The implementation of peer support professionals throughout the behavioral health field has proven to be a valuable resource for clients, patients, and service providers across the continuum (SAMHSA, Value of Peers, 2017). Whether it be in an outpatient clinic, emergency room, or community setting, peer professionals trained to work with substance use disorder (SUD) populations have brought a unique perspective to support patients on their journeys to recovery. Staten Island (SI), a borough within NYC, which has a population of nearly 476,000, has been one of the epicenters of the opioid epidemic. From 2015-2018, there were 383 fatal overdoses on SI, according to the Office of the Richmond County District Attorney. SI overdose rates, as determined by the NYC department of health, were higher than the other NYC boroughs until 2017. Although Staten Island has a strong network of treatment providers and harm reduction services, consistently high rates of overdose indicated the need for creative client engagement and non-traditional approaches. Peer models quickly emerged as a promising method to address this issue, but Staten Island was lacking a sustainable peer workforce.
In 2015, the Behavioral Health Infrastructure Project (BHIP), spearheaded by the Staten Island Partnership for Community Wellness (SIPCW) and the SI Performing Provider System (SI PPS), was established to bring multi-sectoral partners together to build the capacity of systems to address the unique behavioral health needs of the community. Early on, BHIP worked to identify gaps in the behavioral health continuum and surfaced peers as a component to bolster the infrastructure. Through a mixture of DSRIP innovation dollars and OASAS grants, opportunities were created to increase the supply and demand for the peer workforce. Through many local efforts including the development of the SI CUNY and SI PPS Certified Recovery Peer Advocate (CRPA) curriculum, SI PPS scholarships and salary grants, the expansion of OASAS reimbursement criteria, and local and state grants to integrate peer positions, the number of peers on Staten Island has been steadily increasing. Within the past few years, there has been an increase from only two CRPAs in 2015 to 30 new CRPAs in 2018 on Staten Island. It is important to note that other types of substance use treatment and mental health peers exist in the community that are contributing to the pool of qualified professionals providing peer services in addition to CRPAs.
Through BHIP, SIPCW and the SI PPS have been working with behavioral health providers to support recruitment, onsite orientations and training, and workflow improvements to help integrate peers into outpatient substance use treatment settings. Determining where a peer fits within a specific provider’s workflow is one of the first steps in integrating a peer. Whether the peer is activated during a client’s intake or during discharge, a peer advocate can play various roles throughout a provider’s continuum of services. Understanding the scope of the practice, clarifying the value of the role with the care team, and going through a series of ethic trainings has helped seamlessly integrate this valuable role. Having a peer meet with a client throughout the recovery process has added an additional tool to traditional clinical engagement in outpatient settings. Clinicians and peers working together to support a person’s progress towards recovery provide an endless opportunity for both the community and the client. Integrating peer support services into SUD treatment programs has been shown to increase a client’s self-esteem and confidence as well as bring an increased sense of control and ability to bring about changes in their lives (Davidson, et al., 2012).
Depending on the type of service that a provider offers, peer advocates play a different role within the clinical setting. For example, Project Hospitality, a local multidisciplinary and integrated service delivery community-based organization (CBO), utilizes peers within a variety of their programs. One is within an OASAS funded hospital diversion program. In this program, the peer focuses on individuals that are currently at risk for overdose. The program provides Naloxone training to clients and distributes kits. Most notably peers engage clients who are on waiting lists for a treatment bed or upon discharge for continued support in the community. Peers also have Project Hospitality cell phones to ensure that clients can access them during off-hours and can meet with individuals in the clinic or in the community, such as at a local coffee shop. This consistent access and communication during the waiting period is an important aspect of the continuum when trying to keep individuals engaged and ready to seek treatment. The Silberstein Clinic, Richmond University Medical Center’s outpatient SUD treatment center, utilizes a peer as well. Within their clinic, a peer meets with every new client immediately following intake to introduce himself and discuss the services that he can provide. In addition to one-on-one peer meetings with clients, the peer also aids with group therapy sessions and provides outreach at various locations. Using a creative approach to better engage clients, Silberstein’s peer visits probation and parole once a week to speak with the officers about any potential clients that can be referred to the Silberstein Clinic. The peer also frequently visits rehabilitation centers to meet with clients upon discharge to discuss the importance of aftercare and connecting to community resources.
The above examples are two practical applications of peer advocates at outpatient programs. Many other Staten Island providers and institutions employ peers in creative ways to improve patient/client outcomes by providing a human-centered approach to care. Through BHIP, SIPCW and SI PPS are committed to the continued expansion of this workforce as well as ensuring that peers are effectively integrated into workplace operations. While there are various ways that a peer can provide support services, the unique lived experience that they bring to any service provider is invaluable, whether it be modeling coping skills, raising awareness of existing support services, or educating clients about various modes of substance use disorder. By continuing to provide and expand this service, individuals living with SUD can have an advocate who emphasizes knowledge and wisdom through their lived experience as they work towards the ultimate goal of recovery. While there remains a gap in connecting certified peers to available positions in the community, new funding acquired by SI PPS from HRSA, will allow the Staten Island community to continue to tackle this challenge by ensuring peers are trained to meet the specific needs of local programs.
About the authors: Jordan Lowmark, MPH, is Coordinator, Peer Integration; Maralie Deprinvil, MPH, is Senior Coordinator Behavioral Health and Contracts; Jazmin Rivera, MPH, is Director, Behavioral Health; and Adrienne Abbate, MPA, is Executive Director at The Staten Island Partnership for Community Wellness. Victoria Njoku-Anokam, MPH, is Director, Behavioral Health & Care Management Initiatives; and Marianne Howard-Siewers, RN, MS, ED PMHCNS-BC, is Clinical Consultant at The Staten Island Performing Provider System.
Davidson, L., Bellamy, C., Guy, K., & Miller, R. (2012). Peer support among persons with severe mental illnesses: a review of evidence and experience. World Psychiatry, 11(2), 123-128.
Substance Abuse and Mental Health Services Administration. (2017). Value of Peers: www.samhsa.gov/sites/default/files/programs_campaigns/brss_tacs/value-of-peers-2017.pdf