Considering Peer Support Sustainability: Survey of geographic differences in roles, skills, job satisfaction, and financial well-being

doi:10.21203/rs.3.rs-3405876/v1

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Research Article

Considering Peer Support Sustainability: Survey of geographic differences in roles, skills, job satisfaction, and financial well-being

https://doi.org/10.21203/rs.3.rs-3405876/v1

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Background

The peer support workforce has become an established aspect of behavioral health care, with endorsement since 1999 as Medicaid reimbursable and with steady uptake of credentialing by 49 states and the District of Columbia. Yet sustainability issues due to wage and entry-level stagnation lacking advancement paths is a concern for the Certified Peer Support Specialists (CPSSs) workforce.

Methods

This analysis compared cross-regional survey data of employed CPPSs in Utah (U) to a prior Michigan (M) sample. The core areas of investigation were 1) health and well-being, 2) professional settings, activities, and opportunities, and 3) perceptions regarding professional practice.

Results

Over 85% of Utah peers expressed satisfaction with work hours, physical safety at work, and supportiveness of supervisors, similar to 75% Michigan sample satisfaction. Job security satisfaction differed at 87% in Utah and 67% in Michigan, with a higher average wage in Utah. Less satisfaction was reported for promotion opportunities (U-57%, M-41%) and coworker awareness of peer roles (U-34%, M-42%).

Conclusions

Results indicate similar workforce conditions across regions, but with higher pay and slightly higher satisfaction ratings in the Utah sample of mixed recovery and mental health peers. Both areas demonstrate a need for training non-peer staff on CPSS job roles, indicating a lack of clarity regarding the professional contributions of peers. Practical administrative steps to support sustainability include stigma-reducing workplace policies, trainings, career laddering with increased responsibility, sustainable wage and benefit packages consistent with career laddering, and reinforcing consensus around defined roles and competencies of peer support.

peer support

career sustainability

behavioral health

job satisfaction

Certified Peer Support Specialists (CPSS)s are frontline health workers in the behavioral health treatment field with lived experience of behavioral health conditions. They provide non-clinical, strength-based support to individuals experiencing similar conditions and are "experientially credentialed" by their own recovery journey (1). CPSSs have shown demonstrated benefits to behavioral health treatment outcomes in quality and cost-effectiveness (2, 3) at a time when the healthcare workforce needs to be bolstered. It is estimated that 40% of individuals in the U.S. live in areas designated as Behavioral Health Professional Shortage Areas (HPSA) (4). Care shortages combined with a behavioral health crisis indicated by recent increases in suicide (5) and drug overdose death rates (6) argue for an expansion of the cost-effective and impact-laden CPSS workforce supporting treatment services (7).

Starting in the 1970s, peer support became recognized in formal models as an essential component of recovery services (8, 9). Organizational structures for peer-run services remained largely non-professional in volunteer-run programs with few paid staff for decades (10). In 1999, CPSSs became endorsed by the Center for Medicare and Medicaid Services (CMS) as a Medicaid Reimbursable provider. A 2011 review, jointly produced by the Substance Abuse and Mental Health Services Administration (SAMHSA) and CMS, identified peer support as an evidence-based practice and opened the door for peer certification and sustainable funding (9). As of 2022, 49 states and the District of Columbia have developed peer support specialist certification programs, either fully implemented or in the planning phase (see Table 1).

As we examine the sustainability of a CPSS workforce, it is critical to identify and learn from on-the-ground working conditions and supports afforded by employers and policy makers. Conditions like low pay and variable or low Medicaid reimbursement rates impact sustainability (11). Peers also engage in overlapping job roles with other clinical para-professional staff positions which can create ambiguity for both employers and employees (12). Role-confusion can occur when CPSSs are placed in existing clinical positions (like case management), and this role overlap has been demonstrated to be less effective than when peer services are added to existing care delivery (2). Other issues in standardizing the role of the peer include wide variations in service quality, service settings, types of services offered, and differing theoretical orientations and training models for peers (2, 13, 14).

