What are the benefits and challenges of a peer support specialist program? Rosie Arocho from Vocational Instruction Project Community Services, Inc. (VIP) in the Bronx, NY shares her reflections in a Q&A with the HRC. She emphasizes the importance of supervision, training, and support and explains why peer support specialists can make a real difference.

Q: What is your organization’s definition of a peer support specialist?

Our peers reflect the consumers we serve. Peers overcame the same issues around addiction and mental illness as the consumers. We have a peer support specialist in our HIV program. The consumers that do well as peer support specialists are the stellar clients. They have made enormous transformations in their own lives. Peers can model ways to take care of oneself.

Q: How do you use this position?

We use this position to model behaviors. When you work with a community that has multiple stigmas, the consumers are not always comfortable talking to a case manager. They are more likely to bring their concerns to a peer. The peer support specialist helps to reduce the consumer’s level of ambivalence. The peers are good at relating on the same level, which may be difficult for the clinical staff.

Q: What benefits do your consumers get from having a peer support specialist?

The peers bring a level of credibility. They can show that doing “X” will bring this type of benefit because they have lived it. They have legitimacy. They are part of the community. All consumers are part of a team, which has a peer support specialist as a member. All the consumers have immediate contact with the peer support specialist. When you successfully integrate peers into services, you bring an added benefit because consumers will divulge information sooner. This facilitates a quicker intervention and quicker outcomes.

Q: How do you avoid or address issues of co-dependency that may arise?

It is very easy for the peer support specialists to “over-identify.” This position requires a lot of supervision and support. We have weekly team meetings and are available for one-to-one meetings. You have to be sensitive to the needs of the peer support specialist.

One of the first things I learned, years ago at Housing Works, is that peer support specialists can decompensate rapidly if they are not properly supervised. The Housing Works program had a program for consumers to go through to become a peer support specialist. What happened was that within a month, the peer support specialists would stop taking their medications. You have to know how to follow through with the peer support specialist, which is very different from a regular employee. Make sure to be clear regarding roles—be concrete and straightforward.

Q: What are the challenges with this position?

One of the barriers is identifying peers who are ready to take on the responsibility. Make sure they have an understanding of how to have a real dialogue with consumers. The peers should have a year of certification in health education. It would be unreasonable to think that a person without real training can work with this type of consumer. Peers need to see what issues they need to bring to the attention of therapists and what boundaries they should have. Supervision must be there for the peers to reinforce and guide them.

Q: What suggestions do you have for other programs trying to implement a peer support specialist?

Choose carefully. Not everyone is cut out for this work. People need to have a high level of stability. I had a peer support specialist whose psychiatric medications stopped working. We sat down and talked about it. Together, we determined that she needed not to be here. It was hard, because we both thought she was ready to take on the responsibility. Supervision, training, etc. are also necessary. It may look easy, but it is a lot of work. However, in the end, it pays off for the consumers and the organization.