Do We See Eye-to-Eye? Comparing the Recovery Attitudes of Peer Providers and Program Directors in Full Service Partnerships

Background: Peer providers are individuals who use personal experience with mental illness and recovery combined with skills learned in training to deliver mental health services. Peer providers are integral to Full Service Partnerships (FSPs), which are team-based treatment models that do “whatever it takes” to improve the mental health of consumers.  Although peer providers use principles of recovery to empower and engage clients, FSPs can vary in their recovery orientation, and organizational leadership can influence the recovery orientation of its providers.  Whether and how peer recovery orientation reflects the organizational environments of FSPs is unclear. This qualitative study examines peer provider attitudes towards recovery within their larger organizational context of specific FSPs that were implemented under California’s Mental Health Services Act. 

Methods:  Eight programs were purposively sampled from a larger mixed methods evaluation of FSPs throughout California. Full day site visits involving 3 evaluators included in-depth, semi-structured interviews with program staff, which were recorded, transcribed verbatim, and analyzed using NVivo software.  Case study and cross case study analyses were conducted to understand peer attitudes toward recovery within their organizational context. To accomplish this, we compared peer provider perspectives at each program to those of the program directors. Peer provider transcripts were analyzed using concepts from the recovery literature including hope, client autonomy, and coercion. Given that leadership has been shown to highly influence organization culture and climate, we focused on program director attitudes toward recovery as a proxy for the larger organizational context of recovery. Program director transcripts were reviewed and a summary of their perspectives on hopefulness, client autonomy, and coercion was completed for each case. Consistent with a case study approach, we also reviewed site visit reports to provide additional information regarding an organization’s context.

Results: A total of 8 peer providers and 8 program directors participated in semistructured interviews. Peer attitudes towards recovery generally aligned with the recovery orientations of their organizational environments, but in two cases peer attitudes towards recovery diverged. In these cases, the FSP was rated with a low recovery orientation while peers and their program directors were rated as high. Program directors described funding limitations and legal constraints imposed on formerly incarcerated clients as factors that contributed to an FSP having a low recovery orientation.  Peer Providers described several experiences in empowering clients within this context. 

Conclusions: The general alignment of attitudes toward recovery held by peer providers and program directors suggests that recovery attitudes are influenced by agency policies and programmatic rules. Although an FSP’s climate related to client autonomy and recovery is often institutionalized, this study shows that peer providers can serve as agents of client centeredness and recovery in organizational contexts that are less focused on these principles. Ongoing training of peer providers in the principles of harm reduction and motivational techniques is needed to continue supporting their efforts to promote the autonomy of clients.  Policies are needed to support peers in providing recovery oriented care in a range of organizational settings.