Peers That Count: A Call to Action!
A Peer-Led Peer Recovery Census to Determine Where We Are, What We Contribute, and What We Need
Background
Nearly one million Americans have died since 1999 from a drug overdose. Drug use adversely impacts physical, mental, and social determinants of health of those who use drugs and their families. Peers are people in long term recovery supporting others who are in or seeking recovery. Although the important role of peers and beneficial effects of their services are well recognized, there is still much to learn about their presence, contributions, needs, challenges, and strengths. Led by peers, Peers That Count helps fill a research gap with a count of Maryland peers, and an exploration of peer perspectives on important issues impacting peers: service provision, workforce integration, professional development, financial resourcing, social action, and inclusivity.
Methods
This is a mixed-method, quantitative and qualitative study using an online survey and four regional focus groups. Survey questions were developed by the research team and further improved by MPAC regional leaders and members. The survey was shared through listservs, social media, email, text, QR code, and in person at peer-related events, and was open for responses for four months between early February and early June 2023. Quantitative data collected included race, gender, education, geographic area, work placement, income and job benefits, professional development and integration, strengths and challenges within the workforce, and opinions on Medicaid billable services. Data was analyzed by determining frequency and percentages of responses. Focus group members gave important statements that offered greater depth to survey responses. Data was analyzed to identify major themes. Qualitative and quantitative data were then integrated into a cohesive set of results.
Results
There were 465 peers who completed the survey and 21 also participated in focus groups. Within this study sample, 46% were White, 35% Black or African American, 11% mixed racial ancestries (11%), 5% Hispanic or Latino/a/x, and 8% did not give information. There were 56% who were women, 33% were men, 2% were transgender or non-binary, and 9% did not provide information. There were 55% of respondents who were state certified as peers and 45% who were not. Regarding peer workforce integration 81% felt well integrated as peers and 19% did not. There were 51% who had two or more jobs as peers. About half don’t get work-based health insurance (49%). Less than two in five peers get retirement benefits (38%). One third of peers had to move because wages were not enough to live in their communities (33%). The qualitative themes from focus groups were 1) Peers work in diverse settings with a wide range of roles, 2) Peer work is a “lived experience to a lived experience” that goes “deeper than empathy”, 3) More support and resources for peers are needed, 4) There is a growing respect for peers, but significant stigma and misunderstanding remain, and 5) More preparation is needed for peers to navigate Medicaid billable services.
Conclusion and Implications
Peers that Count is an important, peer-led study with a large and diverse sample, using mixed methods, covering a broad array of topics, and with important practice, policy and research implications. The following represent some of the main calls to action generated by study results, with MPAC peer leaders convening to strategize around how their advocacy, education, and leadership development may be informed by study results.
1. To develop and sustain the peer workforce, ongoing efforts are needed to reduce stigma, increase compensation, and facilitate upward mobility through new peer management positions and connections to degree programs in allied health professions.
2. As peers are increasingly asked to support individuals’ social determinants of health (food, housing, etc.), more training and resources to provide this are needed.
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3. Future research can build on this study by examining why some peers get certified and some stay uncertified, using this data set to explore differences across regions (including peer compensation, training opportunities and workforce integration), and seeing how the new Medicaid reimbursable policy is playing out.
