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. Author manuscript; available in PMC: 2022 Sep 1.
Published in final edited form as: Psychiatr Rehabil J. 2021 Apr 22;44(3):212–218. doi: 10.1037/prj0000479

Key Components of Recovery Predict Occupational Performance and Health in Peer Support Specialists

Jessica M Brooks 1, Jia-Rung Wu 2, Emre Umucu 3, Marianne Storm 4, Chung-Yi Chiu 5, Robert Walker 6, Karen L Fortuna 7
PMCID: PMC8443126  NIHMSID: NIHMS1732565  PMID: 34516154

Abstract

Objective:

The primary purpose of the study was to explore and identify how components of recovery are associated with occupational performance and health among peer support specialists.

Methods:

One hundred and twenty-one peer support specialists were recruited from statewide peer certification training programs and the International Association of Peer Supporters. Study respondents completed a survey package including demographic questions and psychometrically sound self-report measures. Two hierarchical multivariable linear regression models were conducted to evaluate whether the recovery components of the process of recovery, social support for recovery, and work self-determination (i.e., work autonomy, work competence, and work relatedness) were associated with indicators of occupational performance (i.e., work engagement) and health (i.e., job satisfaction).

Results:

Work autonomy was associated with the occupational performance indicator, while process of recovery and social support for recovery were the only recovery components associated with the indicator for occupational health.

Conclusions and Implications for Practice:

Findings support the importance of work self-determination and social support and recovery for occupational performance and health among peer support specialists. Mental health and rehabilitation professionals should address these key components of recovery when working with and supporting the work well-being of peer support specialists.

Keywords: occupational performance, occupational health, recovery, peer support specialists, mental illness

Introduction

Recovery is defined by the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA; 2012) as, “A process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential.” This asserts that people with a lived experience of a serious mental illness can work in competitive employment, experience meaningful lives, and fully recover in the community in spite of ongoing symptoms (Swarbrick, 2009). Peer support specialists, one of the fast-growing groups of mental health and psychiatric rehabilitation workers, are uniquely trained and certified to deliver peer support services to people with serious mental illness through the lens of their own recovery from a serious mental illness (Clossey, Solomon, Hu, Gillen & Zinn, 2018; Cronise, Teixeria, Rogers, & Harrington, 2016). Some of the peer support services they deliver include recovery-oriented mental health services, such as coping skills training and personalized recovery planning (Ahmed, Hunter, Mabe, Tucker, & Buckley, 2015). Over the past two decades, peer support services have rapidly expanded and are now an essential part of recovery-oriented mental health programs nationally and internationally (Burr et al., 2019; Cronise et al., 2016; Fan, Ma, Ma, Zhang, et al., 2019; Mulvale et al., 2019; Pathare, Kalha, & Krishnamoorthy, 2018; Payne, 2017).

The benefits of peer support services extend not only to mental health service users but also to peer support specialists themselves (Solomon, 2004). Research shows that most peer support specialists are engaged and satisfied with their jobs (Chang, Mueller, Resnick, et al., 2016; Chappell Deckert & Statz-Hill, 2016; Chinman, McCarthy, et al., 2016; Cronise, Teixeira, et al., 2016). Although these elements of work well-being have remained high, it is not well-established in qualitative studies or survey research whether the action of delivering peer support services is linked to the recovery process of peer support specialists (Burke, Pyle, Machin, & Morrison, 2018; Hutchinson, Lance, Guilkey, Shahjahan, & Haque, 2006; Moran, Russinova, Gidugu, Yim, & Spragu, 2012; Salzer et al., 2013; Weikel, Tomder, Davis, & Sieke, 2017). There are also issues related to job dissatisfaction, work disengagement, and burnout from role obscurity, workplace stigma, high turnover rates, and insufficient supervision practices experienced by many peer support specialists (Chappell Deckert & Statz-Hill, 2016; Davidson et al., 2012; Gillard & Holley, 2014; Relf et al., 2014). Such job-related factors that are internal and external to peer support specialists (Clossey et al., 2018; Chappell Deckert & Statz-Hill, 2016) might, then, negatively affect their overall work well-being and interfere with the recovery process.

