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2015 HSR&D/QUERI National Conference Abstract

3154 — Facilitating Citizenship: The Work of Peer Support Providers in Recovery-Oriented Mental Health Services

Clark JA, COIN- Bedford/Boston; Wang S, COIN-Bedford/Boston; Eisen SV, COIN-Bedford/Boston;

Peer support providers increasing employed as VHA mental health services implement recovery models of care. They are central to the recovery orientation. However, despite job descriptions, training materials, and their many assigned tasks, the actual job practices of peer providers, have not been well characterized. This limits understanding of their effectiveness. The recovery orientation highlights the goal of citizenship, i.e., social integration and participation in valued social roles, for the people who are otherwise marginalized. We sought to define job practices as they relate to this goal: facilitating citizenship.

We conducted qualitative interviews with two groups of peer support providers: 16 Peer Technicians working in mental health care settings and 12 Vocational Rehabilitation Specialists, hired for their shared background with homeless Veterans. All were respondents in a national survey of VA peer support providers. We elicited extended narratives in response to opening requests to describe what they do in their jobs. The inductive, interpretive, and constant comparison procedures of grounded theory were followed in coding transcripts and synthesizing major themes.

Three themes were defined across both groups of peers. (1) Peers described authentic, non-judgmental interaction with clients to learn who they were as individuals and draw them into helping relationships, explicitly relying on their "shared backgrounds." (2) Peers instructed, coached, and sanctioned normatively appropriate behavior relating to two contexts: the program (e.g., participation in therapy or counseling activities, interaction with clinicians and other clients) and the community at large (e.g., interaction with citizens, social decorum, soft skills of the workplace interaction, job-related self-discipline). (3) Peers explained the actions and worldviews of their clients to authorities in program and employment contexts"”clinicians and employers"”to foster understanding and acceptance of clients and their distinct needs

Peer providers have made complex transitions from client to provider. They work to socialize mentally ill and homeless Veterans, teaching the appropriate attitudes and behaviors of citizens and fostering their acceptance in communities.

Improved understanding of the actual job practices of peer support providers may guide their effective deployment and management, and enhance research on the outcomes of recovery-oriented services.