New Article Compares Community Health Workers and Peer Support Specialists

NYAPRS Note: Noted experts on peer support Dr. Allen Daniels, Sue Bergeson and Keris Myrick have published an article in Psychiatric Services that take a probing look at “Defining Peer Roles and Status Among Community Health Workers and Peer Support Specialists in Integrated Systems of Care” in Psychiatric Services.” See below for some excerpts.

Sue will offer presentation on this topic (“The Competitive Advantages of Behavior Health Peers and Community Health Workers”) and on “Making the Case for Peer Support to Payors and Influencers” at this year’s NYAPRS Annual Conference, to be held September 13-15 at the Hudson Valley Resort in Kerhonkson. Register today at

Defining Peer Roles and Status Among Community Health Workers and Peer Support Specialists in Integrated Systems of Care (excerpts)
Allen S. Daniels, Ed.D., Sue Bergeson, Keris Jän Myrick, M.B.A., M.S. Psychiatric Services

“CHWs have primarily been deployed in general medical care and PSSs in behavioral health care. Understanding the unique contributions that CHWs and PSS provide for health promotion and wellness and improved population health outcomes is an important challenge. This Open Forum reviews the key elements of peer status as a way to help illustrate the differences between these workforces and the best deployment strategies for each workforce. A framework is proposed that outlines key support roles provided by the CHW and PSS workforces (Psychiatric Services (doi: 10.1176/

In published work, little distinction has been made between two peer workforces: community health workers (CHWs), who are deployed by the general medical care system, and peer support specialists (PSSs), who are deployed by the behavioral health care system. Service roles of each are separately defined by the system that deploys them. Both workforces have been shown to produce effective and positive outcomes for those they serve (1,2). Assimilating the CHW and PSS workforces into integrated systems of care requires a better understanding of their different roles and unique contributions to supporting patient engagement (connecting patients with health re- sources), promoting activation (helping patients to assume responsibility for improved self-care), and fostering wellness (improving health outcomes).

In deploying the CHW and PSS workforces, a central question is whether each represents distinct service roles and unique aspects of peer status. Or, do the services provided by these workforces reflect a continuum of peer status that can and should be deployed across all health care systems?....

Which Workforce to Use When—and Why

Both CHWs and PSSs are emerging workforces. Each has varying requirements and regulations for training, certification, reimbursement, and deployment, which vary by state and funding sources. The extent to which the two workforces share common roles, skills, or competencies has not been formally established. As a result, there is a lack of consensus about whether their roles are different, the same, or perhaps an extension of one another. This lack of standardization fosters continued confusion and uncertainty about how to best deploy these resources in integrated systems of care.

CHWs are effective in promoting outreach, education, and health care engagement in the communities where they live (1). Peer specialists are effective in fostering hope and supporting individuals to find and use activation tools and resources to support self-care, shared decision making, and adherence to treatment plans (11). PSSs appear to be most effective when the patient has a more severe illness or a high level of hopelessness and disenfranchisement, and the PSS can use his or her lived experiences to promote activation and recovery.

A range of peer roles for the CHW and PSS workforce include providing education and connection to treatment services; prevention to avoid illness; addressing hopelessness and trauma of illness conditions; activation to support wellness, health improvement, and recovery; and promoting self-care, shared decision making, and care plan adherence. CHWs tend to have the highest level of peer activity roles in the areas of outreach, education, and engagement with health services. PSSs have the highest level of peer activity roles in addressing the hopelessness and trauma of health conditions and promoting activation for recovery and resiliency. [A conceptual framework of the different roles played by CHWs and PSSs, as described by the frequency of services they provide—from low to high—is available as an online supplement to this article.] This framework is pro- posed to help guide clinical systems in their deployment of these peer roles.

This framework suggests that CHWs have a primary role that promotes outreach, education, and engagement for individuals with chronic health conditions. Often this role is specific to a defined illness, such as diabetes or hypertension, and the goal is to support healthy communities as individuals seek early diagnosis and treatment.

Also, as the framework illustrates, PSSs generally focus on supporting recovery by using their lived experiences with a health condition to build trust, foster hope, and provide a range of activation tools and strategies that support the individual. PSSs utilizes both their training and their lived experiences to foster activation and recovery among persons living with similar health conditions.

This work supports engagement with treatment teams and self-activation to achieve individual wellness and recovery goals. This proposed framework can help guide and direct the deployment of the CHW and PSS workforces in integrated systems of care.

Implementing Both CHW and PSS Roles

Both the CHW and PSS workforces are important additions to integrated care teams. Peer status involves a continuum of attributes and affinities, including shared ethnic, racial, and cultural similarities; residence in the same communities; common life situations; and shared health conditions. A savvy system of care can use the framework presented here to recognize the different attributes of “peerness” and deploy both CHWs and PSSs in a targeted manner to support individuals to become better engaged to seek treatment, become more activated in their own care, and achieve improved health outcomes.

Dr. Daniels is a behavioral health consultant based in Cincinnati. Ms. Bergeson is with Pat Deegan and Associates, Byfield, Massachusetts, and Recovery, Resiliency, Engagement, and Activation Partners, Lake, Michigan. Ms. Myrick is with the Office of Consumer Affairs, Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, Rockville, Maryland. Send correspondence to Dr. Daniels (e-mail: