Module 2: Recruiting and Hiring Peer Staff
Recruiting qualified peer staff
Wheredo you look to find qualified people in recovery to recruit for peer staff positions? You can, of course, use some of the same strategies you use to recruit qualified people for any staff positions, such as posting ads in local newspapers, sending out emails to various listservs, notifying colleagues at other agencies and institutions, and word of mouth. In the case of peer staff, though, you may also need to look in places you may not ordinarily think of. This is because many people, as they progress further in their recovery, move away from the formal, publicly-funded behavioral health system in which they received services when they were ill. They may become employed and have private insurance that allows them to receive care in the private sector, they may receive what treatment they still use from the primary care sector (where the majority of prescriptions for psychiatric medications are written, for example), they may no longer receive treatment or support at all, and/or they may have shifted the majority of their support to the self-help/mutual support community.
In order to reach those people who have moved along in their recovery to new resources and new communities, outreach to these sectors is often needed to identify and recruit qualified peer staff. This means reaching out to the recovery community in all of its various forms, including self-help/mutual support groups, advocacy organizations, peer-run programs, 12-step fellowships, and recovery community centers. It also means informing colleagues in the private behavioral health and primary care sectors, as well as recruiting through those community institutions and organizations where persons in recovery may be members such as faith communities, civic organizations, community centers, and, increasingly, gyms and fitness centers. If your agency leadership are not already familiar with these community resources, becoming familiar with them in order to cultivate the referral of qualified candidates will only further strengthen the culture change processes described in the previous module.
Qualifications
By definition, a peer support provider has to have his or her own personal history of a mental health and/or substance use disorder and either be in recovery or have recovered from this condition. It also is important that this person have some positive experiences with behavioral health care and views connecting others with behavioral health conditions to care as potentially beneficial for them. Especially when being hired into a behavioral health agency that offers medical/clinical care and other services provided by non-peer staff, it is key that peer staff be able to function as ambassadors for the agency as a whole, and indeed the local behavioral health system as well. To do so, they need to be able to see value in the services offered by their colleagues and feel comfortable advocating for their colleagues with the people they support. In other words, if they are to serve as bridge for connecting people to care, they have to believe that receiving care will be in their clients’ best interest.
An important function of peer staff is to advocate for their clients as well, and most peer staff will identify aspects of the current system of care that needs to be changed in order to serve their clients more responsively and effectively. Just as they will advocate for their colleagues with their clients, they will advocate for their clients with their colleagues. In this sense, peer staff play an important function in helping agencies and systems to transform to a resilience and recovery orientation, and for this reason should not be discouraged from raising issues with colleagues and supervisors that they find problematic. But persons in recovery whose main interest is in changing the behavioral health system, and not necessarily in supporting the efforts of individual clients, may be better employed by advocacy organizations for which system change in their primary focus. Peer staff who choose to work in behavioral health agencies have the difficult challenge of balancing their desire for change with the needs of their individual clients, and thus must be capable of demonstrating considerable tact and diplomacy.
So just as not everyone is suited to be a social worker or nurse, not every individual in recovery will be a good candidate to become a peer support provider. Being effective as a peer staff member requires solid interpersonal and communication skills, a positive and hopeful attitude, and an over-riding desire to support other individuals in their own recovery efforts. These are some of the skills that should be assessed initially in the interview process and then again during the initial trial work period.
In terms of the nature or severity of the behavioral health condition that a person has to be in recovery from in order to quality as a “peer,” debates continue about this controversial issue. As we will discuss below, however, it is not within the purview of the hiring team to determine the nature or severity of the person’s behavioral health condition, as to do so would be to risk confusing job performance with clinical status. The key issue that the hiring team will need to assess relative to the person’s status as a “peer” is whether or not this person will be able to function as a credible role model to the people he or she will be supporting.Have this person’s life experiences with the behavioral health system and with other factors often associated with behavioral health conditions (such as poverty, unemployment, and discrimination) been sufficiently similar to those of the clients your agency serves that they will consider this person to be their peer? Will his or her recovery story speak to the clients he or she is trying to connect to? This is the issue that will most likely determine the person’s effectiveness in the role of peer staff, rather than the particular diagnoses he or she received in the past.
