Supporting Community Health Workers and Peers In Behavioral Health and Reentry: A Community-Engaged, Student-Led Synthesis of Evidence on Retention Barriers and Strategies

Background/Purpose: Although community health workers (CHWs) and peer support specialists (peers) are instrumental in the behavioral health and reentry fields, they experience high rates of stress, burnout, and turnover. Consequently, organizations need evidence-based guidance on how to support CHWs and peers and promote their professional development. This presentation shares findings from a community-engaged rapid review that (a) describes barriers and facilitators of CHW and peer job satisfaction and retention and (b) identifies strategies to address retention challenges. Additionally, presenters will describe how CHWs, peers, and organizational leaders were engaged throughout the process, including design, interpretation, dissemination, and planning for results-based organizational action.

Methods: A rapid review is a community-engaged evidence synthesis that produces expedited results and recommendations relevant to community partners. Rapid reviews abbreviate the steps of traditional systematic or scoping reviews and employ flexible, community-engaged processes to promote rigor and relevance. Community partners were directly involved in all stages of this rapid review, including design, analysis, interpretation, and dissemination. After a two-stage screening of academic and grey literature, 46 sources were included. Data were extracted about barriers, facilitators, and strategies for promoting job satisfaction and retention of CHWs and peers in behavioral health and reentry. The team engaged CHWs and peers to identify priority areas based on initial findings, then conducted an in-depth analysis of the identified priority areas and engaged the community partner on action planning and dissemination efforts.

Results: Six key domains were identified regarding barriers, facilitators, and strategies: compensation (e.g., pay, benefits), work environment (e.g., organizational support, stigma), supervision (e.g., mentorship, supervisor’s peer experience), roles/responsibilities (e.g., always being “on,” unclear expectations), stress/burnout (e.g., secondary traumatic stress, maintaining personal recovery), and systemic factors (e.g., funding sustainability, certification options). CHWs/peers identified compensation and work environment as priority domains. In-depth findings on compensation indicated that peer wages frequently fall below living wages, paid leave and healthcare benefits are associated with higher job satisfaction, and other states have models of career advancement that do not require licensure. Findings in the work environment domain highlighted characteristics of effective peer supervision and the value of trainings that improve organizational understanding of the peer role. Evidence-informed recommendations shaped by CHW/peer input included conducting an organizational needs assessment focused on key domains, leveraging training and supervision to shape organizational culture, and developing a career ladder that does not require clinical licensure.

Conclusions/Implications: Engaging community partners in processes traditionally led by researchers helps ensure that research questions reflect real-world needs and findings are returned in accessible, actionable formats. Social work researchers should strive to involve community partners in evidence synthesis and consider how research training might be adapted to better support community-engaged work through attention to project pace, protocol choices, and dissemination to diverse audiences. Furthermore, the growing number of behavioral health and reentry organizations that employ CHWs and peers should provide adequate and equitable compensation, opportunities for career advancement, non-stigmatizing work environments, trauma-informed supervision, and clear definitions of roles and responsibilities to reduce stress, burnout, and turnover in this essential workforce.