Peer Support Specialist Work and Experiences During the COVID-19 Pandemic: A National Longitudinal Study

Two online surveys were conducted with the assistance of the National Association of Peer Supporters (NAPS), the first of which yielded 1,279 responses from May to June 2020 (3). NAPS distributed the survey through its e-mail Listserv of approximately 6,000 PSSs and non-PSSs; snowball sampling occurred. Of the individuals responding to the first survey, 93% (N=1,187) agreed to be queried again. The second survey was conducted with those respondents in November and December 2020. Both the first and the second surveys were conducted with Qualtrics. The Boston University Institutional Review Board approved all research procedures and materials. As with the first survey, the second survey contained items related to demographic factors, work history and status, work tasks, and challenges and benefits related to the pandemic. The second survey and research procedures were similar to those reported for the first survey (3). For some questions, we had three data points: retrospective information about status in the periods before the pandemic, which was collected in the first survey, and information provided in responses to the first and the second surveys.

The second online survey was distributed via e-mail to respondents to the first survey who agreed to be contacted a second time (N=1,187). Eligibility criteria for the first survey were as follows: resides in the United States, 18 years or older, and had worked or volunteered as a PSS for at least 5 hours a week in February 2020, prior to the pandemic. Inclusion criteria were verified by using screening questions in the first survey.

Responses were collected in November and December 2020. Two reminders were sent, and a final total of 571 surveys were received. We deleted incomplete responses (N=75), which resulted in a final sample size of 496 for the second survey.

Responses were downloaded from Qualtrics into SPSS, version 25.0, for analysis. We conducted chi-square and t tests to compare demographic characteristics and responses to the first survey of those who responded to both surveys (N=496) and of those who completed only the first survey (N=783). No statistically significant differences were found for a variety of demographic characteristics (gender, age, region, race, ethnicity, educational attainment, income, and employer type) or initial survey responses (including work challenges, pandemic benefits, work tasks, and satisfaction with support) (all p>0.05, results not shown). Only one significant difference was found between responders and nonresponders to the second survey, which was related to the variable “engagement in new tasks.” In the first survey, a somewhat higher proportion of those who completed both surveys reported engaging in new tasks, compared with those who completed only the first survey (76% versus 70%; χ²=4.07 df=1, p=0.025). Given the large number of comparisons in which no differences were found, we concluded that respondents to the second survey were not significantly different from respondents to the first survey and were representative of the first sample.

To determine changes over the course of the pandemic in 2020, we used frequency tables, chi-square tests, and paired t tests. Some respondents did not complete all survey items, and percentages presented throughout are based on the total number of responses received for each item.

The 496 respondents to both surveys resided in all regions of the country, and most were female (70%, N=342) and White (76%, N=366). More than half reported having an associate’s degree or above (54%, N=260). Forty-three percent of respondents reported receiving public benefits (N=206), and 47% (N=228) earned less than $30,000 at the time of the second survey. Respondents were employed in a variety of settings, and about half (N=242) reported 5 or more years of PSS employment. In spring 2020, 32% (N=395) of the initial survey respondents reported current or past NAPS membership.

Among the 496 PSSs who completed both surveys, 7% reported not working or not volunteering in the spring 2020 survey, which reflected significantly less unemployment than in the general population (Table 1). In December 2020, although a similar proportion reported not working or not volunteering (7%), larger proportions than in the spring reported working full-time and volunteering. These shifts in employment status were statistically significant.

Among the 496 PSSs who completed both surveys, the proportion reporting an inability to pay monthly bills increased significantly, from 22% before the pandemic to 30% at the time of the first survey (see table in online supplement to this report). In the second survey, 152 respondents (32%) reported an inability to pay monthly bills. In addition, the proportion of individuals receiving public benefits increased from the first to the second survey: 493 (39%) of 1,279 respondents in the first survey and 206 (42%) of 496 respondents in the second.

In our query about job tasks, 86% of respondents to the second survey reported performing new tasks as a result of the pandemic, compared with 76% of these respondents in the first survey (p<0.001). Among the 389 respondents who reported performing new tasks in the December survey, such tasks included those related to technology (N=304, 81%); basic resources such as food, housing, and transportation (N=177, 47%); and COVID-19, such as cleaning and personal protective equipment distribution and training (N=212, 55%).

In the first survey, when asked about standard job tasks, respondents reported that the provision of individual peer support and group facilitation declined significantly from prepandemic levels (see online supplement). From the first to the second survey, time spent on these tasks increased significantly but did not rebound to prepandemic levels. From prepandemic through spring 2020, lesser declines were noted in time spent on the tasks of training and of systems advocacy, which appeared to partially rebound by winter 2020. Between the first and second surveys, no significant change in time spent on performance of clerical or administrative tasks was noted (see online supplement).

