Overdose Measures Matter

Indicator Profile

Description of efforts to support fair treatment of peer workers employed by your organization

Category: Peer Workforce Support

Audience: Program Implementer

Data Type: Qualitative

Indicator Overview

Description:

Description of efforts to support fair treatment of peer workers employed by your organization

Consider any of the following:

  1. Hiring, retention, pay and benefits and reducing or eliminating barriers to career mobility within your organization
  2. Providing onboarding, training, supervision and professional development opportunities
  3. Providing support for mental health, continued recovery and minimizing job stress
  4. Providing training on substance use disorder (SUD) for coworkers and other staff
  5. Providing all needed materials
  6. Providing a safe space for work

Rationale:

Peer support services are a critical component of many harm reduction, linkage to care and overdose prevention programs. Peers may aid in mentoring, education, emotional support, creating community, navigating treatment systems, linking to services, case management and providing vocational and skills training. Several studies have shown that integrating peers into community settings is an effective approach to reducing the risk of overdose and improving a range of health outcomes among people who use drugs.1,2,3

The wellbeing of the peer workforce is important to the health of the organizations where they work. The National Institute of Occupational Safety and Health (NIOSH) study on health workers found that in high stress and emotional situations, such as confronting death and the unpredictability of being on call, situations that may be common for harm reduction and overdose prevention workers, can lead to chronic stress and burnout.4 By assessing efforts to support equitable treatment of peer workers, organizations may be better equipped to identify gaps in support, enhance working conditions and promote fairness and inclusivity within their teams.

Related Indicators:

Consider assessing how your organization engages people with lived or living experience (PWLLE) in planning and key decision making of overdose prevention programs. By looking at these indicators together, programs may be able to comprehensively assess their approach to including and elevating the voice and expertise of PWLLE experience within their organization. Further, knowing the percent of peer workers who have been employed and retained by your organization for at least one year may give some indication of the quality of employment provided.

Indicator Details

Definitions:

Peer workers, also known as peer support workers, peer navigators, peer recovery coaches, peer recovery support specialists or simply, peers, are people who have lived experience of recovery from a substance use disorder and have been hired by their organization to provide support to others experiencing similar challenges.5 Peer workers can provide a range of supports including, but not limited to, advocacy, resource sharing, skill-building and mentoring. They may also provide trainings and education, oversee programs and supervise other peer workers; People with lived experience who assist others who use substances, across the care continuum, to access needed services with non-stigmatizing support and compassion. They may be licensed and undergo continuing training and supervision.

Equitable treatment can be defined as providing fair opportunities for all employees to succeed in their roles and within the organization, based on their individual needs. Equitable treatment may include establishing equity in pay across years of education and years of lived experience, creating advancement opportunities for peers and providing additional supports that may be needed. See the description for additional examples.

Ways to Examine the Data:

  1. Type of supports provided to peer workers. (e.g., training and onboarding processes, supporting peer-to-peer relationships, promoting self-care, providing opportunities for continuing education, etc. (See Description)
  2. Tools provided. (i.e., Do peer workers have all the tools to complete their jobs safely and effectively? This may include phones, computers, defined schedules, transportation, etc.)
  3. Equitability of compensation for work performed, including pay, benefits, paid time off and incentives.

Data Sources:

  • Organizational practices and policies and their implementation
  • Peer workers employed by your organization

Data Collection Methods:

  • Document or policy review of organizational policies to support peer workers
  • Internal evaluations of policies to support peer workers
  • Interviews or focus groups with organizational staff, including with peer workers
  • Surveys among organizational staff, including with peer workers

Application and Considerations

Suggested Use:

  • To assess how organizations are supporting peer workforce development through internal policies, processes and programs
  • To assess organizations’ commitment to offering an equitable workplace to all employees
  • To identify opportunities to expand and strengthen supports for peer workers

Health Access Considerations:

You may want to consider:

  • Are there additional state or regional-level policies that further support or hinder equitable treatment of peer workers? For example, are there institutional barriers to hiring people with criminal records or histories of substance use?
  • How does the hiring process address legal considerations when asking potential applicants about their diagnoses and/or disabilities?
  • What role do peer workers have in decision-making? How does this compare with the decision-making roles of other staff within the organization?
  • Are there opportunities for peer workers to provide feedback on program practices and policies to support them in their role?

Evaluation Considerations:

Limitations:

  • Does not assess outcomes or impacts of these efforts
  • Does not assess implementation
  • May not consider peers’ perspectives or experiences
  • Does not account for accessibility or availability of supports or frequency in which supports are offered to organizational staff

Policy Considerations and Resources:

Additional Resources

Examples:

References:

  1. Winhusen, T., Wilder, C., Kropp, F., Theobald, J., Lyons, M. S., & Lewis, D. (2020). A brief telephone-delivered peer intervention to encourage enrollment in medication for opioid use disorder in individuals surviving an opioid overdose: Results from a randomized pilot trial. Drug and Alcohol Dependence, 216, 108270.
    https://pubmed.ncbi.nlm.nih.gov/32911132/
  2. Bassuk, E. L., Hanson, J., Greene, N., Richard, M., & Laudet, A. (2016). Peer-delivered recovery support services for addictions in the United States: A systematic review. Journal of Substance Abuse Treatment, 63, 1-9.
    https://doi.org/10.1016/j.jsat.2016.01.003
  3. Gormley, M. A., Pericot-Valverde, I. Diaz, L., Coleman, A., Lancaster, J., Ortiz, E., Moschella, P., Heo, M., & Litwin, A. H. (2021). Effectiveness of peer recovery support services on stages of the opioid use disorder treatment cascade: A systematic review. Drug and Alcohol Dependence, 229, 109123.
  4. NIOSH. Risk factors for stress and burnout. (2024).
    https://www.cdc.gov/niosh/healthcare/risk-factors/stress-burnout.html (last retrieved 1/9/2025).
  5. Substance Abuse and Mental Health Services Administration. (2024). Peer Support Workers for Those in Recovery.
    https://www.samhsa.gov/technical-assistance/brss-tacs/peer-support-workers
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