Of the ten components identified by SAMHSA (2006) as guiding principles for the recovery process, more than half of them (e.g., hope, person-driven, many pathways, peer support, relational, strengths/responsibility, respect) are related to self-determination (Chiu, Davidson, Lo, Yiu, & Ho, 2013). Self-determination, is a theory of motivation that has been tested and linked to positive behavior change and outcomes in work settings, as well as other contexts such as health care (Deci, Olafsen, & Ryan, 2017; Williams, Gagne, Ryan, & Deci, 2002). Self-determination theory posits that people are more likely to participate and remain engaged in the workplace when they are in a supportive social environment that facilitates the satisfaction of their basic needs of autonomy, competence, and relatedness (Ryan & Deci, 2000). Autonomy is the need to initiate and regulate behaviors with a high degree of volition and a sense of choice (Baumeister & Leary, 1995; Reeve, Nix, & Hamm, 2003; Ryan & Deci, 2000). Competency is the need to be effective and exercise capacities to actively seek out optimal challenges toward increasing skills and subsequent opportunities (Baumeister & Leary, 1995; Reeve et al., 2003; Ryan & Deci, 2000). Relatedness is the need to establish close, warm, secure attachments with others (Baumeister & Leary, 1995; Reeve et al., 2003; Ryan & Deci, 2000). Yet, it is not known how the needs for work self-determination are related to occupational performance and health in peer support specialists.

To function efficiently and effectively, the mental health system needs to better understand how to support and maintain a motivated, productive, satisfied, and recovery-oriented peer support specialist workforce. Therefore, the purpose of this study was to explore and identify how components of recovery are linked to occupational performance and health among peer support specialists. As such, we hypothesized that several key components of recovery (i.e., process of recovery, social support for recovery, work self-determination) would be associated with occupational performance (i.e., work engagement) and health (i.e., job satisfaction).

Method

Procedure and Respondents

Upon institutional review board approval, a Qualtrics online survey was sent from group email lists to approximately 5,000 members of the International Association of Peer Supporters, and sent to other email networks of peer support specialists trained through several statewide peer certification training programs in the South. Our inclusion criteria included that respondents (a) had a self-reported mental health condition diagnosed by a medical doctor or other health care professional, (b) were 18 years and older, (c) lived in the community, (d) had completed either certified peer specialist or peer recovery support specialist training, and (e) were employed as a peer specialist when they participated in the study. All peer support specialists were instructed to read an online informed consent form online before completing the survey package. Respondents were compensated $15 gift card upon survey completion.

As shown in Table 1, 121 peer support specialists joined this study including 84 females (69.4%), 36 males (29.8%) and 1 transgender individual (0.8%). Respondents ranged in age from 18 to 67 years (M = 47.86; SD = 10.8). More than half of the respondents identified as White/Caucasian (65.3%), followed by Hispanic (19.0%), Black/African American (12.4%) and Native American (0.8%). Most of the respondents acquired postsecondary education (85.9%), followed by high school completion (10.7%) and some high school (3.3%). A majority did not receive any type of cash benefits (71.9%), while 17.4% received Social Security Disability Insurance, 7.4% received Supplemental Security Income, and 3.3% received Military Compensation. More than half of the respondents worked over 35 hours (63.6%), while 36.4% worked 1–34 hours per week.

Table 1.

Sociodemographic and Clinical Characteristics of the Respondents (N=121)

