1. Peer Specialists and Supervision
Melissa A. Hensley, PhD, LISW
Associate Professor of Social Work, Augsburg University, Minneapolis

2. Acknowledgements
The research on peer specialists and supervision was funded by the Augsburg University Center for Teaching and Learning Faculty Scholarship program.

3. Learning objectives for today
To educate participants about the roles of peer specialists within mental health service organizations.
To discuss ways that providers, both peer and non-peer, can better understand each others' values and ethics in practice.
To share information about supervisory practices with peer specialists, including helpful practices and detrimental practices.

4. What has traditionally been the relationship between professionals and peer providers?
“Parallel universes”
Social workers may refer clients to self-help groups (and in some chemical health settings, attendance at “meetings” is considered mandatory), but the framework and philosophy, especially of 12-step programs, is to exist independently of any kind of medical or professional service.
Social workers or other providers may themselves attend self-help groups in order to obtain support for personal concerns, such as addiction.
In some cases, providers may devalue or question the legitimacy of peer services—”beware of those depression support groups; they can be a little bit off the deep end.”

5. How is the concept of peer-provided services changing?
More and more, we are seeing peer providers, such as Certified Peer Specialists and Recovery Coaches, included on the staff of mental health and addictions services organizations.

6. Who can benefit from peer-provided supports?
To name a few…
People with post-traumatic stress disorder symptoms, including veterans.
People with addiction or chemical health concerns.
People who participate in Assertive Community Treatment services.
People who use drop-in center or clubhouse services
People residing in residential treatment programs (IRTS)

7. Peer specialist services—their connection with professional practice
Certified Peer Specialist services are offered at many agencies and organizations across Minnesota.
These include “traditional” community-based providers as well as inpatient settings and community support programs.
In some cases, peer specialists also work for organizations such as NAMI that are more focused on advocacy.
Peer specialists may also work at organizations that seek to provide alternatives to formal mental health services.
Peer specialists may serve at crisis residences, other forms of respite care, inpatient mental health units, community support programs or drop-in centers, employment programs, etc.

8. Minnesota’s Peer Specialist definition
“Certified peer specialists offer support and hope to individuals with a lived experience of mental illness by sharing their story and helping them to discover their strengths. Certified peer specialists assist the people they serve to identify the barriers they encounter for participation in community resources, and provide encouragement for involvement in community based activities that support their goals and interests.” (Northland Counseling Center)

9. Peer specialist services—their connection with professional practice
What activities do peer specialists engage in on-the-job? (findings from M. Hensley’s peer specialist supervision study)
Psychoeducation—support for learning social skills, emotional coping skills, facilitating WRAP training
Employment services—mentoring, guidance in job search
Community support—socialization, help negotiating mental health systems and services
Community-based case management—mentoring, role-modeling, connection with community peer services/groups
Crisis residences/respite care—help in identifying social and mental health supports, crisis intervention, trauma-informed social supports
Addiction services—mentoring, support for recovery skills and coping mechanisms

10. Peer specialist services—their connection with professional practice
Peer support providers are now recognized as providing an “evidence-based model of mental health care” (Center for Medicare and Medicaid Services).

11. What’s so different about peer support?
Certified peer specialist services are intended to complement professional services.
One big difference is that peer services tend to use a “social model” to understand disability.
“Medical” model used by many professionals emphasizes fixing the individual.
“Social” model used by peers emphasizes improving the fit between person and environment, and empowering the individual to determine their own goals.
The purpose of peer services is to provide mentoring and support in a way that maximizes mutuality and minimizes power differentials.
(Source:

12. What’s the connection?
In Minnesota, as in many states, Certified Peer Specialist services can be billed to Medicaid (Medical Assistance).
Peer specialists are also required to complete ongoing continuing education and training related to mental health recovery, mental health rehabilitative services, and peer support.
Formal supervision is also an ongoing expectation.
Clear job descriptions can provide guidance to peer workers but are not always available.
The catch is that the peer specialist must be supervised by a licensed mental health professional or practitioner.
Oftentimes, this licensed provider is a social worker.