Past national surveys of individuals self-identifying as peers indicate an average wage of full-time peers at $16.36/hr. (15). By comparison, Community Health Workers (CHW), who are similarly categorized as para-professionals with personal knowledge of the community served (16), have mean wage averages of $22/hr (17). Despite salary limitations, job satisfaction remains high among CPSS professionals (18-22). A full 57% of peers intended to remain in the job "forever" (15). Combining this level of commitment with improvements in pay could create long-term viable working conditions to build the CPSS workforce as members of integrated treatment teams. Gathering information on variability in working roles and conditions of the CPSS is critical to inform certification agencies, employers and policy makers in the training guidance and economic supports required to strengthen this workforce.

The goal of the present analysis was to compare cross-regional survey data (Michigan and Utah) for differences and similarities in the professional activities and economic outlook of employed certified peers.

State Background Information

Michigan and Utah are geographically large states with similarly dispersed populations, but differences by type and total. In 2020, Utah’s population was 3.2 million. Utah has a large youth population with 28.4 % of persons under 18 years (11.7% of persons 65 and over, average age of 31.1 years)(23). Utah is the thirteenth largest state geographically (84,897 mi²) yet just 10% of Utahns live rurally.

In comparison, Michigan's 2020 population of 10.1 million differs slightly in demographics from Utah (23)(see Table 2). Michigan has an older population with an average age of 39.8 years and 18.1 % of the population is aged 65 and over (21.4% of persons under 18 years). Michigan is the eleventh largest state (96,714 mi²) and over 80% of the population lives in urban areas that account for 6.4% of the land mass (24). Both states have the substantial majority of residents living in urban and semi-urban areas, with large land masses of rurally dispersed populations requiring health services.

Though national standards for content and credentialing are similar, peer support certification programs differ from state to state in topics such as candidate age, education, definition of lived experience, recovery time, and length of training (2, 25). In Utah, peer support in mental health and substance use recovery experience is combined for training and certification, acknowledging comorbidity and shared experiences (26, 27). To be eligible for certification in Utah, the peer must have one year of continuous recovery verified by a behavioral health specialist. A total of 1121 peers received training and certification in Utah since 2010, with 398 maintaining their accreditation through 2021.

In Michigan, peer support specialists specializing in mental health services are differentiated from certified peer recovery coaches (CPRC) with substance use experience. Individuals with co-occurring conditions are occasionally dually certified. The eligibility requirements for the two separate peer roles are similar, with a key difference being a CPRC must have two continuous years in recovery. Although these workforces are trained separately in Michigan, all continuing education training is combined. With initiation in 2006, Michigan has 2,176 CPSS and 976 CPRC trained peers based on the most recent data.

Research Questions

This study's research questions address health and well-being, professional settings, activities, opportunities, and perceptions regarding professional practice. We asked:

What is the mental health, financial health, and overall well-being of CPSS professionals in Utah, and how do these compare to Michigan outcomes?
In what work settings do CPSS professionals tend to work, and what are the opportunities for professional growth in Utah, compared to Michigan?
What are the perceptions of CPSS professionals regarding professional practices, and how do these compare to Michigan outcomes?

This study matched the methods of a published 2018 CPSS workforce survey in Michigan to compare outcomes by state varying in geographic and social demography for common and disparate factors contributing to CPSS workforce successes.

Background

The Utah survey matched the methodology of a Michigan survey completed in 2017. Lapidos et al.'s (20) recruited a community advisory board (CAB) to design the survey on CPSS roles, activities, self-rated skills, and economic wellbeing. The investigators distributed the survey using Qualtrics survey software to 1,128 valid emails. After removing duplications or incomplete surveys, the final sample included 394 responses, for a 35% response rate of all known CPSSs in Michigan (20).

Procedures

The project team adapted Lapidos et al.'s (20) CPSS workforce survey for local voices with input from a Utah CAB of three CPSSs representing a recovery community organization (urban), a peer professional association (urban), and a peer-run organization (rural). The survey was edited to fit the cultural and geographic characteristics of Utah based on suggestions from the Utah CAB. For example, changing “Pillars of Peer Support” (Daniels, et al. 2010) to “fundamentals of peer support” was identified by the CAB as preferred survey language due to its use in the Utah state certification training. The Utah CAB added workplace settings of residential treatment that were not included in the Michigan survey, and the psychiatric hospital language was changed to in-patient treatment as examples of minor changes in survey questions. The four main categories of the original survey were maintained: demographics, professional activities, professional satisfaction, and wages/finances. The complete survey is provided in the supplemental materials.

