New guidelines for peer support supervisors

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In a new article by Online Psychiatry, Dana Foglesong and colleagues report on a new set of guidelines established by the National Association of Peer Helpers (NAPS) for supervisors of peer support workers. Named the National Practice Guidelines for Peer Specialists and Supervisors (NPG-S), they were established to assist supervisors with practical guidance on providing support and staying true to the core values ​​of peer support. peers.

These guidelines respond to growing concerns that supervisors often acted in ways that contradicted the values ​​of peer support, sometimes causing further harm to the peer helpers themselves. This involved helping supervisors learn that the ethics of peer support are often different from those involved in clinical practice. The authors write:

“The main objective of the NPG-S is to help supervisors and peer support specialists to embark together on a process of mutual learning about the values ​​of peer support and how best to put them into practice. in practice. “

Over the past decades, peer support has emerged as an integral part of mental health care. Peer helpers are people with lived experience of a mental health issue who are trained to help others with similar issues. Additionally, many are state certified to do so.

Peer support has been shown to reduce racial disparities and increase the engagement of minority youth when seeking mental health services. Additionally, long before the recent admission by professional organizations, peer support groups recognized that antidepressants need to be tapered off very slowly to avoid severe withdrawal. Peer support has also been associated with reduced chances of psychiatric readmission to acute crisis units.

At the same time, peer support is not without challenges and controversies. For example, the certification provided by Mental Health America for peer helpers has come up against criticism that an expensive online test conflicts with the essence of peer support, which is connection and be with other. The traditional mental health system can also co-opt peer support to provide the same old services at lower cost.

The authors begin by noting the growing popularity of peer support services and attribute it both to their effectiveness and to the fact that Medicaid covers them in the United States. The new guidelines are intended to provide practical advice on how to uphold the original core values, which were first developed in 2013. Below is a list of these core values:

  1. Peer support is voluntary
  2. Peer helpers hope
  3. Peer supports are open-minded
  4. Peer helpers are empathetic
  5. Peer supports are respectful
  6. Peer helpers facilitate change
  7. Peer helpers are honest and direct
  8. Peer support is mutual and reciprocal
  9. Peer support is an equally shared power
  10. Peer support is strengths-based
  11. Peer support is transparent
  12. Peer support is person-centered

For Medicaid to cover peer support services, the supervisor must be a mental health professional. A need for new guidelines arose as concerns arose that those who supervised peer support workers were often acting in ways that went against core values.

This involved assigning menial tasks to peer helpers who were disconnected from the goals and values ​​of the peer support process. In addition, supervisors routinely ignored the role and place of peer support specialists, leaving them marginalized, stigmatized and exploited. The worst part was when the peer helpers were asked to do things that had harmed the worker themselves when they were service users, for example, convincing a patient to receive ECT.

These concerns led to the formation of a working group made up of NAPS members and board members (including current and former peer support specialists). They found that there was virtually no guidance for supervisors of non-clinical peer helpers, especially with respect to the core values ​​of peer support.

To fill this gap, the working group created practical advice and guidelines consistent with the core values; these were called NPG-S. The guidelines were specifically intended to focus on how supervisors can help peer support workers while staying true to core values.

Feedback was systematically solicited at each stage, first from 152 peer helpers and 109 supervisors, then through 4 online sessions focused on the use of the guidelines, and the final version was sent by mail. electronic to the NAPS mailing list. Suggestions and recommendations have been incorporated into each step. However, the authors note that they had some difficulty identifying supervisors for their feedback.

Below are some examples of guidelines that adhere to the core values:

  • For the core value “peer helpers are open-minded”, the practice guidelines are “remain judgmental of others”.
  • For the core value “peer support is strengths-based”, the practice guidelines are “see what is strong, not what is wrong”.
  • For the core value “peer support is voluntary”, the practice guidelines are “choice of support (peer support is not mandatory)”.

With a 91% approval rating from their respondents, the authors write that NAPS has achieved its goal of providing practical advice to supervisors on how to help peer support workers implement the Core Values. The guidelines were formalized in October 2019 and posted on their NAPS website.

In addition, they report that these guidelines have been essential in improving understanding between team members who come from different disciplines, especially non-clinical peer specialists and clinical supervisors. They sometimes have difficulty understanding the role of peer specialists, and this is more likely when they are unfamiliar with core values; it can further lead to the marginalization and mistreatment of peer helpers. For example:

“For example, strategic or judicious self-disclosure is often outside the scope of professional practice of a licensed practitioner; yet licensed practitioners are the most frequent supervisors of peer support staff in traditional service settings. Standard clinical approaches to providing supervision are therefore antithetical to values ​​of peer support when the supervisor’s opportunities to effectively model peer roles are limited.

In recent years, the authors have received a positive response to the guidelines. These include feedback that the guidelines are straightforward and help bridge the gap between the ethics of peer support groups and those essential to clinical settings (to which supervisors adhere). Additionally, others have suggested using these guidelines for peer helpers themselves who can use them to ensure their own practice is aligned with core values.

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Foglesong, D., Knowles, K., Cronise, R., Wolf, J. and Edwards, JP (2021). National Practice Guidelines for Peer Support Specialists and Supervisors. Psychiatry online. https://doi.org/10.1176/appi.ps.202000901 (Link)


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