CREDENTIALLED ‘LIVED EXPERIENCE’ – AN OXYMORON?
Peer support, recognition of the value of people sharing lived experience with others, has saved countless lives and is experiencing great renewed interest from public-health officials across the globe.
Kristie Schmiege elevates it further.
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“Lived experience” or “experts by experience” have become favoured ways of expressing that a person has learned from some experiences in his or her life especially from a mental illness, addiction or mix of both. The intent is to communicate in a single brief phrase that such a person has gained something of great value that can and should be shared with others. The words denote intrinsic value gained through the proverbial school of hard knocks as opposed to in a classroom. Is it thus an oxymoron to couple ‘credentialled’ with ‘lived experience’?
Gaining usable knowledge from someone with practical wisdom is not new. The old english idiom that focuses on walking a mile in another man’s shoes goes back centuries. For at least 50 years, the World Health Organisation has promoted using indigenous Community Health Workers alongside traditional healthcare providers to facilitate improved public-health status of communities across the world. CHWs advocate for and mentor peers in their communities by educating, lending support and facilitating changes in health beliefs leading to improved health practices and reduction of disease and death.
In the behavioural-health field, the incorporation of those with lived experience is also experiencing resurgence. Both UK and US government emphasise the inclusion of and roles for indigenous “peers” with practical experience alongside qualified clinicians in traditional addiction and mental-health settings. These peer support services are performed by peer -recovery coaches, -support specialists, -mentors or other names which advocate, mentor, educate, navigate systems and all the functions described above in reference to CHWs. The outcomes include decreases in morbidity and mortality related to addiction and mental illness through empowerment of service recipients.
Is it enough to simply have and share one’s experience? It is effectively done all over the world on a daily basis. But there is also increasing evidence from WHO and jurisdictional public health authorities as well as national US behavioural-health entities that there is value in identifying, defining, structuring, training and certifying peers in the basic tenets of what makes the sharing of lived experience so valuable.
Also, there is growing keen awareness of the importance of assuring ethical and practice standards are defined and promulgated. And there is focus on the challenges of adding peers to traditional professional settings related to lack of explicit role delineation. Credentialling is an effective tool to address these considerations.
Peer-based recovery support services have become an important component in any recovery-oriented system of care, and it is clear that peer recovery specialists/coaches/mentors are increasingly considered a valuable part of the recovery workforce. Responding to this need, IC&RC’s* newest exciting initiative is the development of a credential for peers. The challenge is striking a balance.
A 2008 report from the US Department of Health & Human Services, SAMHSA’s Center for Substance Abuse Treatment stated that: “Recovery support services are non-clinical services… Maintaining the peer-ness of peer recovery support services and resisting the pressure to professionalise these services is a key challenge”.
It is equally important to facilitate public protection, as with clinical staff, by ensuring ethical and practice standards for peers are identified, learned, supervised and followed. It is also key to ensure that peers understand the distinctions between their role and that of clinicians (and vice versa), which credentialling facilitates by analysing job-specific tasks, required knowledge and skills.
So credentialled lived experience is not an oxymoron. It is possible to respect and enhance the integrity of an individual’s lived experience within the structure of a professional credential. IC&RC is nearing completion of the process of developing a credential for peers. Credential development is a rigorous, psychometric process involving executing a full job task analysis with IC&RC’s international testing company. Peers, used as subject matter experts, developed domains, tasks, knowledge and skill areas. A broader solicitation of peers from across IC&RC boards reviewed the findings of the initial group of peer SMEs through a survey. A group of peer SMEs then reviewed the survey data.
IC&RC thus fulfills its mission of protecting the public, while ensuring that people most familiar with the job tasks have a voice throughout the strictly controlled, multi-stage effort. It is anticipated this process will be complete this year.
Kristie R Schmiege MPH, ICADC, ICCS, CPC-M is IC&RC credentialling services chairperson.
*IC&RC is the largest addiction and prevention credentialling organisation in the world. Today, IC&RC represents 76 member boards and over 45,000 professionals from 24 countries and 47 US states and territories. IC&RC’s credentials include counsellors, clinical supervisors, prevention specialists, criminal justice and co-occurring disorders professionals.