Variable M (SD) N (%)
Age 47.86 (10.8)
Gender
 Male 36 (29.8%)
 Female 84 (69.4%)
Race/ethnicity
 Caucasian/White 79 (65.3%)
 African American 15 (12.4%)
 Hispanic 23 (19.0%)
 Native American 1 (0.8%)
 Other 3 (2.5%)
Marital status
 Single, never married 34 (28.1%)
 Married/domestic partnership 46 (38.0%)
 Separated or divorced 40 (33.1%)
 Widowed 1 (0.8%)
Education level
 Some high school 4 (3.3%)
 High school graduate 13 (10.7%)
 Some college 53 (43.8%)
 College graduate 37 (30.6%)
 Postgraduate 14 (11.5%)
Cash benefit
 None 87 (71.9%)
 Social Security Disability Insurance (SSDI) 21 (17.4%)
 Supplemental Security Income (SSI) 9 (7.4%)
 Military compensation 4 (3.3%)
Working hours per week
 1–14 hours 23 (19.0%)
 15–34 hours 21 (17.4%)
 35–40 hours 39 (32.2%)
 Over 40 hours 38 (31.4%)
Diagnosed age
 Under the age of 19 38 (31.5%)
 The age of 20–24 19 (15.7%)
 The age of 25–29 18 (14.9%)
 The age of 30–40 32 (26.4%)
 Over the age of 40 14 (11.6%)
Diagnosis
 Schizophrenia 5 (4.1%)
 Schizoaffective disorder 8 (6.6%)
 Bipolar disorder 29 (24.0%)
 Major depression 35 (28.9%)
 Other mental health diagnosis 44 (36.4%)
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Measures

Components of Recovery

The Questionnaire about the Process of Recovery (Law, Neil, Dunn, & Morrison, 2014) is a 15-item questionnaire that is based off the original 22-item self-report measure (Neil et al., 2009). This scale was developed collaboratively by service user researchers and clinicians to assess the process of recovery. Items (e.g., “I feel better about myself”; “I feel able to assert myself”; “I can take charge of my life”) are rated on a five-point Likert scale, ranging from 1 (strongly disagree) to 5 (strongly agree). Higher scores on the measure are indicative of better recovery. The internal consistency was reported as .93 for the 15-item scale, and good test re-test reliability and convergent validity was found in the general population (Law, Neil, Dunn, & Morrison, 2014).

The Social Support for Recovery Scale was developed in collaboration with peers in recovery from substance use disorders (Vogel et al., 1998). However, the wording targeting substance use disorder peer groups was slightly modified to be appropriate for the varied peer support specialists in the current study. The scale measures social support for recovery, and includes items such as, “I’m on my own in recovery, I don’t get any support”; “Service providers do not understand my recovery needs”; and “Other peers in recovery are encouraging and supporting me in my recovery efforts”. These items are rated on a four-point Likert scale, ranging from 1 (strongly disagree) to 4 (strongly agree). Certain item scores were reversed (#1, 2, 4, 5, and 7), with higher scores indicative of greater recovery support. Internal consistency has been reported moderately high for the subscales a part of this scale, with Cronbach alphas ranging from .66-.87 (Vogel et al., 1998).

The Basic Need Satisfaction at Work Scale was used as an indicator for self-determination for work (Van den Broeck et al., 2010). This scale is a 21-item questionnaire that assesses the extent to which employees experience satisfaction of their three basic needs forautonomy, competence, and relatedness on the job (Deci, Ryan, Gagné, Leone, Usunov, & Kornazheva, 2001; Ilardi, Leone, Kasser, & Ryan, 1993; Kasser, Davey, & Ryan, 1992). Items (e.g., for competence, “I enjoy the challenge my work provides”; for relatedness, “I really like the people I work with”; and for autonomy, “I am free to express my ideas and opinions on the job”) are rated on a seven-point Likert scale, ranging from 1 (not at all true) to 7 (very true). Internal consistency for the subscales a part of this scale have been reported to be moderately high, ranging from (.73-.84). There is also evidence for construct validity that shows basic need satisfaction at work is associated with work performance and psychological adjustment in the general population (Baard et al., 2000).

Occupational Performance

The Utrecht Work Engagement Scale was used as an indicator for occupational performance. This scale was developed by Schaufeli and Bakker (2004) to assess a unique positive, fulfilling, work related state of mind that characterized by vigor, dedication, and absorption. This scale is composed of 17 items assessing vigor (e.g., at my work I feel like bursting with energy); dedication (e.g., I find the work that I do meaningful and purposeful); and absorption (e.g., time flies when I am at work). Items are rated on a seven-point Likert scale, ranging from 0 (never) to 6 (always or every day). Scores are calculated by averaging ratings across the items, with the higher score indicating a higher level of work engagement. This study used the 9-item version’s total scale, as it is briefer and the psychometrics for its subscales are similar to the psychometrics for the subscales from the original, full-length version. The internal consistency for the original subscales ranged from.80 to .92; and the subscales for the 9-item version ranged from .79 to .89 (Schaufeli & Bakker, 2004).

