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Peer Possibilities: National Peer Workforce Summit

Executive Summary and Meeting Report

Hyatt Regency Reston, Reston Virginia

 

August 23-24, 2023

Realizing Recovery

Policy & Practice Improvement Series

Office of Recovery

Substance Abuse and Mental Health Services Administration

U.S Department of Health and Human Services
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This report was developed by the Substance Abuse and Mental Health Services Administration’s 

(SAMHSA) Office of Recovery, with contributions from Jessi Davis and Dana Fogleson (National 

Association of Peer Supporters). The content of this report was reviewed, and all themes within 

were identified or expressed by technical experts/those with lived experience (see “Appendix A” 

for a full list of participants) during the National Per Workforce Summit. 

Please note that the views, opinions, and content expressed within do not necessarily reflect the 

views, opinions, or policies of the Office of Recovery (OR), the Substance Abuse and Mental 

Health Services Administration (SAMHSA), or the U.S. Department of Health and Human 

Services (HHS).

A special thanks to each participant for their time and dedication to advancing the 

field of recovery.
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Table of Contents

EXECUTIVE SUMMARY ................................................................................................................... 4

Common Themes ...................................................................................................................................... 4

Solutions and Thoughts Moving Forward ................................................................................................ 5

MEETINGREPORT ............................................................................................................................... 7

Welcome ................................................................................................................................................... 7

Overview of SAMHSA’s Office of Recovery .......................................................................................... 7

Speed Introductions .................................................................................................................................. 9

Keynote: The Power of Hope ................................................................................................................... 9

Authenticity Panel ..................................................................................................................................... 9

Breakout Sessions ................................................................................................................................... 12

Peer Financing Panel ............................................................................................................................... 12

Day Two Welcome ................................................................................................................................. 16

Federal Representatives Panel ................................................................................................................ 17

Breakout Sessions ................................................................................................................................... 18

Peer to Career Panel ................................................................................................................................ 18

Final Thoughts: Identify a Priority.......................................................................................................... 21

Appendix A – Participants List ............................................................................................................... 23

Appendix B – Breakout Session Reports ................................................................................................ 29
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EXECUTIVE SUMMARY

The SAMHSA Office of Recovery has a vital role in advancing recovery across the nation. The 

elevation of efforts to reduce barriers to recovery supports and advance systematic changes to 

promote access to mental health and substance use recovery supports is best strengthened 

through regional, state, and local coordination that aligns with the principles and values of 

recovery, while recognizing the expertise of individuals with lived experience, their families, and 

caregivers. On August 23-24, 2023, the Office of Recovery hosted the Peer Possibilities: 

National Peer Workforce Summit. The gathering brought together over 100 individuals 

representing persons with lived experience of mental health or substance and staff of federal and 

state partners.

The purpose of this Summit was for SAMHSA to solicit feedback from stakeholders to better 

understand the variables that impact the expansion of the peer workforce, as well as identify

gaps and scalable solutions to increase peer support across the country. 

Over the two days, speakers and panelists provided perspectives on authenticity; financing of 

peers; and peer career considerations. There was also a panel with Federal stakeholders where 

representatives from National Institute on Drug Abuse (NIDA), the Centers for Medicare and 

Medicaid Services (CMS), Department of Veterans Affairs (VA), SAMHSA’s Office of Recovery, 

and the Health Resources & Services Administration (HRSA), discussed peer workforce issues. 

Several themes emerged over the course of the two-day convening along with suggested follow up 

items for SAMHSA’s Office of Recovery to consider in future peer workforce initiatives. 

Common Themes

Following are common themes identified during meeting discussions.

• Defining the Term ‘Peer’ - SAMHSA’s Core Competencies for Peer Workers in 

Behavioral Health Services describes peer support as “offering and receiving help, based 

on shared understanding, respect and mutual empowerment between people in similar 

situations.” The terms ‘peer supporter’, ‘peer worker’, and ‘peer specialist’ are 

interchangeably used to describe a person (including family, friends, and loved ones) with 

lived/living* experience involving problematic mental health and/or substance use 

conditions, and who engages in a wide range of activities, including advocacy, linkage to 

resources, sharing of experience, social support, community and relationship building, 

group facilitation, skill building, mentoring, goal setting, and more. Across the United 

States, various other terms such as recovery coach, mentor, peer provider, or peer navigator 

are used to describe peer workers. In the context of the peer summit meeting, the term ‘peer 

worker’ was used to generally describe someone working in a peer support role (both 

certified & non-certified, unless specifically noted). 

