2022 California Council of Community Behavioral Health Agencies (CBHA) Conference

Peer Workforce Integration in Integrated Healthcare

Advancing workforce integration is a key objective for NYC Peer and Community Health Worker Workforce Consortium. The NYC Peer and Community Health Worker Workforce Consortium at the NYC Department of Health and Mental Hygiene strengthens understanding about the Peer/Community Health Worker (CHW) Workforce roles. The Consortium maximizes the opportunities for Peers and CHWs to contribute their strengths to the behavioral health workforce. Peers use their personal recovery experience to support individuals facing mental health and substance use challenges and Community Health Workers draw upon community ties and cultural awareness to help individuals manage their health and wellness.

The Consortium has identified several practices that drive the capacity of organizations to support Peers/CHWs in their roles, to promote their career growth, and to facilitate effective structures for collaboration in the workplace. These practices are outlined across nine domains in the Consortium’s Needs-Based Toolkit, which can be accessed by visiting https://www1.nyc.gov/site/doh/providers/resources/supporting-peers-and-community-health-workers-in-their-roles.page.

The active transformation of service delivery models also emphasizes the value of integrated care. It is important to be aware of distinct implications of these integration processes, and to recognize where they overlap. Since New York State’s 2016 delegation of Peer Support as a Medicaid-reimbursable service, awareness of Peer Support has grown and efforts to implement peer services have expanded. The increased uptake of Peer programs presents a greater number of positions for Peers and increases the diversity of the types of programs offering Peer services. For programs that are still becoming familiar with the Peer Support model, this may result poorly defined role and responsibilities within the workplace.

Workforce Integration

Organizations should be equipped with a clear understanding of the Peer roles, particularly at a time of such significant expansion. Accordingly, there are important concepts to be clarified when discussing “Peer workforce Integration.” Integration is different from “mixing” all roles together, which would detract from the recognition of the unique value that Peers add to organizations.

The Consortium has prioritized the preservation of the Peer role’s core principles and values while encouraging advancement as a workforce. The Consortium presents a framework for workforce integration that views all employees as complementary “pieces of a larger puzzle.” This framework means that effective operation is built on various areas of expertise and diverse perspectives of team members.

Integrated Care

Models of integrated care demonstrate some variation in the structures and processes used to drive desired physical and behavioral health outcomes. Ultimately, the shared foundation of the various integrated care processes and selected indicators is the person at the center of the care delivered. With this shift towards integrated care, recognition of how social determinants impact health has advanced. Insight has improved as we acknowledge measurable gaps in care quality, and disparities in access to care and health outcomes. This insight elucidates the need to address multidimensional and inter-related needs. Integrated care models focus on how to best meet those needs in a way that is individualized, supports positive health outcomes, and reduces healthcare costs.

Where these Concepts Come Together

Between the integration concepts mentioned, the intended use of the term “integration” differs. However, the aim of meeting the needs of individuals through a “whole person” lens presents a shared priority. When the Consortium refers to “Workforce Integration,” it recognizes that support for Peers requires attention to the needs of all employees working with Peers at an organization. When employees with a variety of skill sets collaborate, there is greater capacity to support each individual and address their needs and goals more fully. The Peer Workforce understands wellness as part of an individualized recovery pathway that incorporate one’s own goals. Peer service models incorporate multiple components of well-being, and value the use of related resources, such as a Wellness Recovery Action Plan (WRAP) or Peggy Swarbrick’s model of Wellness in Eight Dimensions (2015).

Strategies for workforce integration are provided by the NYC Peer and Community Health Worker Workforce Consortium toolkit. In the toolkit section about Role Clarity, for example, the Consortium recommends using a detailed workflow to help navigate responsibilities that may be non-specific to a role and those that require a team member’s unique expertise. The collaboration of inter-disciplinary team members can be strengthened by shared training and education opportunities and by cross-disciplinary, strengths-focused activities. The Consortium works to ensure that Peers are not excluded from these processes.

The workforce integration practices outlined by the NYC Peer and Community Health Worker Workforce Consortium are not limited to Peers, however. The practices that drive workforce integration for Peers hold the potential to facilitate successful shifts to integrated care and to more collaborative support for unique and multi-dimensional individuals.

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