Occupational Health

The Job Satisfaction of Persons with Disabilities Scale was used as an indicator for occupational health. This scale was developed by the Rehabilitation Research and Training Center on Evidence-Based Practice in Vocational Rehabilitation at the University of Wisconsin-Madison to assess multidimensional job satisfaction (Chan, 2014). The original scale was comprised of 21 items (e.g., “I feel a sense of accomplishment from my job”). and each item was rated on a five-point Likert type rating scale ranging from 1 (strongly disagree) to 5 (strongly agree). The total score was averaged with higher scores indicating a higher level of job satisfaction. Smedema et al. (2016) validated this scale for use with people with disabilities and reported a three-factor structure: (a) integrated work environment, (b) job quality, and (c) alienation with Cronbach’s alpha internal consistency reliability coefficients for integrated work environment, job quality, and alienation to be .91, .77, and .59 respectively. The 14-item scale was adapted and validated by a group of researchers and peer support specialists in an attempt to enhance the usefulness and appropriateness of the scale for peer support specialists, which also reported a Cronbach’s alpha of .83 for the total scale (Brooks et al., in press).

Data Analysis

For sociodemographic and clinical characteristics, we calculated descriptive statistics such as counts, means, and standard deviations. A correlation analysis was conducted to examine interrelationships among study variables. We evaluated two hierarchical multivariable linear regression models to determine associations between components of recovery and indicators of occupational performance (i.e., work engagement) and health (i.e., job satisfaction). Consistent with the premise of self-determination theory that social environmental factors are necessary precursors to motivation, we first regressed occupational performance and health variables onto process of recovery and social support for recovery simultaneously (Step 1). In Step 2, we simultaneously ran multivariable regressions with all of the predictor variables, including process of recovery, social support for recovery, and the 3 self-determination theory factors (i.e., autonomy, competence, and relatedness).

Results

Correlations, means, and standard deviations for the criterion and outcome variables in the models are shown in Table 2.

Table 2.

Correlations, Means, and Standard Deviations for Variables Used in Models (N=121)

Variable 1 2 3 4 5 6 7
1. Work engagement --
2. Job satisfaction .53*** --
3. Process of recovery .26** .46*** --
4. Social support for recovery .23** .47*** .55*** --
5. Work autonomy .44*** .45*** .26** .31*** --
6. Work competence .36*** .45*** .30*** .25** .57*** --
7. Work relatedness .37*** .45*** .18* .33*** .59*** .58*** --
Mean 5.46 3.94 4.28 3.11 5.12 5.25 5.06
Standard Deviation .79 .65 .70 .54 .97 .76 .85
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*

P < 0.05

**

P < 0.01

***

P < 0.001

Table 3 presents the results from the hierarchical multivariable linear regression models. In the first model that focused on an occupational performance indicator (i.e., work engagement), process of recovery and social support for recovery were entered (Step 1). However, there were no significant associations found. In Step 2, process of recovery, social support for recovery, autonomy, competence, and relatedness were all entered. This combined set of variables accounted for a significant amount of variance in work engagement, R = .485, R2 = .235, F (5, 115) = 7.082, p < .001. Examining the standardized partial regression coefficients, work autonomy alone was found to be significantly associated with work engagement (β=.272).

Table 3.

Components of Recovery Predicting Occupational Performance and Health in Peer Support Specialists

Work Engagement (Model 1)
 Job Satisfaction (Model 2)
Variables B SE B β B SE B β
Step 1
 Process of recovery 0.221 0.118 0.197 1.609 0.086 0.291**
 Social support for recovery 0.173 0.155 0.117 0.269 0.113 0.313**
 R2 0.078 0.282
 F 4.9912,118** 23.1702,118***
Step 2
 Process of recovery 0.165 0.113 0.147 0.221 0.081 0.239**
 Social support for recovery −0.007 0.150 −0.005 0.249 0.108 0.205*
 Work autonomy 0.220 0.088 0.272* 0.096 0.064 0.144
 Work competence 0.079 0.112 0.077 0.128 0.081 0.151
 Work relatedness 0.132 0.103 0.142 0.126 0.074 0.164
 R2 0.235 0.413
 F 7.0825,115*** 16.1985,115***
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*