Three CPSSs piloted the survey for time completion, averaging 20 minutes. The Utah State University institutional review board (IRB) approved the full study protocol (IRB #11720). University investigators and state CPSS certifying board officials obtained inter-agency IRB approval and data-sharing agreements. A participant list of all CPSS-certified individuals in Utah (2010 and 2021) was created using data provided by Utah's Department of Human Services. Of 1,121 individuals trained and certified during this period, the survey was sent to the 398 individuals maintaining a current CPSS registration with the state agency in Fall 2021, all survey data was collected within a 3-week window.

The secure Research Electronic Data Capture system sent emails to the participant list. The email contained an IRB-approved letter of information, a link to the Qualtrics survey of IRB-approved questions, and an incentive notification of being entered into a $50 Amazon gift card drawing upon survey completion (participant incentive was one gift card awarded per 50 completed surveys). In addition, one automatic reminder was set if no response was received within five days. The final sample included 92 responses for a 23% response rate.

Data Analysis

Analyses were designed to extend the work of Lapidos et al. (20). Descriptive statistics were calculated for all variables of interest, including counts, percentages, and averages, both across the whole state of Utah and stratified and statistically tested by key demographic characteristics (i.e., gender, race, age, education level, income, and marital status). For analyses by age, analysis of variance for continuous measures (28) was used, while chi-square tests of independence for categorical measures were used for the other demographic characteristics.[1] Descriptive comparisons of results between states were evaluated. All analyses were completed in the R statistical environment version 4.1.0 (29) using the tidyverse, gtsummary, and janitor packages (30-32). Data, code, and output are available upon request.

[1] Notably, analyses by race were limited as the sample was highly homogenous (82% were Caucasian).

Participants

A total of 92 respondents participated in the survey with gender variation (U-62% female vs. M-69% female)(20). Other demographic aspects showed more variability across state samples (see Table 2). A higher percentage of African American peers in Michigan (M-24% vs. U-1%) and Latino peers in Utah (U-11% vs. M-2%) largely reflect state demographics. A larger percentage of Utah peers (82%) were Caucasian compared to the state average (78%), while this percentage was lower for responding peers in Michigan (64% Caucasian vs. 75% of population). The majority of participants had completed some college (U-48% vs. M-62%) or higher (U-31% vs. M-30%).

Table 1

Peer Support Formal Professionalization/Certification Year by State
Year Initiated	States
Before 2000	South Carolina, Alabama, Georgia
2000–2004	Rhode Island, District of Columbia, Pennsylvania
2005–2009	Washington, Kentucky, Maine, Michigan, North Carolina, New Mexico, Tennessee, Idaho, Massachusetts, Louisiana, Minnesota, Oklahoma, Wisconsin
2010–2014	Utah, Arizona, Hawaii, Delaware, Connecticut
2015–2019	Iowa, Maryland, Virginia, New Hampshire, Colorado, New York, Ohio, Mississippi, Montana, Texas, Arkansas, Illinois, Nebraska
2020- present	Alaska, Wyoming, Kansas, California
Initiation Date Unavailable	Florida, Indiana, Missouri, Nevada, New Jersey, North Dakota, Oregon, Vermont, West Virginia
Inactive	South Dakota
* Timeline developed through personal communication with state representatives and review of state websites. A detailed list of table sources is available in online supplemental materials

Table 2

Demographic characteristics of the Utah sample, the Michigan sample, and the census data for each state and the US.
	Utah		Michigan		US
Variable	N (%)	Census	N (%)	Census	Census
Gender
Male	33 (37%)	50.4%	187 (31%)	49.3%	49.2%
Female	56 (62%)	49.6%	208 (69%)	50.7%	50.8%
Non-Binary	1 (1.1%)	-	-	-	-
Race
Caucasian	74 (82%)	77.8%	255 (64%)	74.7%	60.1%
Hispanic/Latino	10 (11%)	14.5%	8 (2%)	5.3%	18.5%
American Indian/Islander	4 (4.4%)	2.7%	24 (6%)	0.7%	1.5%
Asian	1 (1.1%)	2.7%	3 (.75%)	3.4%	5.9%
African American	1 (1.1%)	1.5%	96 (24%)	14.1%	13.4%
Age
18–24 years	3 (3.3%)	-	4 (1.3%)	-	-
25–29 years	5 (5.4%)	-	7 (2.3%)	-	-
30–39 years	22 (23.9%)	-	51 (17%)	-	-
40–49 years	24 (26.1%)	-	71 (24%)	-	-
50–59 years	24 (26.1%)	-	116 (39%)	-	-
60+	14 (15.2%)	-	52 (17%)	-	-
Education
High School or GED	19 (21%)	22.0%	31 (10%)	28.5%	26.7%
Some College/Associates Degree	44 (48%)	35.5%	189 (62%)	32.8%	28.9%
Bachelor’s Degree	21 (23%)	23.0%	63 (21%)	18.3%	20.2%
Master’s Degree or Higher	7 (8%)	11.7%	21 (7%)	11.7%	12.7%
Wages per Hour
$5–10	1 (2%)	-	26 (9%)	-	-
$11–15	16 (30%)	-	170 (58%)	-	-
$16–20	27 (51%)	-	75 (26%)	-	-
$20+	6 (11%)	-	23 (8%)	-	-
Volunteer	3 (6%)	-		-	-
*State1, State2, US Census Information: https://www.census.gov/data.html

