam; Work with the program’s developer to create a resume and prepare for interviews; and Connect with employers on Staten Island.
Community Health Worker (CHW) Certificate Training Program: SI PPS and CSI developed a new Community Health Worker certificate training program which has four tracks. One specific track has a behavioral health focus to train future CHWs who will work in behavioral health settings and other settings with people living with mental health and/or substance use disorders. The CHW Certificate Training Program provides learners with the skills and knowledge to enter the workplace as a CHW, Advocate, Navigator, Outreach or Resource Coordinator, whether in community-based organizations or clinical provider organizations. The CHW training program’s goals are to: Learn about the chronic physical and behavioral health disorders impacting community members; Help clients make positive changes using Motivational Interviewing skills; Build awareness of the importance of culture in healthcare; and Provide college credit through the study of Anthropology , an effective tool for CHW’s to understand the communities they serve.
Phase 3: Post-Training Job Placement Assistance: The third phase focuses on job placement assistance for students who graduate from the CRPA/CHW training programs. The College of Staten Island works closely with SI PPS, SIPCW, and community partners to match graduates to appropriate employer sites based on current job needs, roles and responsibilities, as well as the graduate’s needs and interests. To support the recruiting and job placement process, CSI has dedicated a Job Developer Staff to identify employers and their needs and prepare students for interviews with those employers. In addition, for CRPAs, the SI PPS with SIPCW has also dedicated a Peer Integration Services Coordinator staff to support partner employers with the recruitment and job placement process as well as orientation and workflow improvement upon CRPA employment.
Phase 4: Curriculum Refinement with Community Input: The fourth phase involves the collection of critical feedback from both employers and graduates of the training programs to further enhance the training curriculum and job placement process. Structured discussions including focus groups are conducted to understand how effective the current training curriculum is, as well as to identify any additional elements and recommendations to improve the experience of future students and to prepare graduates more for employment. Focus groups and curriculum review meetings occur routinely to gather information from both employers and graduates to ensure that the expectations of the CRPA and CHW job roles align with the classroom experience and employment readiness of CRPA and CHW candidates peer advocate. Input from employers, for example, have ranged from increased role playing to test motivational interviewing skills, diverse employer site panel or spotlight discussions to understand different work settings, to special workshops on navigating the HR, background clearance, and legal documentation process during hiring.
This four-phase model with DSRIP funding have been critical to transforming and expanding the CRPA and CHW workforce on Staten Island. The CRPA workforce has grown from 2 to 30 from 2015 to 2018. In 2018 alone, SI PPS and CSI graduated 11 CRPAs of which 8 are working as CRPAs at different partner employer sites. Similarly, between 2017 and 2019, SI PPS with CSI have graduated 31 CHWs and all graduates have gained new employment or upskilled their role with current employers.
Victoria Njoku-Anokam, MPH, is Director of Behavioral Health and Care Management Initiatives; and William D. Myhre, MPA, is Senior Director Workforce Transformation/HR, at Staten Island Performing Provider System (SI PPS). For more information, please visit our website at www.statenislandpps.org.