P < 0.05

**

P < 0.01

***

P < 0.001

In the second model that focused on an occupational health indicator (i.e., job satisfaction), process of recovery and social support for recovery were entered (Step 1). There were significant associations found by examining the standardized partial regression coefficients for the process of recovery and social support for recovery (β=.291 and β=.313, respectively). In Step 2, process of recovery, social support for recovery, autonomy, competence, and relatedness were all entered. This combined set of variables accounted for a significant amount of variance in job satisfaction, R = .643, R2 = .431, F (5, 115) = 16.198, p < .001. Examining the standardized partial regression coefficients, only process of recovery and social support for recovery were found to be significantly associated with job satisfaction (β=.239 and β=.205, respectively).

Discussion

The purpose of this study was to explore and identify how components of recovery are associated with occupational performance and health among peer support specialists. Overall, our study results offered empirical support for the research hypotheses. Work autonomy was associated with the occupational performance indicator, while process of recovery and social support for recovery were the only recovery components associated with the indicator for occupational health. This is one of the first studies to document links between work autonomy and work well-being among peer support specialists. Findings support the importance of work autonomy as well as social support and recovery for occupational performance and health among peer support specialists. Mental health and rehabilitation professionals should address these key components of recovery when working with and supporting the work well-being of peer support specialists.

Reaching higher stages in the process of recovery and reporting greater degrees of perceived social support for recovery were significantly associated with occupational health (i.e., job satisfaction). The regression model including these key recovery components accounted for 43.1% of the total variance in job satisfaction, which is considered a large effect size according to Cohen’s standards for the behavior sciences research (Cohen, 1988). This is consistent with past work well-being research that shows the opposite results of reduced job satisfaction in less-than-optimal workplace social conditions--where peer support specialists are experiencing difficulty locating other peers for support, or where peer support specialists are reporting that agencies are not sufficiently recovery-oriented (Clossey, Gillen, Frankel, et al., 2016; Clossey, Solomon, Gillen et al., 2018; Mancini & Lawson, 2009; Moran et al., 2013; Walker & Bryant, 2013).

Greater levels of perceived work self-determination (i.e., work autonomy) was also found to be significantly associated with increased occupational performance (i.e., work engagement), but not occupational health (i.e., job satisfaction). Autonomy, or the ability to choose and self-regulate tasks when at work, might then be an important facilitator of work engagement among peer support specialists. This finding is consistent with past research on the influence of autonomy on behavioral engagement in work and health care settings (Deci, Olafsen, & Ryan, 2017; Williams, Gagne, Ryan, & Deci, 2002), as well as aligned with the strong emphasis that has been placed on consumer’s choice and self-determination in the recovery movement (Fortuna, Brooks, Umucu, Walker, & Chow, 2019; Piltch, 2016; Swarbrick, 2009; Umucu et al., 2016). Therefore, a work environment and culture that promotes autonomy might lead to enhanced work engagement. Peer support specialists--just as mental health service users--should be entitled to have a voice and make choices about their work task options, goals, and roles.

In contrast, we did not find any significant associations between other work self-determination factors (i.e., competency, relatedness) and occupational performance and health in peer support specialists. This is unexpected given the findings on the links between competency and relatedness with positive work outcomes in other organizational contexts (Deci, Olafsen, & Ryan, 2017). However, it might indicate that work autonomy, process of recovery, and social support for recovery are better determinants of occupational performance and health in peer support specialists. Recovery-specific supervision topics when supporting peers might then be more effective, compared to a focus on generalized social support or building competencies at work. Overall, our findings are partially consistent with the strong emphasis that has been placed on consumer choice and self-determination in the recovery movement (Mancini, 2008; Piltch, 2016; Swarbrick, 2009; Umucu et al., 2016). However, future studies should continue to examine links between work autonomy and work well-being outcomes.

