NYC Health + Hospitals, the nation’s largest municipal health care system and New York City’s largest behavioral health provider, serves individuals with complex behavioral health and social needs including homelessness, justice involvement, and chronic medical conditions. In this landscape, peer professionals—individuals with lived experience of mental health and/or substance use recovery—play a critical role in engagement and recovery support.
As NYC Health + Hospitals expands mobile outreach and community-based services, peer professionals help extend care beyond hospital walls. They model recovery, share resources, build trust with individuals hesitant about treatment, and bridge patients to multidisciplinary teams. Their lived experience helps strengthen person-centered care and shared decision-making, enhancing continuity of care and community integration.
Integral to this workforce strategy is the NYC Health + Hospitals Peer Academy (Academy), which serves as a training hub and employment pipeline. The Academy provides foundational instruction in recovery principles, ethics, boundaries, and health care systems operations. Graduates are prepared for roles across mental health and substance use inpatient, outpatient, and community-based service settings. In addition to skill development, the Academy cultivates professional identity aligned with public-sector behavioral health expectations. As placements increase, the Academy represents a significant infrastructure investment in workforce development.
Demand for peer services continues to grow, particularly among individuals with complex needs, for whom NYC Health + Hospitals delivers approximately 53% of the acute care citywide. Caring for patients with such multifaceted needs carries significant responsibility, and without adequate scaffolding, the peer workforce may disengage, experience burnout, or choose to leave NYC Health + Hospitals. Meanwhile, policy shifts recognizing peer services as reimbursable and evidence-informed present an opportunity to leverage their unique talents in service of our most vulnerable patients. The current moment underscores the critical importance of expanding and retaining our peer workforce, yet doing so requires attention to operational and professional challenges.
Challenges and Opportunities
Despite strong organizational support, integrating peers into the large health system presents issues, spanning human resources, organizational buy-in, foundational workplace skills, and demanding working conditions.
Human resources processes are an important component of successfully integrating peer roles into the workforce. Our health system’s behavioral health programs operate across multiple service models, each with distinct job descriptions, which can make recruitment and onboarding more complex. Peer candidates may also have limited formal employment history and can benefit from additional support with pre-employment preparation, such as mock interviews and orientation to workplace expectations. In addition, public-sector hiring processes are designed to ensure fairness and compliance, though they can sometimes extend the time required to bring candidates onboard. Addressing these dynamics requires close collaboration among workforce development teams, human resources partners, and program leadership to streamline hiring pathways while maintaining organizational standards.
Obtaining organizational buy-in also requires thoughtful engagement. Clinicians who are less familiar with peer roles may inadvertently conflate peer responsibilities with clinical or administrative tasks, which can blur role differentiation. In some settings, peer roles are introduced in response to contractual requirements, which may lead to perceptions of compliance rather than program enhancement. Addressing these dynamics involves fostering a shared understanding of peer roles among leaders and staff, along with establishing clear role definitions. Integration should also be data-driven, demonstrating the impact of peer professionals on metrics such as high utilization and uptake of community services. Collaboration strengthens when peers are recognized as integral members of the interdisciplinary team.
While many trainees prefer hospital-based roles, community-based work, such as outreach in shelters or on the street, can be emotionally demanding. Peers who draw on lived experience while meeting productivity and documentation demands face heightened burnout risk without adequate training and support. Ongoing professional development is essential in areas such as motivational interviewing, trauma-informed care, documentation, and boundary management. Without clear career paths and growth opportunities, retention may suffer.
Looking Ahead: A Multipronged Approach
To strengthen integration and meet rising demand, a comprehensive strategy is needed that bolsters both individual peer performance and strengthens the environments in which they work:
- First, standardized professional development for incumbent peers can extend learning beyond initial training. A Workforce Foundations program could include advanced engagement techniques, interdisciplinary communication, crisis response, quality improvement, and self-care. Modular formats would accommodate varied experience levels while reinforcing shared competencies.
- Second, fostering a shared understanding among facility leaders and clinical staff of the peer role and scope of work is critical to maximizing peers’ contributions. Interactive workshops, case presentations, and targeted technical assistance can support supervisors in integrating peer staff effectively, clarifying expectations, and addressing common operational questions. Ongoing feedback from clinicians and leadership helps guide implementation supports and strengthens interdisciplinary collaboration.
- Third, one-on-one coaching with Academy leadership can support skill development and reinforce professional identity. Coaching offers structured space to navigate workplace challenges and align recovery values with organizational culture, particularly during the first year of employment when learning about the health care system itself may create additional anxiety.
Finally, and equally important is establishing clear career pathways for peers. Senior peer roles with opportunities for supervision and training reinforce organizational commitment and enhance retention. Advancement should occur within the peer framework, preserving peer identity rather than requiring transition into non-peer roles.
Success can be evaluated through multiple measures: streamlined hiring processes, stronger stakeholder perception of peer value, improved interdisciplinary collaboration, higher job satisfaction, and increased retention among peer professionals.
Conclusion
Peer professionals offer transformative potential for large public behavioral health systems. Within NYC Health + Hospitals, their lived experience strengthens engagement, promotes equity, and advances recovery-oriented, community-based care.
Realizing this potential requires thoughtful attention to hiring processes, organizational culture, professional development, and career advancement. By continuing to address systemic and administrative barriers while investing in sustained support, NYC Health + Hospitals is building the infrastructure to fully integrate peer providers and establish itself as a leader in peer services, enhancing person-centered care and improving outcomes at scale.
Gita Enders, LMSW, MA, NYCPS, is Director of Peer Services, and Sophie Pauze, MPA, is Senior Director of Strategy & Impact in the Office of Behavioral Health at NYC Health + Hospitals. For more information, contact Sophie Pauze at pauzes@nychhc.org, (347) 675-8928, or visit the NYC Health + Hospitals website at www.nychealthandhospitals.org.