• History Matters – Participants recommended reclaiming their history which includes 

strong examples of peer empowerment and advocacy. 

• The Peer Community is Not Homogeneous – Participants appreciated the Office of 

Recovery convening diverse aspects of the peer community together and providing a space 

for uncomfortable discussions. But there is more work to be done to be fully inclusive of
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members of the disability community; Black and African Americans; those who practice 

harm reduction and non-abstinent approaches; and family/parent peers. 

• Federal Partners Need More Peer Input– Federal partners are often not fully engaging

people with lived experience in their efforts. While it was acknowledged that some Federal 

restrictions are statutory, engagement between peers and Federal partners helps with 

education; reducing stigma; and, most importantly, ensuing that the policies and financing 

are relevant to peer services. 

• Clinical Systems Need to be Recovery-Friendly – There were many concerns related to 

the well-being of peer support staff within clinical settings. These ranged from not 

understanding what peers do (e.g., supervision); to more serious allegations of co-opting 

peer services and creating toxic environments with burnout, tokenism, stigma, and 

disrespect. Further, peers, when placed in clinical settings, can be pushed into a medical 

model approach, and asked to do things not within their scope of work like run therapy 

group sessions) or do clerical or administrative tasks. 

• The Peer Role is Valuable and Should be Protected –To bolster the peer workforce, it is 

essential to fortify peer-run agencies. This involves enhancing their capacity and 

infrastructure, while concurrently cultivating leadership skills to thrive in the healthcare 

landscape where they can make a significant impact. Defining the peer role and values are 

a prerequisite for the community to grow. There was creative tension between whether peer

workforce should be an identity. a role, or a relationship. Too broad a definition will water 

down the value. Too narrow will exclude valued members of the peer community (e.g., 

harm reductionists). 

• Financing Barriers Limit Peer Efforts– Again there is tension in having sustainable 

funding but having to accept the administrative requirements. For example, fee for service 

approaches may employ “medical necessity determinations” and 15-minute billing 

increments. Funders also tend to not finance important infrastructure and Social 

Determinant of Health (SDoH) needs. And braiding services along with some reporting 

create administrative burdens taking peer leaders away from doing more direct service 

delivery and staff support. Flexibility was also mentioned noting that there is not a single 

pathway to recovery so all options, including culturally relevant practices, need to be 

covered.

• Peer Career Issues are a Symptom– Low pay, burnout, lack of workforce are symptoms 

of an unhealthy system. Peer burnout and well-being cannot be rectified without addressing 

the systemic environment in which they operate.

Solutions and Thoughts Moving Forward

Following are some solutions and thoughts that may guide the Office of Recovery, SAMHSA, and 

the peer community. 

• Broker More Conversations – SAMHSA is wellpoised to broker efforts to get peers involved with 

other Federal partners (e.g., CMS, Department of 

Labor, etc.). In addition, the Office of Recovery should 

An overarching theme for solutions moving 

forward focuses on ways that peers can 

change the system from within.
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continue to provide space for internal peer community discussions to resolve issues and 

develop a sense of community. 

• The Important Role of Community Based Organizations (CBOs)/Recovery 

Community Organizations (RCOs) – These are peer-led organizations and can serve the 

role of supporting peers (e.g., like unions) and ensure authenticity. It was noted that a model 

of “infusing” peers through peer organizations rather than integrating them as employees 

in larger systems would be more effective and improve the well-being of the peer 

workforce. However, peer organizations need to have a strong infrastructure, and funding 

is rarely available for that need.

• Elevate Equity Concerns – While there are admittingly significant external equity 

concerns, SAMHSA can help address equity concerns across different members within the 

peer community. 

• Provide Better Understanding of Federal Assets and Barriers – A participant noted that 

there was a lot of jargon expressed that grassroots peers were not familiar with. In addition, 

some Federal participants explained reasons why certain policies are made (e.g., statutory 

requirements). Bringing in the peer community to work on these issues helps with that 

education but also allows the community to identify advocacy needs and creative ways to 

address these barriers. 