Work Settings and Responsibilities

Roughly half of currently working peers in Utah work in outpatient behavioral health (27%) or residential living (26%) centers, with 18% working at peer-led community organizations. The remaining third were spread across agency types from hospitals to jails to health plans, among others. Some characteristics differed by workplace setting. Residential living facilities had the highest counts of those making more than $20 per hour (5 of the 6 respondents; p = .002). Peers working at a Veterans Affairs (VA) center (p < .001) or in-patient hospital facility (p = .001) held CPSS certification longer. Paid CPSS positions were significantly more likely in agencies offering outpatient (p = .04) or residential (p = .009) behavioral health services.

Utah and Michigan peers reported the same top two professional responsibilities (sharing recovery stories; health and wellness support) (see Fig. 1). Crisis and integrated care support were both in the top four professional activities for both states. Participating in person-centered treatment plans ranked fifth of 14 tasks among Utah peer professional tasks, but in the lowest three for Michigan peers. The three professional tasks most related to community resources (housing, vocational, and financial assistance) ranked in the lowest third for Utah peers, but were mid-tier for Michigan peers.

Workplace Conditions and Satisfaction

Over 85% of Utah peers expressed satisfaction (agree or strongly agree) with work hours, physical safety at work, job security, and supportiveness of supervisors, which is similar to 75% agreement in the Michigan sample, though just 67% of Michigan respondents were satisfied with job security (see Fig. 2 for Utah counts and percentages). There was slightly less agreement (agree or strongly agree) that levels of stress are acceptable (U-72% and M-52%) and with satisfaction about chances for a promotion (U-57% and M-41%).

Similar to the Michigan finding, over 80% of peers agreed that their job description is clear, their competencies relate to their job description, and they are aware of ethical requirements. Over 70% of Utah peers agreed that they have access to employer-supported continuing education (Michigan over 80%), but peers in both states reported less employer support for advanced professional training (U-57% and M-42%). In addition, insufficient training to explain the roles of peers to non-peer professionals was reported (U-34% and M-42%). In Utah, 39% of peers reported they were not satisfied with the overall supportiveness of non-peer professionals at work.

Just a third of the Utah peer workforce (32%) earned less than $15 an hour, compared to two-thirds in Michigan (67%). Hourly pay had a wide range, with 11% (Utah) and 8% (Michigan) of peers reporting wages over $20/hour. Being "certain" they could not generate $2,000 in emergency funds within 30 days (Lusardi et al. 2011) was reported by 31% of Utah and 38% of Michigan peers. An additional 36% (Utah) and 28% (Michigan) indicated they were uncertain whether they could raise emergency funds. As such, both state's certified peer groups had a financial fragility rate of 66%.

The Utah study of self-reported CPSS skills, satisfaction, and finances has shown remarkable similarity to the original Michigan study upon which it was based, despite the states' disparate locations and demographic differences. Peer roles shared the four most frequent professional responsibilities, suggesting role consistency across regions. Our review of wages suggests that peers in Utah earn more, but without improving financial fragility. Not more than 11% of either Utah or Michigan peers earned over $20 an hour, which is less than the average wage reported by the U.S. Bureau of Labor Statistics (17) for CHW healthcare para-professionals. Yet despite low wages for peers, 87% of peers in Utah reported job stability. Combined with the other indicators of job satisfaction, the reported workforce expectations and experiences align with findings in the literature of 57% career stability in the peer workforce (15). It is interesting to note that the reported job satisfaction persists despite low wages and financial fragility.

