Organizational Barriers and Support Strategies for Promoting Peer Support Workers In Crisis and Emergency Response Teams

Background/ Rationale

Peer Support Workers (PSWs) are increasingly recognized as essential members of behavioral health crisis response teams in the U.S. With the launch of the 988 Suicide and Crisis Lifeline, the scaling of crisis care infrastructure has heightened the need for non-law-enforcement crisis responders and rapid workforce expansion, positioning PSWs as essential contributors across the crisis care continuum – from someone to contact, to someone to respond, to a safe place for help. Despite their growing role, limited qualitative research has examined how organizations and agencies can effectively support PSWs in crisis and emergency response settings. The presentation will explore the organizational barriers PSWs face and the strategies they perceive as helpful in supporting their roles within crisis and emergency response teams.

Methods

Five semi-structured focus groups were conducted with 23 PSWs actively working in crisis settings across New York City. Participants described the organizational barriers they faced and the support strategies they believed would better support their roles in crisis settings. Transcripts were analyzed in NVivo using an inductive, iterative, team-based coding process. Two coders independently coded transcripts, and inter-rater reliability was assessed using Cohen’s kappa (k = 0.81), indicating strong agreement. The codebook was further refined through regular consultation with the broader research team and a peer working group comprising government and non-profit sector leaders with professional peer roles.

Results

Analysis identified organizational barriers across three overarching domains. Structural and systemic barriers included the absence of peer-specific infrastructure, inadequate compensation, insufficient crisis-specific training, and limited organizational support for vicarious trauma. Role-based barriers included tokenism and role ambiguity, while relational and cultural barriers encompassed stigma and failures in interdisciplinary coordination. Participants also identified several organizational strategies perceived as helpful for strengthening peer integration, including developing peer-informed supervision and tiered career advancement structures, establishing sustained funding mechanisms rather than reliance on time-limited grants, embedding PSWs directly within responding agencies, expanding public education about crisis services, and institutionalizing post-crisis debriefing and cross-disciplinary training.

Conclusion and Implications

These findings highlight the critical role of organizational practices and culture in shaping how PSWs are understood, valued, and supported within crisis response systems. Without structural investments in sustainable funding mechanisms and peer-specific infrastructure, including dedicated supervision, crisis-specific training, and support for vicarious trauma, PSWs’ integration and effectiveness will remain limited. By ensuring sustainable funding and strengthening institutional support, organizations can enhance workforce sustainability, improve peer role integration and integrity, and maximize PSWs’ contributions to crisis response. These findings have important implications for organizational leadership, workforce development, and crisis care policy aimed at optimizing PSWs’ effectiveness in high-intensity behavioral health settings. In addition, findings have direct implications for social work education and practice. Social work training programs should incorporate curricula that emphasize interprofessional collaboration with PSWs, recognition of lived experience as a form of expertise, and strategies to address stigma and tokenism within multidisciplinary teams.