We Need to Get Paid for Our Value: Rhode Island Study Addresses RCs and CHWs
Having read the documents I created recently, a colleague of mine who works with BSAS and teaches the CCAR RCA training classes, sent me the results of a 2023 study about RCs and peer workers by faculty and employees at Brown University; Rhode Island Hospital; Project Weber/Renew, Pawtucket; and Lifespan Division of Addiction Medicine.
The paper, titled, “We Need to Get Paid for Our Value’: Work-Place Experiences and Role Definitions of Peer Recovery Specialists/Community Health Workers” is published “Alcoholism Treatment Quarterly” It’s posted in the “Recovery Coach Resources” Section of this site and can be downloaded here.
The study looks primarily at low wages among peer recovery specialists (PRS) and community health workers (CHW), which they consolidate into a single category, explaining, "Both roles can be understood as part of a broader workforce that we will call Community-Based Health Workers (CBHWs)."
The paper was sent to me because it touches on several of the issues I addressed in my documents, “Recovery Coach Guidelines” and “Recovery Coaching by AI.”
What I hadn't considered that this paper alludes to, is the very real and important aspect of potential emotional and psychological risk CBHWs are exposed to when an organization doesn't fully understand the role or the people who are working in those roles.
As my colleague put it, "You would think that healthcare and behavioral health organizations would do a better job when dealing with vulnerable populations and treating them with respect." His words, not mine.
In the paper, the authors write:
"CBHWs face particular challenges working in traditional health care and mental health settings – such as hospitals, community mental health centers, primary care offices, and SUD treatment centers – where leadership and staff committed to clinical models of care may have an incomplete or inadequate understandings of these roles. If we hope to undertake the expansion of this workforce in a form that is both sustainable and meets the ambitious public health goals now being placed on CBHWS, while avoiding the perpetuation of new forms of harm, we need a far more empirically robust account of CBHW role responsibilities and challenges in practice.
A first step toward achieving this understanding is listening to the experts: CBHWs themselves."
Later in the document, they write, "Most CBHWs that we interviewed see their responsibilities as substantially exceeding written job descriptions and sometimes perceive the formal framework of their employment as misaligned, if not conflicting, with their actual responsibilities. Additionally, they reported widespread misunderstanding of their role by both supervisors and coworkers in traditional health care, SUD treatment, and mental health settings"
This observation falls in line with the premise discussed in my document, "Recovery Coaching by AI" in which I used AI to curate information. The most widely identified cause of friction and disagreements is the lack of understanding and respect for their role, particularly for those working in healthcare.
When it comes to the consequences felt by peer workers as a result of this lack of understanding, the Rhode Island paper suggests, "By generating a conflict between institutional expectations and the responsibilities felt by the CBHW, this approach creates the conditions for “moral injury:” a profound injury to self created by the perception of betraying or violating one’s moral obligations. At the same time, this dilemma appears to be a false dichotomy created by an inflexible structure." They go on to say, "There may also be an emotional cost for the CBHW, who can experience this work of reframing challenging situations as normalizing abusive institutional dynamics that they themselves have experienced."
As with most papers on this topic, the authors critically note that agencies and organizations, "must start with an empirical understanding of actual work conditions and functions, rather than existing (and largely prescriptive) role descriptions."
The writers also speculates - and this was of particular interest - that much of the negative aspects shared by CBHWs about working in environments like this may be muted or understated, pointing out how people in recovery are less likely to speak about the negative aspects of the job, as public knowledge of their lived experience may lead coworkers to question their competency as an individual and member of a stigmatized community and that they feel they are continuously on trial.
"While there is no question that our participants were sincere in praising the benefits of the role, this larger context may have informed how participants framed the position’s challenges, potentially leading them to understate its personal costs. Similarly, CBHWs in recovery from addiction often participate in cultures, such as 12-step fellowships, that stress gratitude, hope, and service as core recovery values. In some interviews, this culture may have shaped how participants narrated their experiences as CBHWs, likewise leading to an accentuation of the benefits of the role at the expense of personal costs and challenges."
In the paper, are other examples of issues concerning mistreatment, stigmatization, discriminatory actions and behaviors by coworkers and agency staff. Included in this paper and some of which some of you may have experienced yourselves, are discriminatory and disparaging remarks, being removed from workplaces, questioning qualifications and competence, being devalued, fears that their history would be used against them, "and class hierarchy that is operationalized by the (more) elite and protected classes of professionals in treatment and medical settings."
And while the paper admittedly highlights some positive experiences of this work and I would be remiss if I did not say that I have dealt with some wonderful clinicians, I have never seen the need to celebrate being valued and respected for our contributions or congratulating people for treating each other with dignity and humanity. That should be the norm. Particularly in an environment in which compassion and care are the main focus and objective.