A notable similarity between the two states was 70–80% employer support for continuing education for peers, but support dropped off for professional advancement past entry-level. Yet peer services must move beyond frontline workers (33, 34). The Utah survey found that in-patient hospital and VA-employed peers had more average years of work experience, suggesting some worksite factors influence career stability. Overall, more peers are employed in out-patient settings, and in Utah 26% work in residential facilities. These are worksites with the lowest reported average wages.

It has been suggested that implementation of peer services must move beyond front-line workers ((33, 34). Credentialing an advanced standing for peers could provide advancement that would align with more advanced job roles or supervisory responsibilities of in-patient or institutional work settings. A notable similarity between the two states was 70–80% employer support for continuing education, however, employer support waned for professional advancement past entry level. Formal certification programs credentialed by state licensing could increase employer support for professional advancement opportunities that train peers for high-demand work settings, offering an additional argument to support wage growth for the peer workforce.

Peer advancement is connected to career laddering -- defined as the process in which individuals can move "up" or "over" to positions of higher responsibility, esteem, and corresponding pay (35). Historically and as indicated in survey responses, integration of peer support has been in entry-level positions. This can be intentional at times, to maintain certain classifications that allow for continued disability benefits for some peer workers, such as Social Security Disability and Supplemental Security Income (33). This practice and thought processes however limits peer support roles to part-time, low-paying positions, and doesn't account for federal financial incentives for full-time benefit-protected work. The entry-level limitation has the potential to perpetuate stigma related to peer support employment and decreases the sustainability of these roles. Professional stigma toward the CPSS’s health history has been cited as an ongoing concern for full integration of peers into interprofessional health teams (15). Creating opportunities for individuals to progress throughout their career, earn more, and receive continuing education and credentials through career laddering addresses these problems of low wages, workplace stigma, and career sustainability (36).

Currently, there is variation across states in peer certification and standards, likely due, in part, to the CMS 2007 rule, p.3; "peer support providers must complete training and certification as defined by the State" (37). It has been suggested that career advancement requires better-defined peer roles and competencies (35). Consensus in defining and professionalizing peer services is reflected in recent publication of the Substance Abuse and Mental Health Services Administration (SAMHSA) core competencies (38) and the National Association of Peer Supporters (NAPS)(39) national practice guidelines. This definition of roles, combined with supervision on specific peer competencies, will create potential for increasing managerial-level peer support positions, as advanced peers supervise new peers with clearly defined job roles (33).

The survey found that there is insufficient training to explain the roles of peers to non-peer professionals (U-34% and M-42% agree/strongly agree). Perhaps due to this lack of training, roughly 40% of peers in the Utah survey were not satisfied with the support they received from other professionals in the workplace. The lived experience aspect of peer support requires self-disclosure and may be a contributing factor to reports that 2/3 of peer workers report professional stigma in the workplace (15). Yet satisfaction with support from direct supervisors was high (U-87% agree/strongly agree). This suggests a training opportunity to reduce stigma or to provide a pathway to incorporating peers in integrated team-based care. Literature on stigma reduction states that increased contact with excluded and stigmatized groups can impact biases, but only when those in the stigmatized group are placed as equals (40). Researchers have proposed solutions to reduce this workplace bias (1, 40). One main solution proposed is providing training and education for non-peer staff on discrimination legislation, expectations for peer staff and non-peer staff, respect, and ethics (1). Our results suggest that these trainings are desired by peer workers. An actionable step that can be taken from these findings was implemented following the Michigan survey CPSS and CPRC (20) where state trainers developed and implemented a curriculum entitled ‘Supporting the Partnership Between Administrators, Supervisors and Peer Workers’ to reduce stigma through knowledge sharing and integration.

There are notable limitations to the study. First, the time delay (2017 Michigan vs. 2021 Utah) might impact financial comparisons, though inflation in the intervening period is estimated at less than 10% (41). In addition to standard temporal and cultural effects, the period included societal changes related to the COVID-19 pandemic. Second, there were differences in response rates, 35% in Michigan compared to Utah's 23% rate. Though both surveys yielded adequate sample sizes for analysis, both are subject to self-selection bias. Relatedly, the surveys could only be sent to those maintaining a current CPSS certification with the state. As such, there may be an over-representation of individuals that are 1) enjoying the work more, 2) have better working conditions, or 3) are physically, emotionally, and mentally capable of working as a CPSS. Lastly, our relatively homogenous sample did not include sufficient numbers of black, indigenous, and people of color to study that particular group specifically. The experiences and perspectives of this group of individuals are important to study in future research.

