Employment Outcomes After Certification as a Behavioral Health Peer Specialist in Four U.S. States

Employment Status Following Peer Specialist Certification: Results of a 3-Year Multistate Survey

OBJECTIVE

A cohort of certified peer specialists (CPSs) was surveyed to investigate factors affecting postcertification employment and retention.

METHODS

Survey data were collected in 2020, 2021, and 2022 from 591 CPSs in four states (North Carolina, Oregon, Pennsylvania, and Texas). The data were analyzed via percentages, means, and multilevel regression models.

RESULTS

Postcertification employment remained high: 76% (N=448 of 591) in 2020, 73% (N=329 of 448) in 2021, and 77% (N=279 of 364) in 2022. However, the proportion working in peer support positions declined significantly-from 73% (N=325 of 448) in 2020 to 63% (N=175 of 279) in 2022-despite the significantly higher job satisfaction, greater access to job benefits, and longer average job tenure reported by those working in peer support versus nonpeer jobs.

CONCLUSIONS

Although the individuals who completed certification appeared to remain employed, a significant proportion appeared to leave peer support for other work. These trends should be monitored to evaluate investments in peer certification and service capacity.

Postcertification Wages Among Certified Peer Specialists Working in Peer Support and Other Occupations

OBJECTIVE

Although certification can raise the status of peer support work, certified peer specialists (CPSs) may continue to face financial hardship that affects their employment choices. This study aimed to explore how wages and financial well-being changed for CPSs over a 3-year postcertification period.

METHODS

This study examined wages, job characteristics, and financial well-being for a cohort of 448 employed CPSs working in peer support (PS) or other, nonpeer (NP) jobs during the study period. Self-report survey data were collected on current jobs, hours worked, and job tenure. Financial well-being was assessed by using the Consumer Financial Protection Bureau's Financial Well-Being Scale. Differences in job characteristics over time were described by using chi-square and t tests, and mixed-effects logistic regression models were used to model job attributes and financial well-being.

RESULTS

Hourly wages for both PS and NP jobs increased significantly between 2020 and 2022, with smaller increases for PS than for NP positions. Individuals with PS jobs were significantly more likely to have longer job tenures than those with NP jobs. Higher hourly wages were associated with a greater likelihood of longer job tenure. Financial well-being did not improve significantly over time.

CONCLUSIONS

The larger wage increases and shorter tenures characteristic of NP jobs, relative to PS positions, suggest that workers may have switched from PS jobs to other jobs to improve their financial and career mobility opportunities. CPSs are part of a trend in the general U.S. adult population of declining financial well-being, despite increased wages.

Employment Trajectories of Recently Certified Peer Support Specialists: A Longitudinal Qualitative Analysis

BACKGROUND

Recent work has highlighted the challenges and benefits that certified peer specialists (CPSs) experience in the workforce. While their work can lead to personal fulfillment and financial independence for CPSs, and improved mental health and substance use recovery outcomes for their clients, little is known about CPS employment trajectories or the circumstances that impact their early-career workforce involvement over time.

METHODS

This study used within- and across-case analyses of longitudinal data from qualitative interviews with 13 CPS that participated in a multistate, 3 year observational prospective cohort study of CPS graduates to explore employment changes and circumstances that led to these transitions. Qualitative results were organized according to whether cases were "employed as a CPS at follow-up" (N = 5) or "not employed as CPS at follow-up" (N = 8).

RESULTS

Participants "employed as a CPS" at follow-up held various positions following certification, and they shared a sense of optimism about their future work. At the second interview, most remained in the same positions they held at baseline and described personal fulfillment and a supportive work environment as reasons for remaining. Participants who were "not employed as a CPS" at follow-up were also not employed as a CPS at their baseline interview but aspired to pursue future CPS work. At their second interview, many remained unemployed due to poor health and disability, or described past traumatic experiences, stress, and burnout related to being a CPS as reasons for leaving the CPS work force. All participants were challenged to find work as a CPS at various moments in their trajectories.

CONCLUSION

Results indicate that securing employment as a CPS was challenging for participants. Findings are discussed with implications for supporting CPS job seeking, well-being, and workforce retention.

