Exploring Recovery As a Mediator in Certified Peer Specialist Services and Community Integration Outcomes: Certified Peer Specialists As Translational Practitioners

Background and Purpose: The rapid expansion of certified peer specialist (CPS) services to align mental health treatment with the recovery paradigm highlights the key intersection of recovery, community integration, and CPSs. This confluence suggests that recovery lies at the crossroads between peer delivered services and community integration. From this perspective, CPSs are translational practitioners who amplify recovery through their own personal narratives and embody recovery values through a relational approach that may help to explain the impact of their services on community integration outcomes. The relationship between peer provider and peer recipient is then both an actualization of recovery philosophy and a vehicle for transformation toward community integration outcomes. As the CPS role is formalized, a general lack of clarity about the services CPSs provide and/or state regulations that enable reimbursement highlights the difficulty for providers in carving out a unique role for CPSs in the promotion of community integration outcomes. Continued growth and expansion have exacerbated confusion over how to integrate CPSs into services, widening a gap in policy and practice. This study explored recovery as a mediator of the relationship connecting reported community integration outcomes to quantity and variety of CPS services delivered to individuals with severe mental illness receiving community mental health treatment.

Methods: Two survey data sets (sample of104) - one measuring community integration and one measuring recovery, were correlated with CPS service utilization data from the prior month. Regression modeling was used to examine those measures of CPS services and covariates most likely to predict community integration, with significant predictors for community integration proceeding to mediation analysis. The goal of hypothesis testing was to investigate recovery as a mediator of the relationship between CPS services and community integration.

Results: Three measures of CPS services: embedded clubhouse hours, community hours, and total hours emerged as greater predictors of community integration and proceeded to mediation analysis. Of the three services, only embedded clubhouse services showed partial mediation. Total CPS service hours were positively correlated with community integration but did not show mediation. Community CPS service hours however, were negatively correlated with community integration, and the relationship was not mediated by recovery.

Conclusions and Implications: These results suggest greater impact for CPS interventions in programs and settings highly aligned with recovery. The results favor site-based programs, particularly the clubhouse model for this sub-population of service recipients. Negative findings for community- based services highlight challenges for individuals living in restrictive settings and characteristics that likely accompany that, suggest more deliberate approaches to services in the community may be necessary. The identified potential for CPSs to promote recovery may help guide the rapid expansion of CPS services and the growing movement for national CPS training and certification. These findings are essential for social workers to support CPSs in their work as well as services recipients to enhance their community integration.