The hiring process
The hiring process is that aspect of the implementation process that most agency leaders find the most anxiety provoking or confusing. We have therefore included a number of tools to make the development of job descriptions and interview questions as clear as possible.One of the areas of greatest confusion in our experience, though, has been related to issues that generally fall within legal considerations related to hiring people with a history of disability. For this reason, we address this particular issue at length in its own section next.
Job Postings and Descriptions
To continue the culture change process described in Module 1, it is preferable for discussions about possible job duties and responsibilities to be included in a job posting and job description to include agency leadership and non-peer staff, especially those who will be working the most closely with the peer staff to be hired. Job descriptions should also include the competencies the person will need in order to fulfill the job requirements and provide the basis for future performance evaluations. For these reasons alone, the development of a job description for the positions to be filled is an extremely important matter that deserves careful consideration.
As we will reinforce in the following module (Module 3: The Importance of role clarity for all parties), though, the most important thing about developing a job description for a peer position is to be clear about the nature of the role you are looking for the person to perform. There are many different ways to provide peer support and you need to be clear about what specific tasks and responsibilities you are including within any one staff position. The fact that a position is described as being a “peer” position does not tell you much about what exactly the position entails; rather it tells you something about the person who fills the position. But there are peers who function as psychiatrists, psychologists, nurses, social workers, addiction counselors, and occupational therapists as well as those who function as peer supporters. What specifically will you be looking for this peer worker to be doing in this particular role?
To help answer this central question, we have included in the Appendix a Job Posting Form developed by Via Hope in Texas and a Job Description Development Guide developed by Lyn Legere and Pat Nemec of the Transformation Center in Massachusetts. We also have included a number of sample job descriptions from both public and private sector agencies. We encourage you to take a look at these tools to help build job descriptions that will suit the needs of your agency. After reviewing these tools, consider the set of questions below:
Who is responsible for the hiring process for new peer support positions? Who will serve on the hiring committee?
How many peer specialist positions are you looking to fill right now? How many are full time, how many are part time?
Develop a job posting, job descriptions, and interview questions for the positions for which you are hiring. Have these documents been authorized by your human resource department and other executive leadership?
Personnel and Legal Considerations
In this section, we outline common personnel and legal issues that may arise as behavioral health agencies strive to maximize the employment of persons in recovery in multiple roles and across all levels of the service system. These roles include employment in positions tied directly to individuals’ own experiences of behavioral health conditions and recovery, i.e., “peer-based” positions, as well as any general employment role within the behavioral health system–from administrative assistant to security guard to Chief Executive Officer. While we have tried to be comprehensive, this discussion is not intended to be an exhaustive review; nor is it to substitute for situation-specific counsel from human resource and legal professionals.
General Considerations:
What types of employment-related laws may be relevant as we expand our hiring of people in recovery?
The Rehabilitation Act of 1973 was the first “rights” legislation to prohibit discrimination against people with disabilities. The scope of this law, however, was limited to programs conducted or funded by Federal agencies. It did not extend protections to the private sector.
The Family and Medical Leave Act (FMLA) of 1993 provides employees with up to 12 weeks of unpaid leave within a 12 month period during which their jobs are protected. Job restoration is guaranteed unless the employee is unable to perform the essential functions of the job.
The employment provisions of the Americans with Disabilities Act (ADA, Title I) of 1990 prohibited discrimination against persons with disabilities in regard to job application procedures; the hiring, advancement, or discharge of employees; employee compensation; job training; and other terms, conditions, and privileges of employment. Title I of the ADA provides extensive guidance for organizations and employers regarding compliance expectations both pre- and post-hire.
But does the ADA apply to persons with behavioral health conditions?