Implications

Peer support specialists are a critical part of the recovery-oriented mental health movement, and it is essential to address their occupational performance and health as a strategy for enhancing overall work well-being. Our findings underscore the positive value of supporting work autonomy and other key recovery components. Peer support specialists might be more engaged in work if they believe they are in a more autonomous role in the workplace. They may also find it satisfying to have others in and outside of their jobs who they believe support their recovery regardless of their current symptom severity. A way to enhance recovery support, work autonomy, and work well-being outcomes among peer support specialists, then, might be to start with the priorities of peers, including the identification of the type of social support for recovery needed and chosen by peer support specialists (Tang, 2018). After the acquisition of employment, peer supervisors might also need to consider monitoring and discussing the continual recovery process with peers, given that peers in our study were already employed and still benefited from social support of recovery.

Peer support specialists also are likely benefit from being in a higher stage of the recovery process, which means that they might feel that they are more empowered and in control of their life. It does not necessarily mean that these peer support specialists have reduced symptom severity. While only a few qualitative and survey-based studies have focused on the secondary gains of peer support services such as increased sense of recovery among peers themselves (Burke, Pyle, Machin, & Morrison, 2018; Hutchinson et al., 2006; Moran et al., 2012; Salzer et al., 2013; Weikel, Tomder, Davis, & Sieke, 2017), our finding on the importance of recovery to occupational health is aligned with successful recovery being listed as a major qualification in job descriptions and other hiring guidelines of peer support specialists (Clossey et al., 2018; Chappell Deckert & Statz-Hill, 2016; Davidson et al., 2012; Gillard & Holley, 2014; Relf et al., 2014). However, because recovery is a long-term, non-linear process and is intertwined with occupational health, it might need to be a permanent focus in both mental health services and peer supervision settings.

Limitations

This study identified key components of recovery that are associated with occupational performance and health for peer support specialists. However, there are factors that limit the generalizability and findings should be interpreted with caution. First, most of the respondents were Caucasian females, although this does represent the current national population of peer support specialists. Second, we did not assess length of employment, which should be explored as a potential contributing factor in future research on occupational performance and health. Third, we were unable to calculate the response rate to the online survey, as the potential participants from the pool of 5,000 peer support specialists may have missed or elected to not open the email announcement, might not have met the inclusion criteria for the study, or might have chosen not to start or complete the survey after reading the informed consent on the first page of the survey website. However, lower response rates often occur in survey research. Fourth, this study used self-report measures, which may be susceptible to social desirability issues. Fifth, some of the items measured were somewhat similar across measures and such overlap can create a problem, as it can lead to ambiguity within the theoretical constructs being measured. Lastly, this is cross-sectional study, and we cannot conclude that there are causal relationships between study variables, which suggests that the collection of longitudinal data is encouraged for future study.

Conclusion

Several key components of recovery might be predictive of work well-being among peer support specialists. Our findings indicated work self-determination (i.e., work autonomy) was linked to occupational performance (i.e., work engagement), and process of recovery and social support of recovery were associated with occupational health (i.e., job satisfaction). Despite the promotion of recovery among mental health service users, there has been a limited focus on recovery and recovery support following the employment of peer support specialists in mental health systems. These findings underscore the need for mental health providers, employers and supervisors of peer support specialists to address key components of recovery and work well-being among peer support specialists. Although peer support specialists are employees instead of service users in these programs, they still might need to include a focus on recovery and work well-being as a part of their mental health and career development goals. A shift to recovery-oriented supports and supervision of peers means that they might experience improved self-determination, engagement, and satisfaction on the job.

Impact and Implications.

Our findings indicated key components of recovery are linked to work well-being among peer support specialists. Despite the promotion of recovery among service users, there has been limited focus on the recovery process experienced by peer support specialists employed in mental health systems. These findings underscore the need for service providers, employers, and supervisors of peer support specialists to address both recovery and work well-being among peer support specialists.

Funding:

Dr. Brooks was funded by the Hogg Foundation for Mental Health grant.

Dr. Fortuna was funded by a K01 award from the National Institute of Mental Health (K01MH117496).

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