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The Future of Mental Health Peer Support in Vermont

Written by Amey Dettmer, Training Specialist, with editorial support from J Helms, Director of Training and Advocacy.

I started working as a peer support specialist in 2011 in Pennsylvania before a certification board oversaw the profession. I then witnessed the profession turn to a professional certification overseen by a certifying body that provides oversight of the peer support certification in PA. As both a certified peer supporter overseen by a certifying body and as a peer support before professionalized certification, I worked in direct service in various settings. My work experience includes residential care homes, community-based support services, and peer-run respites. I worked for large and small provider agencies, some with over 1,000 employees, and peer-run organizations with less than 20 employees. I worked as a Peer Support Supervisor and helped organize regular community meetings for peer support workers to gather in the name of support and to grow our profession locally.

L to R: Amey Dettmer, J Helms, Alex Ferguson

In 2016, I started working at a national peer-run organization where my job consisted of providing training and technical assistance to the peer support workforce nationwide. I organized statewide networks of peer support workforce leaders. I helped organize national groups to discuss nuanced areas of our profession (youth and young adult peer support, warmline operator peer support, justice-involved peer supporters, veteran peer support, etc.). I facilitated peer support-related training and worked with peer supporters in every state. I studied peer support certification and peer support networks in all 50 states. I heard from peers nationwide about their concerns, problems, and successes within the peer support profession.

The knowledge I gleaned from the peer support workforce and historical movement leaders I met is information I carry with me and share with others as I continue my profession as a Training Specialist here at Pathways Vermont. Today, I am thankful to ground my work in only one state: our beautiful state of Vermont, which I have lived in since 2018. My role here primarily focuses on providing training for Vermont’s Peer Workforce Development Initiative, which keeps me updated on Vermont’s certification status and intentions for the peer support profession. You can read more about my specific role at Pathways here.

As 2025 begins, our beautiful Green Mountain state is on the brink of launching a peer support certification process that will increase opportunities for Vermonters to have access to voluntary peer support services through Medicaid and potentially other insurance types. Certification will expand opportunities for people who want to work in settings that consider lived/living experiences of mental health struggles as an asset to community and mental health services. It will offer career growth and professional credentialing to people already working as peer supporters. This soon-to-be-recognized certification-based profession for Vermonters will take the title of Certified Peer Support Provider (CPSP). This certification is a critical step to meet the needs of our Vermont communities. It also comes with some risks – risks that the peer support workforce and supporting systems need to be aware of as we enter into this new phase of professionalizing peer support in Vermont.

Mental health peer support was born out of the need for social change. This social change is about human rights and dignity. Peer support offers people choice, connection, and community when seeking support for mental health challenges. Peer support is an invaluable cultivator of systems change, with people with lived/living experiences steering systems and providers of mental health services to better meet the needs of people in a more dignified, humane, and compassionate way.

Historically, and sometimes still today, psychiatric patients and service recipients have received “care” in traditional mental health settings, like state hospitals and other involuntary and restrictive settings, which has caused many people to feel harmed, to have distrust in the system, and not to have access to community-based, trauma-informed, healing centered approaches. The psychiatric survivors who joined together for the protection of human rights started the mental health peer support movement as we know it today. This movement was founded on activism for social change, working towards the types of support, alternatives, and community that the movement believes all people should have access to. Judi Chamberlain, an internationally recognized psychiatric survivor who gave substantial voice and momentum to this movement, describes this social change as a “moral imperative.”

In the Intentional Peer Support training that we offer through Vermont’s Peer Workforce Development Initiative and the Pathways Vermont Training Institute, we discuss that activism and mutual aid are foundations of peer support and the movement that has now morphed into what we now know nationwide and in Vermont as the peer support workforce.

In peer support, we build relationships centered around mutuality, vulnerability, and connection. These relationships offer empathy and shared understanding and prioritize dignity of risk and personal choice. Peer support relationships promote autonomy, self-determination, self-exploration, and personal discovery. Nationwide, peer support is recognized as an evidence-based practice. Research suggests that peer support has a transformative impact on those in peer support relationships and on the mental health system as a whole.