The ADA does not contain a list of “covered” conditions that constitute disabilities. Instead, the ADA has a general definition that each person must meet in order to be considered a “qualified individual with a disability.” This definition focuses on whether or not the person is regarded as having physical or mental impairment that substantially limits one or more major life activities, or a record of such an impairment (EEOC, 1992). Therefore, some people with behavioral health conditions will have a disability that is covered under the ADA and some will not.
Pre-Hire Issues for Consideration:
How do we word and handle advertisements/postings as we do outreach to hire persons in recovery?
For all employment positions, the EEOC advises employers to include a non-discrimination clause in job postings, e.g., “We are an Equal Employment Opportunity Employer. We do not discriminate on the basis of race, religion, color, sex, age, national origin, or disability.” For specialized positions tied directly to individuals’ personal experiences of behavioral health conditions and recovery (i.e., “peer-based” positions) it is allowable to refer to psychiatric disability within the job description/posting if having had this particular life experience is considered to be related to an “essential function” of the job. For example, Chinman and colleagues (2009) provide the following suggested wording for posting peer-based positions:
“As people who has availed themselves of [behavioral] health services, [peer providers] will share their own experiences and what skills, strengths, supports, and resources they use. As much as possible, [peer providers] will share their own recovery stories and will demonstrate how they have directed their own recovery processes.”
But are there certain types of questions we can/cannot ask during the interview and hiring process?
Title I of the ADA prohibits employers from asking disability-related questions at certain points in the employment process. Disability-related questions are those that are likely to elicit information about a disability. The types of questions which are prohibited differ across the following three phases: pre-job offer, post-job offer, and during employment.
At the pre-offer stage, an employer cannot ask disability-related questions: either directly or indirectly. For example, it is prohibited to ask the following: “Do you have any physical or mental impairment that would keep you from performing the job you seek?” or “What medications are you currently taking?” or “How many days were you out sick last year?” or “When were you last in the hospital or in a detox program?” These questions, either directly or indirectly, require an individual to disclose personal medical or disability-related information, and they are prohibited to ensure that an applicant’s possible disability is not considered before employers objectively evaluate the applicant’s qualifications.
In addition, these questions are considered potentially discriminatory because they do not focus on what should be the sole topic during the interviewing phase, i.e., whether or not the applicant can perform the essential functions of the job, with or without reasonable accommodations. In contrast, once a conditional job offer has been made (and before an employee starts work), employers may ask disability-related questions and may also require medical examinations, but only if such questions/examinations are: a) job related and consistent for business necessity, and b) required for all other entering employees in that same job category.
Post-hire Issues for Consideration:
Will a person in recovery be entitled to accommodations on the job due to his or her disability?
Do not assume that a person in recovery will require any modifications on the job. It can be presumptuous and offensive to an employee to assume he or she will need accommodations or to automatically “exempt” him or her from performance expectations that are applied to others on the job simply because he or she has had a behavioral health condition. If and when performance issues do arise, employers should also not assume these issues are necessarily related to the person’s behavioral health condition. However, if an employee does disclose that he or she has a disability (behavioral health or otherwise), and this disability is interfering with his or her ability to meet expectations, then he or she has the right to request “reasonable accommodation.” A reasonable accommodation is any change in the work environment or in the way a job is performed that enables a person with a disability to enjoy equal employment opportunities. The employee may make the accommodation request in “plain English,” which might include language such as: “I have a medical condition that requires breaks every two hours…” or “Because of health issues, I need a quiet work space at the back of the office.”
What should we do when presented with the request for reasonable accommodation?
Prior to responding to the request, the employer does have a right to request documentation of the disability and the nature of its impact on work performance. The important thing to remember is that requested medical documentation should focus not on things such as diagnosis or history of hospitalization, but rather, on: a) the functional limitations of the disability; b) how these limitations might impact work performance; and c) recommendations for what types of reasonable accommodations might be effective. While the employer has a right to request such documentation, this can often be avoided by first having an informal and supportive conversation with the employee in order to clarify needs and identify appropriate accommodations. Remember, your best source of information is the employee him or herself!
How does reasonable accommodation apply to persons in recovery?