• Address the Peer Role Drift – Now that the SAMHSA’s National Model Standards for 

Peer Specialist Certification have been issued, the Office of Recovery might focus on the 

definition of peers; the threats to the role of a peer (which may even include certification); 

clear job definitions; and a set of common values that can unify the community. 

• Provide Clarity on the Intersection of Recovery and Harm Reduction Services and 

Approaches – Where does harm reduction begin and end within a recovery context? Vice 

versa, where does recovery begin and end when applying a harm reduction lens? There is 

a lot of support from both harm reductionists and recovery advocates to coordinate services 

that are complimentary of each other. The goal is saving lives and assisting individuals 

with their health and wellness goals; however the individual defines them. The tools that 

service providers use to accomplish this though, need further clarification for efficacy 

purposes. 
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_____________________________________________________________

DAY ONE

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MEETING REPORT

Welcome

Kristen Harper with SAMHSA’s Office of Recovery gave an overview of the agenda and goals of 

the meeting. She also shared that she initiated her own personal journey of recovery at 19 years 

old. She acknowledged the roles of peers in this journey and thanked the meeting participants for 

the work they do daily. 

Sonia Chessen, SAMHSA’s Chief of Staff also welcomed participants on behalf of the Assistant 

Secretary for Mental Health and Substance Use, Dr. Miriam Delphin Rittmon, and Acting 

Principal Deputy Assistant Secretary, Mr. Tom Coderre. She noted that the Biden Administration 

has elevated the role of peers, both in providing recovery support as well as addressing the opioid 

overdose epidemic. Regarding SAMHSA, the agency has been engaged in the following peer 

support activities:

• Launching the Office of Recovery

• Incorporating recovery as one of SAMHSA’s 

strategic plan guiding principles 

• Collaborating with other Federal partners (e.g., 

the Centers for Medicare and Medicaid Services 

(CMS), the Health Resources and Services 

Administration (HRSA) and the Department of Veterans Affairs) to build up the peer 

workforce and provide sustainable funding streams. 

Keris Myrick, Vice President of Partnerships at Inseparable served as the Day One facilitator.

Overview of SAMHSA’s Office of Recovery

Paolo del Vecchio, Director, Office of Recovery 

Mr. del Vecchio revealed that he is a person in long-term recovery (e.g., 38 years) and that there 

are over 50 million Americans who also identify as being in recovery. He encouraged the 

participants to lean boldly into discussions on the struggles and challenges with expanding the peer 

workforce. Potential topics for consideration include the following: 

• Authenticity

• Financing 

• Career advancement and pay scales

• Supervision and peer drift 

• Diversity, equity, and inclusion 

Peers demonstrate the power of recovery 

every day.

Sonia Chessen

There will be a lot of work to do in this 

Summit. But also, a lot of promise and 

possibilities.

Paolo del Vecchio
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Office of Recovery

Mr. del Vecchio then gave an overview of the Office of Recovery. He noted that while the Office 

is not quite a year old, it grew out from a long history of recovery advocacy. In 2022, SAMSHA 

convened a Summit and out of that event and there was a clear direction from attendees to adopt a 

“big tent” approach to recovery. This means focusing on people in recovery from substance use 

and mental health conditions, family members, and those who are in recovery but not abstinent. 

And accepting multiple pathways to recovery. 

Since the Office’s launch, they have been engaged in the following efforts: 

• Development of a National Model Standards for Peer Support Certification;

• Regional meetings; and

• Technical expert panels on a variety of topics including warmlines, criminal justice 

involvement, and housing. 

He then highlighted some of the Office’s works across SAMHSA’s five recovery goals: 

• Inclusion – Most of the Office staff are themselves in recovery as SAMHSA has issued a 

formal policy on inclusion to be a ‘model employer” for individuals in recovery. 

• Equity – The Office has advanced understanding and support for underserved 

communities. Several weeks ago. the Office convened a 300-person tribal summit on 

recovery which focused on historical trauma and healing practices. They are also 

developing a compendium that will include practice-based evidence. 