The data shows that peer support:
– Improves quality of life
– Improves satisfaction with services and supports
– Decreases hospitalizations and inpatient stays
– Lowers overall costs of services
– Improves whole health, including physical health

Now, let’s discuss the future of professionalizing mental health peer support in Vermont. Here is the proposed plan:

  • A yet-to-be-determined, peer-led organization will be responsible for the screening and training of CPSPs. The organization will screen applicants for eligibility and deliver the Department of Mental Health’s approved curriculum and training that CPSPs will need to obtain certification. The details of this training content and length have not yet been finalized; however, they will include state-approved core competencies that outline the peer support professional approach. The current conceptualization of this training proposes that a 5-day Intentional Peer Support Core Training will be a prerequisite, followed by up to 15 days of additional VT-specific peer support curriculum. There will be separate pathways for people to transfer certification from another state to VT and for people already working as peer support providers in VT to obtain this new CPSP credentialing without undergoing the new training requirements.
  • A second yet-to-be-determined peer-led organization will be responsible for credentialing CPSPs, which includes the delivery and grading of the test that will be required for CPSP certification. The entity will process all applications for peer support certification, verify documents and information, and oversee continuing education credits, which includes approving which training will qualify as continuing education.
  • The Office of Professional Regulation (OPR) will oversee the profession of Certified Peer Support Providers (CPSP). This includes receiving applications and renewing, denying, revoking, suspending, reinstating, or conditioning certification credentials. The OPR will also collect certification fees and address professional disciplinary measures and appeal processes.

(To learn more about the plan, click here to read Wilda White’s “Current Conceptualization of Certification Process for the Mental Health Peer Support Provider Certification Program.”)

While certification will be required to bill Medicaid (and hopefully other types of health insurance) for services, we know that not all peer support workers or peer support organizations/programs in Vermont will decide to pursue certification. For many years, peer support programs have operated and offered life-changing peer support services to Vermonters without peer certification. These programs include drop-in community centers, telephone support lines, and peer-run respite centers, all of which have operated with funding not attached to a certification requirement. Many of these programs throughout the state have had enormous success offering peer support and community-based mental health options without the level of oversight, time, and cost-consuming requirements proposed with a professional certification. As certification becomes available, Vermont’s peer workforce will shift to certified peer support providers AND peer support workers who don’t seek certification. At Vermont’s Peer Workforce Development Initiative, we’re committed to ensuring that all peer support providers in Vermont, regardless of certification, provide values-aligned peer support and have the means to continue to operate invaluable peer support programs across the state.

Earlier, I mentioned the risks of peer certification. Let’s talk about that: The oversight, standardization, and professionalization of a workforce can (and does!) ensure values alignment and best practices. As with any bureaucratic process, it also comes with risks. I’ll touch briefly on some of the risks here, though these are issues that require more elaboration and discussion:

  • Workforce co-optation: Regretfully, peer support co-optation is happening across the US. Peer support, a values-based approach rooted in human rights and social change, is being co-opted by the wide net of mental health systems to assimilate peer support workers into a system that continues to work as it always has – often causing harm and human rights violations – rather than address the human rights violations that frequently occur within these systems. Co-optation can happen due to programmatic misunderstanding of the peer support role or due to Medicaid/funding requirements which are in misalignment with peer values. When co-optation happens, peer supporters are often asked to do things within their role that are outside of the scope and values of a peer support role.
    • Examples include (I have experienced all of these first-hand):
      • Asking someone in a peer support position to involuntarily surveil someone they support. This might occur through a common and invasive practice known as “1:1”, an approach many organizations take if there is a risk of suicide or self-harm. Asking a peer supporter to engage in this practice when a person receiving support/services does not consent or agree to this goes against the practice of peer support, which is guided by the value that all support is voluntary.
      • Asking a peer supporter to conduct clinical assessments on someone receiving services. Clinical assessments typically include a provider making recommendations on ways for the person receiving services to “improve” or “change” – this goes against the practice of peer support. Peer support is person-driven, strengths-based, and rooted in regarding each person as the expert of their own experience; the role is to provide mutual support, not steer service participants one way or another.
      • Requiring someone in a peer support position to engage in “medication management.” Medication management is the practice of overseeing a person’s medication compliance and maintenance. This practice is misaligned with peer support values, as peer support consists of shared power and mutuality in relationships. Peer support is not meant to be a role of having oversight or control of the people receiving support.
  • Workplace tokenism: The Merriam Webster definition of tokenism is “the practice of doing something (such as hiring a person who belongs to a minority group) only to prevent criticism and give the appearance that people are being treated fairly.” Tokenism creates inequity, injustice, and a lack of true inclusivity. Tokenism can look like a large organization hiring one or two peer supporters and asking them for questions/guidance about “lived experience” and peer support values without making any real or substantial structural change. Additionally, workplace tokenism for peer supporters can look like hiring peer supporters in leadership roles and/or including peer supporters in committees or processes for only symbolic purposes without actually sharing decision-making power.
  • Funding the peer support role: Funding for peer support programs, including through Medicaid billing, changes the nature and interaction of the peer support relationship. When one person is paid to support a person receiving services, this creates a power imbalance that can sometimes challenge the mutual and reciprocal nature of peer support. This can happen in the dynamic of any paid peer support role. However, the difference in Medicaid billed services is in the documentation requirements. Documentation requirements can take away time from the peer support relationship and challenge the relationship’s mutuality.
  • Peer support is in demand: Organizations and new programs scramble to fill peer support jobs as encouragement and funding grow for employing peer supporters on mental health teams. This eagerness to fill roles often includes organizations cutting corners without taking the time to understand the ins and outs of the profession. Job descriptions that don’t align with peer values get developed, and peer supporters might be asked to do jobs that are not within the scope of what peer supporters should be doing. Sometimes, this also means that someone is hired for a peer support position but isn’t getting adequate training needed to understand the role of a peer supporter, which includes having a social change orientation and values-based approach to service delivery. Additionally, as organizations may be “checkboxing” that they have peer supporters on their team, sometimes people are asked to fill a dual role, meaning they are asked to simultaneously be in two conflicting roles. This could look like someone working simultaneously as a Certified Peer Support Provider and Case Manager. This dual role is problematic as these professions may operate under different values and ethics, and this dual role would continue to perpetuate a common myth that “peer supporters are mini case managers.”
  • Financial Risks: Professional costs will grow for both organizations and individuals. Peer Support Provider Certification will now have associated costs, including, but not limited to, application costs, training costs, testing costs, employer costs to send people to training, and ongoing costs of CEU training. This may make the profession more inaccessible to under-resourced and oppressed populations within our communities.

Here are some ideas for addressing these workforce risks:

  • Workforce co-optation: Supervisors and organizational leaders must be well informed of peer support values. Specifically, in Vermont, our profession will be guided by core competencies. People working in peer support roles need to be heard when speaking out in the name of human rights and bringing forth ideas for systems and social change. Supervisors and organizational leaders should learn the origins of peer support and the history of the psychiatric survivors movement to truly understand the profession of peer support.
  • Workplace tokenism: Organizations would benefit from addressing their culture and readiness to implement peer support and support individuals with lived/living experience in the workplace. They should consider people working in peer support roles as an asset to organizations, teams, and services. Peer supporters should be involved in provider/direct service roles and leadership roles to ensure that peer support values are considered at all levels of organizational decision-making.
  • Funding the peer support role: Since documentation requirements can change the nature of the peer support relationship, there needs to be peer-led oversight thoroughly thinking through whether or not required documentation aligns with the professional values and competencies. For example, peer support is strengths-focused; since our profession works from a place of strengths, we should not be conducting safety/depression, etc. assessments with individuals – these approaches are centered on illness-based approaches rather than the holistic, strengths-based view that is intended in peer support relationships. Additionally, peer support workers and supervisors must be trained in collaborative documentation; this approach allows the peer support worker and the person receiving services to share power and have input into the documentation regarding the service relationship.
  • Peer Support is in demand: As the peer support workforce expands, organizations must train supervisors and organizational leaders on peer support. Peer support supervisor training exists to support this learning. Employers should seek technical assistance and training from peer-run organizations and groups to implement new peer support roles. Also, it is not recommended that peer supporters be hired to fulfill conflicting dual roles within an organization.
  • Additional ideas: Peer supporters should have an opportunity to be connected to an alliance or coalition of peer support workers throughout the state to ensure a central connection point of information for peers by peers. Also, employers should offer paid regular attendance of Intentional Peer Support Co-reflection as a space for peer workers to come together and discuss the practice of peer support regularly.

Vermont’s Peer Workforce Development Initiative has established a peer support fidelity committee to ensure that we address these risks and concerns across agencies and at a statewide level; the committee is composed of leaders in Vermont’s peer workforce. Additionally, our training team here at Pathways Vermont is passionate about ensuring this certification rollout remains true to peer support values and that we are available for organizational and individual training needs to support this work. Please reach out to [email protected] to learn more or get involved.

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