In both the first and the second surveys, respondents were provided a checklist of possible adverse experiences as a result of the pandemic. Almost all who responded to these questions indicated that the individuals they supported were experiencing high levels of isolation (N=358, 90%) and mental health symptoms (N=357, 90%) during winter 2020 (Table 1). From spring to winter 2020, respondents also reported significantly increased rates of housing instability, substance use, and interpersonal violence among their peer clients.

Among the 496 PSSs who completed both surveys, the threat of job loss continued, although it was down from 30% (N=101) of spring respondents to 25% (N=84) of winter respondents (see online supplement). Rates of reported isolation, communication challenges, lack of training, and lack of protective equipment also dropped modestly but significantly over the course of 2020, although the proportions reporting some challenges, such as isolation and communication challenges, remained high.

We examined shifts over time in respondents’ perceptions of pandemic-related work benefits. In the spring survey, respondents reported benefits such as less time spent commuting and the opportunity to learn new technological skills. Among the 416 respondents in the second survey who answered this question, 312 had responded in the first survey that they perceived pandemic-related benefits. However, by the second survey, 53 of those individuals’ perceptions shifted, and they no longer perceived benefits. In the first survey, 104 of the 416 (25%) respondents reported not perceiving pandemic-related benefits. However, by the second survey, 52 of those 104 (50%) reported perceiving benefits. These shifts in perceptions from first to second survey were statistically significant (χ²=45.05, df=1, p=0.001). Similar patterns of changing perceptions were noted in other responses. Respondents in the second survey reported benefits for the PSSs themselves (N=227, 68%), for individuals supported by PSSs (N=270, 80%), and for the peer support field in general (N=205, 61%). On a Likert scale (1, very satisfied, and 5, very unsatisfied), respondents to the second survey expressed being satisfied (means ranging from 1.85 to 2.19) with the amount and type of support they were receiving since the pandemic began from their organization, their supervisor, and their coworkers (see online supplement). These satisfaction ratings were similar to those in the first survey.

In May 2020, a total of 1,279 PSSs in the United States qualified for, consented to, and responded to an online survey about the impact of COVID-19 on various aspects of their work (3). Of those individuals, 496 participated in a follow-up survey implemented in winter 2020. Although all respondents were working or volunteering as PSSs before the pandemic, approximately 7% of respondents in both the first and second surveys reported no longer working or volunteering as PSSs. They also reported increased inability to pay monthly bills and continuing, perhaps cumulative, pandemic-related economic harm.

Results suggest that the work of the PSS continued to adapt to the pandemic as service needs and resources evolved over 2020. Traditional tasks, including individual peer support and group facilitation, partially rebounded from the early part of the pandemic to the third wave—an encouraging trend.

Although respondents in the second survey reported continued personal challenges (especially isolation and communication difficulties), the proportions reporting most challenges decreased over 2020. This decrease was likely related to the relatively stable and high levels of satisfaction PSSs reported regarding social, educational, and material support provided by their organizations, supervisors, and coworkers. Unfortunately, PSSs reported increasing challenges among the individuals they supported; these challenges were related to mental health symptoms, substance use issues, interpersonal violence, and housing instability. Isolation, job loss, and hunger remained high among peer clients.

In both surveys, most respondents reported positive impacts from the pandemic, including impacts they personally experienced, impacts on the broader peer support field, and impacts on those they supported. Many of these positive impacts included the adoption of technologies for the provision of remote and telehealth support (14, 15).

Several limitations of these data should be noted, including sample representativeness. Other limitations of this research were addressed in reporting from the first survey (3). Given the similarity of the demographic characteristics of the first and second samples, we are reasonably confident that these results provide a valid picture of PSS work tasks and challenges over the course of 2020.

This may be the only longitudinal examination of the work tasks and challenges of PSSs employed in mental health settings during the pandemic. From our initial survey, we concluded that PSSs were working creatively to meet the increasing needs of the individuals they served, and we continued to observe this creativity in the second survey. We were encouraged to see that PSSs as a group did not experience high levels of unemployment. PSSs reported somewhat decreasing adverse effects for themselves personally but continued high levels of social isolation, mental health symptoms, and substance use among those they served, an important finding for mental health providers and programs. As job tasks continued to evolve and rely heavily on technology and meeting basic needs of the clients they supported, PSSs continued to innovate in their work to address these effects and needs. PSSs reported substantial positive impacts of the pandemic, without which we assume that coping with the pandemic would have been considerably more difficult. Mental health organizations that employ PSSs should take heart at the high levels of workplace support PSSs reported receiving, which remain critical to serving individuals greatly burdened by this long-lasting pandemic.