• Peer Services – Today’s meeting is part of this effort which is focused on raising the 

quality and authenticity of peers. The National Model Standards also focused on peer 

services and SAMHSA just released a guidebook on hiring individuals who have been 

involved in the criminal justice system. There is also work to strengthen recovery-based 

organizations and high-school/collegiate recovery programs. 

• Social Determinants of Health – SAMHSA has held meetings on housing and 

employment issues and worked with partners like the Office of National Drug Control 

Policy to provide technical assistance and guidance. 

• Wellness – Mr. del Vecchio noted that individuals with substance use disorder (SUD) and 

mental health conditions, even when in recovery, die far too young from other 

comorbidities. There are also issues related to restraint during crisis. Advocacy is needed 

on these fronts. 

Mr. del Vecchio noted that baked-in to all these efforts are the core principles of data and evidence, 

trauma responsiveness, and rights protection. 

September is National Recovery Month, and the theme is “recovery is real.” Some of the activities 

that SAMHSA will be participating in include the following:

• A Recovery Month Toolkit to organize local efforts 

• A Recovery Housing report (early September) 

• A Recovery Luncheon in DC followed by a walk to the U.S. Capitol (September 7) 
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• A Release of data on mobile recovery (September 20) 

• A Day of Service (September 30)

Speed Introductions

Participants had ten minutes to do speed introductions with others in the meeting. A list of 

participants is provided in Appendix A. 

Keynote: The Power of Hope

Kathryn Goeztke, M.B.A., The Shine Hope Company 

Ms. Goeztke has been in recovery for 19 years and shared 

her journey in the field of “Hope Science.” She shared that 

she founded an organization called Mood Factory. She 

learned that a consistent predictor of behavioral health 

struggles is hopelessness. She noted that hopelessness has an emotional component (despair) and 

a motivational component (helplessness). 

These experiences became a catalyst for her in researching the science of “Hope,” and specifically 

how to measure it and redirect outcomes for this protective factor. She founded the Shine Hope 

Company which developed both an adult and children’s Hope Scale. 

Authenticity Panel

Through a series of guided questions from Ms. Myrick, panelists responded to the overarching 

question “what is an authentic peer experience”.

Please share a brief introduction and how it relates to authnticity. 

Kevin Rumley 

Mr. Rumley is the Executive Director for a Veterans Treatment Court in North Carolina. He is a 

Marine Corp veteran who was injured and witnessed his best friend killed in combat. During his 

recovery from his wounds, he was placed on morphine and that led to an opioid use disorder 

(OUD). He suffers from PTSD and depression. He has been on medication assisted treatment 

(MOUD) for the past 12 years. 

Daryl McGraw

Mr. McGraw is the Director of Formerly, Inc. a reentry consulting service. He has been 

incarcerated, tased, choked and has an SUD. He noted that the turning point in his life was a 40-

day spiritual motivation guide that he read in jail while waiting for his court date. He was sentenced 

to four years but used that time for his recovery journey and to help others. He now often works 

with the public defender’s office and highlights systemic racism within the system.

Sue Smith

Dr. Smith is the CEO of the Georgia Parent Support Network. She shared a personal story of her 

family “adopting” a young waitress and her daughter. She noted that this encounter was a blessing 

Hope is a strategy, not just a wish.

Kathryn Goeztke
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which didn’t just change the trajectory of the waitress but also Dr. Smith’s family. As an example, 

her husband had an alcohol use disorder and he ended up being in recovery. 

Jessi Davis

Jessi Davis is the President of the National Association of Peer Supporters as well as a Senior

Administrative Program Coordinator with SAMHSA’s South and Southwest Mental Health

Training and Technical Assistance Center. Jessi noted that peer support programming impacted 

her life when she was under the age of 18 and she wants all young people to have access to quality 

Peer Support. Jessi created a training program to teach Peer Specialists how to work with young 

people. 

Wayne Cortez

Mr. Cortez is a peer recovery support specialist at Riverside-San Bernadino County Indian Health

in California. He spent over 22 years incarcerated. He noted the value of tribal healing traditions 

and works to engage youth in these practices for prevention and intervention needs. He noted that 

American Indians have been particularly hard hit by behavioral health issues.

What are some of the nuances that SAMHSA should understand regarding peer support? 