13. Supervision of peer specialists
What makes for good peer specialist supervision?
Some aspects of supervising peer specialists are similar to good practice in social work or other “professional” supervision.
Peer specialists may seek guidance in planning appropriate interventions for clients.
Peer specialists may request feedback related to professional or emotional concerns, such as vicarious trauma.
Peer specialists may need encouragement to practice self-care.

14. Agency climate
When bringing a peer provider “on board” for the first time, it is important to ensure a welcoming organizational climate (for example, to address staff’s use of stigmatizing language or micro-aggressions.)
Agency staff may need training and information about the scope of peer specialist practice, to ensure that expectations of certified peer specialist workers are appropriate.
Agency staff should be encouraged to learn more about social models of disability as well as the utility of recovery models in promoting mental health.

15. Melissa’s study on peer supervision
In Summer, 2015, I traveled around the state, interviewing Certified Peer Specialists.
The interviews included questions about the scope of work that peers were engaged in.
In addition, questions were asked about peer specialists’ experience of professional supervision.
Interview data was transcribed and coded.

16. What constitutes good supervision?
From Hensley’s data on peer specialist supervision:
Though this was a small sample size and cannot be generalized, one interesting finding is that peer specialists mentioned several times that supervisors who had completed a formal training course on supervising peer specialists appeared to be more effective in practice.
When supervisors were strongly committed to a “recovery model,” they were more welcoming and supportive of peer specialists.
Peer specialists described good supervision as supporting an attitude of mutuality throughout the organization.
Well-thought-out job descriptions helped ensure accountability for peers’ work and clarity of roles within organizations.
It is very important to understand differences between, for example, social work professional ethics and the code of ethics of peer specialists. With peer specialists, self-disclosure and personal mentoring are not boundary violations; they are expected activities.

17. What, in practice, is a recovery model?
Working common definition of recovery from mental disorders and/or substance use disorders:
A process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential
(SAMHSA, 2012)
How does this differ from “conventional” mental health practice? (for example, use of a medical model of disability)

18. Professional vs. peer-provider ethics
There are many similarities between the National Association of Social Workers Code of Ethics and the International Association of Peer Services Code of Ethics.
Open-mindedness, empathy, hope, respect, social justice are common values.
Some possible differences:
Peer support is voluntary.
Peer support is equally-shared power.
Peer support is mutual and reciprocal.
Source: “National Ethical Guidelines and Practice Standards: National Practice Guidelines for Peer Supporters”

19. What constitutes bad supervision?
From Hensley’s data on peer specialist supervision:
Lack of time for one-on-one supervision was identified as one of the key problems in peer specialist supervision.
The more hierarchical the organization, the less satisfying the experience of supervision.
Peer specialists were at times being used as “cheap substitutes for case managers,” which made it hard for them to really use their strengths and training.
Supervisors who adhered to a very medical or “clinical” model of mental health practice were less effective in their supervision.

20. What can we do? Seek supervision training opportunities.
Seek opportunities to learn about peer-provided interventions such as eCPR (Emotional CPR) and WRAP. (Wellness Recovery Action Plan). Many peer specialists identify WRAP as an essential intervention for the peers they serve.
Address issues of organizational climate.
Increase our understanding of professional ethics and peer support ethics.
Don’t just say your agency “supports recovery”; take action to de-emphasize medical models and support wellness.

21. Advocacy for peer services
Make efforts to learn more about the different kinds of peer supports in the community and ways in which they could be helpful to the people we serve.
Provide accurate information to others in our organizations and communities about the value of peer supports.
Support the inclusion of peer specialist services in a wide variety of service settings. Make WRAP training a priority.
Provide information to clients and families about peer-provided supports that are available in the community.

22. Minnesota resources Northland Counseling Center
Minnesota Recovery Connection
MN Department of Health and Human Services
Wellness in the Woods
National Alliance on Mental Illness (NAMI) Minnesota
Mental Health Minnesota

23. National REsources
Substance Abuse and Mental Health Services Administration
Depression and Bipolar Support Alliance
International Association of Peer Supporters
Intentional Peer Support
Mental Health America

24. National resources National Empowerment Center
National Mental Health Consumers’ Self-Help Clearinghouse
Hearing Voices Network USA