Recent meta-analytic review of the benefits of peer services indicates moderate support for increased treatment access to peer support as seen in reductions in time spent in hospital as a small but important benefit when peers are a part of a treatment approach (2). Review studies indicate peer support may have less measurable impact on some outcomes like psychiatric symptoms, but other outcomes such as empowerment, hope, and recovery levels show greater gains (14, 42). Peer support is expanding with integration into innovative programs that utilize lived experience background (25). Unlike other behavioral health workers, peers rely on their own stories that are directly applicable to clients. Our results show that both Utah and Michigan peers are confident in this core competency and utilize this skill often. Peers can also model recovery and instill hope that recovery is possible (25).

In conclusion, peer support is an evidence-based practice demonstrating a solid growth of the workforce across the nation. As a respected Medicaid reimbursable provider and vital member of the healthcare workforce, the peer specialist workforce can continue to grow with support from practitioners, program directors, and policy makers. Though we present arguments for an advanced credential, even the basic credentialling should be recognized through adequate compensation, career advancement, and workplace appreciation and inclusion. Practical administrative steps include stigma-reducing workplace policies and trainings, career laddering reflecting increased responsibility, sustainable wage and benefit packages consistent with career laddering, and a growing consensus and reinforcement around defined roles and competencies of peer support.

CAB: Community Advisory Board

CMS: Center for Medicare and Medicaid Services

CPRC: Certified Peer Recovery Coaches

CPSS: Certified Peer Support Specialist

HPSA: Health Professional Shortage Area

IRB: Institutional Review Board

M: Michigan

NAPS: National Association of Peer Supporters

SAMHSA: Substance Abuse and Mental Health Services Administration

U: Utah

VA: Veterans Affairs

Ethics approval and consent to participate: Utah State University institutional review board (IRB) approval of study protocol (IRB #11720).

Consent for publication: Not applicable

Availability of data and materials: The datasets generated and analyzed during the current study are not publicly available as they contain information that could be identifiable due to geographic location and small sample size by region. However, de-identified data removing certain regional components are available from the corresponding author on reasonable request. Complete survey items can be found in the supplementary material at https://osf.io/k6jrd/

Competing interests: The authors declare that they have no competing interests

Funding: This project was supported by the Health Resources and Services Administration (HRSA of the U.S. Department of Health and Human Services (HHS) as part of an award totaling $2,295,760 through grant T26HP39463 with 10% financed with non-governmental sources. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS, or the U.S. Government. For more information, please visit HRSA.gov.

Authors' contributions:

Maren Wright Voss, Conceptualization, methodology, validation, formal analysis, data curation, writing (original and review)

Tyson S. Barrett, Methodology, validation, formal analysis, data curation, writing (editing and review)

Adrienne Lapidos, Conceptualization, , methodology, validation, writing (review)

Pam Werner, Conceptualization, validation, writing (review)

Pamela J. Bennett, Conceptualization, validation, writing (review)

Amy Campbell, Conceptualization, validation, writing (review)

Amelia Van Komen, Writing (original and review), project administration, data curation

Acknowledgments: This project was supported by the Health Resources and Services Administration (HRSA of the U.S. Department of Health and Human Services (HHS) as part of an award totaling $2,295,760 through grant T26HP39463 with 10% financed with non-governmental sources. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS, or the U.S. Government. For more information, please visit HRSA.gov.

Authors' information (optional): None to report

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Editorial decision: Reject after peer review
29 Apr, 2024
Reviewers agreed at journal
06 Nov, 2023
Reviewers invited by journal
09 Oct, 2023
Editor assigned by journal
04 Oct, 2023
First submitted to journal
03 Oct, 2023

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Considering Peer Support Sustainability: Survey of geographic differences in roles, skills, job satisfaction, and financial well-being

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Abstract

Background

Methods

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Background

Methods

Results

Participants

Work Settings and Responsibilities

Workplace Conditions and Satisfaction

Discussion

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References

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Version 1