Jessi Davis

Our field has challenges because of the "plain language" wording that we have added additional 

meaning to (i.e., Peer Support from a Peer Specialist is not the same as "peer support" in the plain 

language form). There are also many ways of offering Peer Specialist services. For example, just 

with youth, there is school-based peer support, alternative peer groups, special services for first 

episode psychosis. Age differences matter even with young people (e.g., a 13-year old’s needs 

differ from a 16 year old), but that doesn't mean that Peer Specialists who are not near in age should 

be barred from working with a young person. Near-Aged Peer Support should always be 

recognized as the best practice regarding working with young people. 

Wayne Cortez

Culture, particularly for marginalized communities, are important for recovery. The Native 

American community has deep intergenerational trauma and these approaches (e.g., sweat lodges, 

Bird Dancing) helps in making individuals feel connected and have a sense of belonging. Some of 

the programs also have an intergenerational component with elders and youth connecting. It is 

important to note that each tribal culture is different. 

Sue Smith

Ms. Smith shared the story of an employee (Natalie) who had lived in a shelter. She had immense 

passion for her work as a peer and did a lot of home visits. When the Family Network did a survey 

to measure their outcomes, Natalie was consistently rated high by families as a resource. 
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Natalie faced stigma from staff (e.g., accusations of not doing her job) but she consistently went 

out of her way to help. Many peers have that passion within them, are willing to remain in the role, 

despite putting up with a lot of workplace issues. 

Kevin Rumley 

Soldiers while enlisted have a strong sense of purpose and 

community. When they return to civilian life it can feel 

like being removed from their tribe. The Veteran’s court 

is a 2-year diversion court, and everyone is matched with 

a veteran peer. Peers who have been the most successful 

are the ones that honor the dignity of the other person. 

Healing is often found within relationships. 

Daryl McGraw

Mr. McGraw advocated that the term peer be replaced with PIR (Person in Recovery) as it honors 

the person’s experience rather than the credential.

He noted that the organizations with the most authentic PIRs often do not have grant writers and 

as a result the right people are not getting the money to do their work. 

Regarding individuals who are justice-involved, they need support starting at the beginning of their 

sentence not 30 days before release. Their families also need support. And many will need support 

for basic needs like housing. 

What does authentic peer support mean to you? 

• With families it is complicated because each has 

different needs, so whose goal is right and who 

do you listen to? Also, with transitional youth, 

there is the issue of when a child is old enough to 

make their own decisions. 

• It means having lived experience but also 

listening to the individual’s needs (e.g., not projecting your beliefs of recovery onto them). 

• The individual gets to decide the definition of veteran. Some females won’t reveal that 

identity and conversely there are some instances where someone doesn’t fit that definition 

(e.g., 2 years enlistment.) 

Discussion

Participants then had an opportunity to provide questions and comments. 

• Balancing Expansion and Authenticity – The effort to expand the workforce to meet the 

demand could undermine authenticity. 

• Consistency in Identity – We should not feel we need to “code-switch”. Your identity as 

a peer is the same identity when you present in a board room. 

Veterans are willing to die for their 

country, but they sometimes are not sure 

how to live for it.

Kevin Rumley

Show your true self and nothing but. Youth 

know when you aren’t being authentic. 

And sometimes wear jeans. 

Jessi Davis
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• Peer Supervision – What is the impact on peers in working within systems where the 

culture may be clinically-focused. Several panelists responded:

o Peers should be supervised by other peers to prevent peer drift. 

o Some peers are pressured to do policing (e.g., doing urinalysis) for those that are 

trying to engage and build trust with. Peers should not be doing urinalysis.

• Peer Exploitation – One participant noted the low pay and that after a grant ended, was 

asked to volunteer his services. 

• Funder Demands – A participant shared funders will impose their demands and even set 

unreasonable expectations (e.g., time limits for results). There is a need to educate funders 

that peers deal with human beings not widgets.

• Abstinence – While there is appreciation for the inclusion of individuals in recovery who 

are not abstinent, this belief isn’t put into practice. This creates stigma and alienates 

segments of the peer community. Another person added that living experience has value 

just like lived experience. 

• Tokenism – While tokenism isn’t an ideal outcome, it is unfortunately a step in the process 

of getting in the door. those that who get in the door should hold it open for others. And if 

you are a token, don’t assimilate. 

