People experiencing homelessness and fighting addiction often feel isolated with no one to pick them up if they fall. Peer staff with lived experience — serving as case managers, housing navigators, or in other roles — who’ve walked “in their shoes” can help provide a foundation to help people journey to recovery. Through shared backgrounds and similar experiences, peer staff can better understand and relate to their clients. However, staff with lived experience of homelessness and/or substance use disorders need their own support network and careful training to equip them for their critical yet challenging role.
The Center for Health Care Strategies (CHCS) recently spoke with Katelyn Taubman, Manager of Case Management and Substance Use Disorder Counselor at Illumination Foundation about how to best support staff with lived experience who work with clients experiencing homelessness, including many who have substance use disorders. As Katelyn celebrates her 10th year of sobriety, she spoke to us about the positive impact staff with lived experience have on clients and the workplace supports that peer staff need through her lens at Illumination Foundation. This blog post is a product of the Partnerships for Action: California Health Care & Homelessness Learning Collaborative, led by CHCS and made possible by the California Health Care Foundation.
Q: Where have you found peer programs to be most impactful?
A: At Illumination Foundation, we try to hire people with lived experience of homelessness and/or addiction if they are going to be working directly with people who are currently unhoused. The connection and rapport these peers build with their clients offers a one-of-a-kind type of bond allowing clients to trust this person and feel like they have someone in their corner.
There is something very special about someone who has been through a very dark time and comes out on the other side willing and wanting to give back. Make sure these peers know how important their contributions are — they bring something to the table that is unteachable, something you can’t go to school and get educated on. It’s so important for them to be aware of their value and necessity through this work.
Q: How can organizations best support peers in the workplace? Is there a supervision framework that has been effective in supporting peer staff?
A: It’s important to make sure people with lived experience who are serving as peer navigators for people experiencing homelessness feel supported and have easy access to resources they need. As a manager, I see a lot of staff burnout. At Illumination Foundation, we practice close supervision and an “open-door” management style with all staff. If they need to talk through situations prior to making a decision, leadership is always there for them to offer support.
Case management and housing navigation can be very draining — physically, emotionally, mentally. The most important thing I’ve learned is how critical it is to connect peers to counselors, psychologists, or therapists who can check in with them on a regular basis to talk about whatever issues they’re going through on a given day. I have one-on-one meetings with my direct reports and make sure to ask how comfortable they feel with their current work, check-in about their clients, and see if there are any areas that they want more training on.
The reality is that the mental toll of this kind of work is not something you can fully prepare a person for, each case varies widely, and every client is going to react and show-up to a situation differently. As case managers we’re so busy that we don’t have time to even process when a client has passed away a week before, or to heal from it, because there’s another client who just got into the hospital and the focus needs to be on getting them help — it’s a very busy job.
We have trainings on trauma-informed care, harm reduction, and Housing First too. We throw these words around, but a lot of staff, unless they’ve been trained, don’t know what these things are, and it can be very frustrating for them. Supporting their development is something we take seriously, whether that’s through classes at local colleges or trainings from organizations, nonprofits, etc. — we cover those development opportunities to help them grow.
Q: How do you help peers prepare for emotional situations with their clients and set boundaries as needed?
A: Our peers are doing this work from the depths of their hearts and it’s their duty to help their clients. And it’s our duty [as managers] to determine if they are totally ready to face these situations. Make sure that a clear line between peers and clients is an expectation that is set from the start, acknowledge that we can still support the client while keeping safety a top priority. In heightened emotional situations, there is a fine line between a staff member remaining and staying firm or walking away when feeling unsafe. If staff are trained [e.g., in conflict resolution and de-escalation techniques], they may opt to stand firm with a client and set a boundary by saying, “I’m here to help you, you’re not going to talk to me like that.” Making it past a situation like that can be really amazing for the client, giving them an opportunity to calm down and say, “Wow, you didn’t walk away from me like everybody else does.”
It’s important to let peers know sharing lived experience with clients is not always well received — it takes time to build the trust and relationship. My first week as a case manager I went to visit a client — I got to his space, let myself in with the code I was provided, took out my badge, and introduced myself. My client came running out of his room yelling, “Who are you and what are you doing in my house?! You need to introduce yourself loudly and knock on my door when you come here!” I immediately freaked out and told him that I understood where he was coming from, and I went through something similar… it went terribly. He responded to my story and said, “I don’t care what you did. I don’t care what you went through. This is about me! We need to talk about me!” Reactions like this can be hard for peers to hear — their personal story is special to them and a response like that can be a trigger and make them think they’re not helpful — but it’s important for peers to be prepared to hear things like this.
Q: What are the top things you look for when hiring a peer advocate?
A: Be clear and direct when interviewing people for peer roles — we want to know about a candidate’s path of life and how they became interested in a position like this. Through the hiring process, we welcome interviewees who have a wide range of lived experience in housing instability and substance use disorder as well as those familiar with harm reduction. It’s important through this process to also determine those who may be new to these types of situations mentioned above but are willing to learn. Asking questions that get a sense of their personal values and assess how they fit into the organization’s mission, values, and approach to service delivery is key when trying to hire the right person. Ask questions like: What is your lived experience?; Are you aware of harm reduction strategies?; or What does harm reduction mean to you?
Another tactic that has been successful for us is giving candidates scenarios that are occurring in real time and getting their feedback on it. Give specific scenarios and talk through how they would handle it to gauge their reactions. Some of the best advice I’ve ever got from a previous manager is “at the end of the day, the job still needs to get done and some people just aren’t fit for this work.”
In my experience, some people interviewing for a peer role won’t know anything about a lot of this stuff — so being vulnerable and honest with them about what this work looks like is so important to hiring the right person as is identifying who is ready and willing to train and learn. We know they’re likely to face traumatic experiences serving in a peer role and it’s our responsibility to make sure they know what they’re getting into and that they’re ready to do this life-saving work.