This is an exclusive BHB+ story.
Lived experience is considered a cornerstone of substance use disorder (SUD) care through employed peer specialists. Their involvement with patients is an asset shown to improve outcomes, yet the same experiences that make them optimal for patient support can also be barriers to entry, leaving roles unfilled in an industry already under-resourced.
Around 44% of peer recovery support specialists also have a history of involvement with the criminal justice system. Because of that, the high demand for these individuals is met with growing shortages driven by barriers such as background check rules that can block hiring and certification, as well as inadequate reimbursement for providing Medicaid-billable SUD services.
The SUD treatment industry often considers itself open to second-chance employment, knowing how many peer recovery specialists have a criminal background that is related to past drug use, but sometimes these structural barriers can evaporate employment opportunities altogether and make retention challenging, too.
“It is very, very difficult in America to get a job — any job — if you have a criminal record,” Cooper Zelnick, CEO of Groups Recover Together, told Behavioral Health Business. “It is also the case that many individuals struggling with active addiction commit crimes, subsistence-level crimes, drug-related crimes, etc. And as a result, many people who are in recovery have criminal records. That has historically been and remains a very significant barrier for folks who want to work in the field.”
Groups Recovery Together is an SUD treatment provider that operates in 11 states. The company supports employees through expungement processes, and Zelnick himself sometimes even appears before licensing boards on their behalf.
That isn’t unique to the company. A growing number of organizations offer peer specialists support to navigate record expungement, streamline background checks, obtain waivers and secure legal support to meaningfully build careers without limitations from their past. Failure to support peer specialists in these ways could worsen the shortage, executives shared with BHB.
“It definitely limits the size of the workforce, and definitionally, those restrictions limit the breadth of lived experience that can make its way into the workforce,” Zelnick said. “I understand why those regulations exist, to keep people safe. In cases of folks living in active recovery, those regulations aren’t always applicable.”
What the barriers look like
Even though around 30 million U.S. adults are eligible for criminal record expungement, fewer than 10% successfully do so, according to the Center for American Progress.
Cindy Raymond, manager of member outreach at Wayspring, has been in recovery for nine years and recently earned a master’s degree, advancing her role to the management level. It has been 15 years since she faced new charges and she has spent years working to have her records sealed or expunged. Varying state and county rules, legal fees and limitations on where she can live, work and obtain licensure have made the past a constant part of her present, requiring her to re-explain it, even though she already has peer recovery qualifications.
“The entire reason that I chose social work was that I knew that I could have a career in social work because of my lived experience,” Raymond told BHB. “It has really dictated every single thing, every move that I’ve made because the workforce is not necessarily felony friendly. … When I finished my master’s degree, the goal was to go on to get my licensure. It became so overwhelming, trying to explain myself and send in all this paperwork that I just stopped. I was overwhelmed. I felt like I had no support in it and didn’t know where to start.”
Wayspring is an addiction care provider that partners with health plans to manage SUD care across six states. The company launched a second-chance scholarship program in January to provide employees who face these challenges with funding and support to navigate the legal and financial barriers of the records expungement process.
Raymond, who has now worked at Wayspring for three years, applied to and was accepted into the company’s second-chance program. Now she has a combination of both financial aid and access to legal support to assist in the process, as well as colleagues who are actively offering to write letters of recommendation and moral backing on her behalf while she continues to pursue licensure.
“These are charges that I fought when I was 21 years old, and due to active use and being in addiction, I continued to violate my probation,” Raymond explained. “They say that the sky is the limit, but that’s not the case for everyone, and especially for people in my situation. But once this record is gone, that will be the case for me.”
Wayspring has also changed key hiring policies, Tanya Deane, chief human resources officer at Wayspring, explained, including moving away from automatic disqualification for felonies of any kind and how long ago they occurred. The company now reviews non-violent felonies if it has been a minimum of five years since the offense was committed. Misdemeanor charges, which Wayspring also scrutinized in the past, can now be reviewed for consideration if they are at least three years old. Cases can also be taken to an internal review panel for final consideration around both felonies and misdemeanors, rather than facing automatic rejections like before.
“My assumption is, for a lot of employers — even just generally in the health care space — that it’s kind of a black and white ‘no’ answer for most cases,” Deane told BHB. “I think our employee base and our culture have been made richer by being able to be more flexible with these things, because of the diversity of thought and background and the ideas on how we deliver care to people, because of being able to employ people with similar experiences.”
The company has also removed its bachelor’s degree requirements from many job descriptions to lower the barrier to entry for individuals with similar histories.
Internal support for employees with criminal records is growing
While it does not engage in record expungement processes for employees, Bradford Health Services, an addiction treatment provider that operates in six states, offers a similar concept, a second-chance option for both prospective and current workers. While some offenses — particularly violent ones — still automatically disqualify a candidate, for those who have non-violent offenses or a moderate criminal history, the company evaluates the scope and history of the crimes and asks whether it was related to their addiction, Rob Marsh, CEO of Bradford Health Services, explained to BHB.
“If a person is a candidate for employment and they’ve got a criminal history, we have this second chance opportunity where we give them the parameters of what we’re looking for in the role and what we would expect from them,” Marsh said. “Then we outline going forward, in terms of behavior and consequences for certain behaviors. We give them this really nice, structured path that says, ‘Here’s how you can go from wherever you are to being employed with our organization and being just as vibrant a part of it as anyone.”
Bradford’s second-chance policy for its existing employees applies in cases of relapse or related challenges. The company supports them by engaging them, “instead of immediately terminating them or sending them on the way,” Marsh said. Bradford connects them to counseling and treatment services as appropriate and once they recover, they are put on a similar structured path to re-enter the company’s workforce.
At Workit Health, a telehealth provider of addiction treatment that operates in 12 states, employees with a criminal record are given financial support to bolster their training via a professional development allowance, pay that is between 10% and 25% higher than market averages and bonuses. The company also has policies that acknowledge and support lived experience and recovery.
“We’ve created essentially a compassionate policy that allows our employees who might be experiencing addiction, whether that’s wanting to go into a program, wanting to navigate some legal hurdles, to use job protection to take care of themselves,” Sara Shapiro, vice president of people and culture at Workit Health, told BHB. “We know we’re hiring people with live experience who just might need a little bit of additional support.”
Prospective candidates for employment who have a criminal history are evaluated individually to understand the scope of their clinical effectiveness and skillset.
“We’re really just evaluating their skill, their experience and their potential to run the clinical appointments, and that’s not solely based off of their past,” Clare Mulford, vice president and clinical director at Workit Health, added. “A justice-involved background doesn’t define someone’s character. It certainly doesn’t define their work at the core, their ability to engage in our appointments and be able to add value to our members.”
Particularly as the field of SUD care is in the middle of a workforce shortage that is anticipated to persist with a projected deficit of more than 200,000 mental health and addiction treatment counselors by 2037, according to some projections. Rethinking internal policies and hiring practices like these may alleviate some of that burden by lowering the barrier to entry for employment despite a criminal history.
“Providers who are serious about the mission that we have as an SUD industry have to rethink the hard and fast rules about criminal histories and backgrounds when working with the populations that we work with,” Marsh said. “Recovery is all about second chances. Recovery is all about giving people an opportunity to rebuild something that they lost.”