• Paternalism Towards Individuals with Disabilities – while self-directed recovery is 

universally accepted, there may be paternalism for individuals with more stigmatized 

disabilities. There should be ASL interpreters always be available to the deaf and hard of 

hearing to ensure that they can fully participate in the process of their own recovery, and 

other accessibility accommodations must be discussed and provided throughout the 

entirety of the person's interactions with systems and peer specialists. 

• Language Matters This can reduce peer drift (stay focused on the role) and co-opting of 

the role by systems. 

Breakout Sessions

Breakout sessions were convened to discuss the following subtopics: 

• Authenticity – diversity of workforce, supervision and training, distinction 

of peerness in integrated settings, advocacy and education of policy makers, peer 

employers and payers

• Financing – pay scale, cost effectiveness measures, diversifying funding streams

to support peers (Medicaid, private payers, grants, etc.)

• Peer to Career – pay scale, certification, barriers to certification and or

employment, reciprocity issues, career ladders, mentorship, networking

Written notes from these sessions are in Appendix B. 

Peer Financing Panel

Through a series of guided questions from Ms. Myrick, panelists responded to the issue of how to 

support peer financing. 
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Please share a brief introduction and how it relates to peer financing. 

Lauren Foster

Ms. Foster is the Behavioral Health Program Manager at BlueCross of Minnesota. She noted that 

BlueCross has a new benefit that covers peer support.

Dana Foglesong 

Ms. Foglesong is the National Senior Director for Recovery and Resiliency Services at Magellan 

Health. She also is the immediate past president of the National Association of Peer Supporters. 

She noted that peer services changed her life and wants to ensure that peer services follow peer 

support values and competencies. She has previous work in state government where she supported 

block grant funded peer services and started a statewide peer support program. For the past seven 

years, she has been in managed care where she leads peer support teams and programs. 

Greg Williams

Mr. Williams is the President of Third Horizon Strategies which does advocacy. He said that 

storytelling is needed to explain to third party payors about the value of peers. And how to purchase 

the services in a value-based and sustainable way. 

 

Joe Powell

Mr. Powell is the President of Association of Persons Affected by Addiction (APAA). He stated 

that in addition to financing of peers, there needs to be financing of recovery community 

organizations which serve as the support system for peers. Other needs are equity, wellness 

services and addressing SDoH needs. 

Amy Brinkley 

Ms. Brinkley is a Recovery Support Systems Coordinator with the National Association of State 

Mental Health Program Directors (NASMHPD). She previously worked for the Indiana State 

government. She noted that while many in this room have concerns about systems, there are peers 

in decision-making roles that are pushing internally within these systems to support peers. And 

that includes improving financing. 

Share how you have been working to improve financial sustainability for peers. 

Joe Powell

It is important to leverage relationship at all levels (Federal, State and local). These relationships 

helped towards building an infrastructure, then getting services billable as well as increasing 

placement opportunities. The relationships go beyond advocacy. They help educate 

decisionmakers and reduce stigma. 

Greg Williams
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In 2007, the Center for Medicare and Medicaid Services (CMS) issued a letter providing guidance 

to States on Medicaid reimbursement for peer support services. States are the decisionmaker, but 

the Federal CMS carries a lot of influence. Today, 49 States have peer support as Medicaid service. 

He noted that many States require supervision to be done by clinicians. 

Mr. Williams also noted that Medicaid can be used to creatively purchase other services such as 

housing. 

Amy Brinkley 

In her role with a national association, Ms. Brinkley gets to see State innovations. For example, in 

Illinois, the State invested $11 million with a university to develop peer programming and 

internships. They expected to train 200 individuals but now have trained 800. In her prior State 

role in Indiana, there was no budget nor data do she tried to advocate for funding. It was right at 

the beginning of the COVID pandemic and inmates were being released from jails. It was an 

opportunity to provide peer support. After implementing the program and providing data, 

leadership saw the value of using peers. 

Dana Foglesong

Ms. Foglesong cited several barriers in financing peer 

support services. One is that the "in the community" 

nature of peer support services makes it difficult to fit 

into 15-minute billing units. She noted that peer run 

organizations often offer the best environment for peer 

support specialists to work in, but they are typically not 

Medicaid providers. Block grant and opioid response funding is more flexible but is not as 

sustainable. Smaller nonprofit and peer run organizations need additional support in navigating 

funding pathways. 

