Peer Specialists: Enhancing the Behavioral Health Workforce to Address Tobacco Cessation
Interview with Heath Hayes, Senior Director – Communications and Strategic Engagement
Oklahoma Department of Mental Health & Substance Abuse Services
Tell us a little more about how you first got involved in peer specialists and tobacco control.
I never thought that this would be something that I’d be doing – but it’s interesting how things fall into place based on your lived experience. I got a degree in psychology and started my career working with the homeless population. I eventually began working with consumer and family-run organizations that contract
with the Department of Mental Health and Substance Abuse Services in Oklahoma. Part of my role was also to coordinate our certification process for the peer program. I started to understand my own recovery journey as I worked more with the peer workforce. We started providing technical assistance in the wellness space, and that coalesced into us figuring out how wellness plays into recovery
and lived experience. Our leadership was supportive of my efforts to merge these concepts in an innovative way. We also had some synergy happening between our public health and other state agencies. Our state Medicaid program really wanted to focus specifically on tobacco cessation within the wellness framework. So that’s how the world of peers and tobacco and wellness all merged here in Oklahoma.
“That experience- working with the homeless – opened my eyes to social injustice and ignited a fire of advocacy within my heart and soul that was always there!”
Oklahoma has the highest proportion of behavioral health treatment agencies in the nation that offer cessation interventions such as state quitlines, prescribe cessation medications and provide tobacco-free campuses. That’s quite an impressive feat – what is your state’s secret and what role did peer specialists play in getting there? How does expanding the peer workforce support this increase in services and service delivery?
Every state is different, but the best way to get systems changed in Oklahoma is to cast a vision that relates to your mission, use incentives and set standards. We are the primary funder of all the treatment services statewide, and we contract and certify the majority of agencies providing treatment. We hold our community mental health centers accountable to certain outcome benchmarks – for example, in order to obtain enhanced tiered payment systems, they must ensure that 40% of the people they serve interact with a peer recovery specialist. In addition, treatment agencies are contractually expected to refer at least 20% 
of the people that they identify as tobacco users to our tobacco helpline. We also provide training and technical assistance while reiterating to providers that one of the ways they can hit all these metrics is to use peers. We have had peer-support specialists and a certification program for more than a decade. In the first three years, we established our training curriculum and pushed for a state plan amendment to make this curriculum Medicaid-compensable. After that, we hired peer specialists and began more narrowly defining their roles. We tried to use our lived experience to give hope to the next person, keep them engaged, move them through the treatment process so that they can be successful, and then share their story in some kind of way with the next person. For myself and others, talking about tobacco use on its own was an off-putting topic. However, when we framed tobacco use as an aspect of recovery and wellness, tobacco cessation just came into the conversation naturally. The wellness framework just kind of naturally evolved into something that this workforce owned as part of their recovery. It gave our system of treatment something to actualize and focus on with the peers.
“We tried to use our lived experience to give hope to the next person, keep them engaged, move them through the treatment process so that they can be successful, and then share their story in some kind of way with the next person.”
What are some common myths about recovery and tobacco cessation that you’ve encountered in your work? What can and does the peer workforce do to dispel these myths, for organizations that may be reluctant or cautious to use peers in tobacco cessation contexts?
Some of the more common concerns I’ve heard are “Tobacco is the only thing they have left” or “People won’t come to treatment or they will leave treatment if they cannot smoke.” We can counteract those concerns by creating context such as “Why would we put so much effort into people getting sober and 
helping them manage their mental health, only for them to die prematurely from other diseases associated with tobacco use?” Also, sharing research and evidence that highlights how most people who use tobacco want to quit helps. The best strategy I’ve found is by reiterating that if we’re able to help somebody quit tobacco while we’re addressing their mental health or substance use concerns, there are many studies that support the fact that we can improve their chances of full recovery by 25%. Who wouldn’t want to be able to do that? People are also unsure about how to implement a peer workforce program. We remind them that their future workforce is the people they are serving right now. We assure them that creating a peer workforce will give their clients the hope they need to stay focused on their recovery journeys and make a huge impact in people’s lives.
“When we framed tobacco use as an aspect of recovery and wellness, tobacco cessation just came into the conversation naturally. It gave our system of treatment something to actualize and focus on with the peers“
In the realm of tobacco control we constantly talk about the importance of helping patients quit or reduce their tobacco use, and in doing that we sometimes miss the people that are in our clinics every day – our staff. What is some advice you would give to clinics looking to help employees quit or reduce their tobacco use?
From a perspective of someone with lived experience, it’s very difficult to motivate a person to change their behavior if you’re not actively working on your own behavioral changes. All our certified or contracted agencies have tobacco-free policies that mandate that employees can’t smoke on the grounds at all. We also reinforce through a hygiene policy that you can’t smell like smoke because it can be a trigger for folks. We treat it as an addiction, and we stipulate that if our contracted agencies have staff who use tobacco, we expect that they offer them nicotine replacement therapy (NRT) and cessation support counseling services that will be covered under insurance. Both staff and clients should benefit from tobacco use treatment regardless of where they fall in the makeup of the organization.
“Both staff and clients should benefit from tobacco use treatment regardless of where they fall in the makeup of the organization”
Where do you think the future of tobacco control is headed and what do you think are some ways the role of peers may evolve? How do you think this will strengthen the behavioral health workforce?
I cannot stress enough how important it is to leverage your state quitline. Every state has a tobacco quitline and offers at least two weeks’ worth of NRT. Since we’ve seen such a significant success with addressing tobacco cessation within a wellness framework in the peer workforce, the next phase will be specializing our peers. We call them wellness coaches who are specifically working on physical activity, nutrition and even sexual health. That is the next evolution for our peer workforce. Overall, it’s great to see more organizations adopt and embrace how important having someone with lived experience can be for folks in recovery. When we positioned this as only tobacco cessation, nobody would come. When we reframed the process in a wellness framework, people showed up.