It's Like Adding a Drop of Ink to Milk and Shaking It: Newly Certified Peer Specialist Reflections on Lived Recovery Expertise and Professional Identity

INTRODUCTION

Self-disclosure of lived recovery experiences is a cornerstone of peer support work. However, few studies have explored how early career certified peer specialists (CPSs) integrate or plan to integrate their own lived recovery experiences into their CPS work, or the challenges they expect to experience when doing so. In this qualitative study, we explore how early career CPSs use their lived recovery experience and challenges that accompany self-disclosure.

METHODS

Qualitative data were collected as part of multistate, 3-year observational prospective cohort study of CPS graduate employment trajectories. We conducted in-depth, semi-structured interviews with a subsample of early-career CPSs about their transition to the workforce; this study reports on interview material focused on how participants use and expect to use their recovery experiences. Data were analyzed using thematic and content analysis informed by constant comparative methods.

RESULTS

N = 25 individuals participated in an interview. While participants generally felt positive about sharing their personal recovery stories in their CPS role, some reported potential challenges they expect to experience, such as misalignment of recovery experiences or being re-traumatized when sharing their recovery stories with clients and coworkers.

CONCLUSION

That study participants held mixed feelings about sharing lived experience suggests that the peer support workforce needs early career professional support, such as peer-to-peer supervision models that focus on CPS wellbeing, in addition to job performance.

The peer to career pipeline: An observational study of peer worker trainee characteristics and training completion likelihood

INTRODUCTION

Peer recovery support services (PRSS) for substance use disorder (SUD) are a flexible and evidence-based intervention employed across multiple settings and for a variety of populations. These services have expanded over the past two decades, but there is little research on recruitment and training of prospective peer workers - the peer to career pipeline. This study observed training outcomes for applicants to a peer worker scholarship program in Texas.

METHODS

A total of 448 participants provided baseline personal history information, and a subset of participants (n = 239) completed optional psychosocial surveys. Logistic regression analysis tested associations of personal history and psychosocial variables with three training stage completion outcomes: classroom training completion, placement at an internship site, and full certification.

RESULTS

The greatest decline in advancement between stages occurred in the transition between classroom training (78.1 % of participants completed) and internship placement (43.3 % of participants completed). Participants were diverse in terms of race/ethnicity and life experiences salient to the peer worker role, but Hispanic/Latinx peer workers were under-represented. Past work with a SUD peer worker, age, and having a bachelor's degree were each positively associated with training stage completion across multiple models, while having basic technological access, being a woman, and veteran status were each positively associated with training stage completion in only one model. Years since recovery initiation date, non-monosexual orientation, White race, and quality of life were each negatively associated with training stage completion in only one model.

CONCLUSIONS

The existing peer workforce may be a key source of recruitment for new peer workers; thus retention of existing workers is key to ensuring continued expansion of these services. Additional support may be required to recruit and retain younger peer worker trainees, men trainees, Hispanic/Latinx trainees, trainees who lack basic technological access, or trainees without bachelor's degrees. Unanswered questions about the peer workforce remain and must be addressed to ensure that an appropriately diverse workforce is recruited, that disparities in training outcomes are minimized or prevented, and that existing peer workers are well-supported.

Employment of Certified Peer Specialists in Mental Health Professional Shortage Areas

The current demand for mental health services is exacerbated by an ongoing shortage of behavioral health care providers in the United States. The Health Resources and Services Administration has identified 5,833 Mental Health Professional Shortage Areas (MHPSAs), many of which are rural, and could be served by Certified Peer Specialists (CPSs). This paper examines the relationship between CPS employment and MHPSA residency. Data are from a 2020 survey of 572 CPS certified in one of four states. Random effects logistic regression models were used to test the relationship between MHPSA residence and employment outcomes. Of 166 unique counties identified by participant zip codes, 47 were characterized as being MHPSAs with 14% of participants residing in one of these counties. A higher proportion of those living in MHPSAs were employed in peer support jobs (rather than other job types or unemployed) compared to those living in non-MHPSAs (68% vs. 54%, p = .020). MHPSA residential status was not a significant predictor of employment status (OR = 1.14, p = .728) but was significantly associated with greater likelihood of employment in peer support compared to other jobs, both for the entire sample (OR = 2.13, p = .026), and among those currently employed (OR = 2.90, p = .032). The greater likelihood of working in peer support among those residing in MHPSAs suggests that CPSs may leverage their credential to address shortages. As a result, peer support may become a more necessary part of the traditional service array. Policies that enable CPS to practice in MHPSAs should be encouraged.