Lauren Foster

The three main barriers to private payor financing have been provider buy-in, cost and lack of 

workforce. Pilot studies can help demonstrate effectiveness and create buy-ins. they also can help 

demonstrate return on investment. They also will recognize that the workforce is a vital component 

and make efforts to maintain the current workforce (e.g., pay) and prime the pump for new peers. 

But this all takes time. 

As an innovation, Ms. Foster noted that they had an app that allowed individuals to read a bio and 

do direct online scheduling with a peer specialist. Another innovation was a zero cost care 

approach for in-network use of peers. 

What is your dream scenario for funding peer support? 

• Peer support is available in all settings and there is braided funding. The goal is that the 

“right people get the right funding.” 

With financing, we shouldn’t change the 

service. It is the system that needs to 

change. 

Dana Foglesong
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• There is asset mapping of RCOs and needs so peer services can be transferred to where the 

most need is. 

• Have annual or monthly value-based payments rather than fee for service which is a 

common financing approach for public safety net services. Build up the infrastructure. Also 

allow for more than 15-minute increments 

• Serve peers before a crisis rather than always working within an acute care model. 

Financing should allow for fidelity and integrity rather than forcing peer services to fit into 

funding models 

• How can we have a more value-based model. Would also like to see peers in 

hospice/palliative settings. 

Discussion

Participants then had an opportunity to provide questions and comments. 

• Denied Claims – One participant who runs an RCO noted that Medicaid billing is 

frustrating (e.g., sorting out denied claims) and not worth the effort. She had met with State 

legislators, but it is still not a viable option because of the administrative burden. 

• Fidelity – While it was mentioned during the presentation, a participant echoed the concern 

that trying to accommodate funding requirements may pressure peer services to shift away 

from fidelity and authenticity. 

• Value of Champions – A participant shared that the North Carolina Single State Agency 

Director promoted peers and was able to get media coverage about it. As a result, they were 

able to get the funding written into the system. 

• Infrastructure – The strongest RCOs are often the ones that are given infrastructure 

money on the front end. SAMHSA’s block grants should have a recovery set-aside just as 

there is a set-aside for prevention. Without it, States will make other choices with the 

money. 

• National Leadership – While States often make the decisions on behavioral health, there 

is a need for Federal leadership to help to bolster the system. 

• Recognizing Diverse Peer Leadership – One participant shared that it is important to 

honor those within marginalized communities who have made significant inroads but are 

not recognized (e.g., the Zuni Federation of Mental Health). 

• Certified Community Behavioral Health Centers (CCBHCs) – One participant asked 

how peers could be leveraged in CCBHCs (e.g., outsourced to peer agencies). Peers have 

value but should not be marketed as the solution to the clinical workforce issue.

• Need to be at the CMS Table – Several participants emphasized that peers need to be 

more engaged with CMS. 

• Sustaining the Office of Recovery – Ms. Fogelsong shared that the Office of Recovery is 

not codified into statute though there is a need to address this. 
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_____________________________________________________________

DAY TWO

_____________________________________________________________

Day Two Welcome

Brandee Izquierdo, Director of Behavioral Health at Pew Charitable Trusts served as the 

moderator for Day Two. She shared several high-level takeaways from Day one.

Authenticity 

• Equity and inclusion focus may result in more diversity.

• Funding sources impact peer drift.

• More discussion is needed on the authentic human experience versus the authentic peer 

experience.

• There is discussion on whether to have peers integrated into a system or infused (e.g., 

provided by RCOs).

Financing 

• There is a lack of flexibility of funding. 

• There is a need for funders to be more accountable to those they fund.

• Funding impacts authenticity

• Infrastructure funding is needed, for RCO/PRO’s

• There are different types of funding for peers in various settings.

Peer to Career 

• The career ladder is hierarchical in nature and in messaging.

• Peer to Career implies that peers are an entry level position.

• Is being a peer an identity or a relationship (e.g., place the focus on the person being 

served)?

Dr. Izquierdo then opened the discussion for participant comment: 

• Authenticity – There is a need to refocus peers on the lived experience to ensure that the 

umbrella didn’t become so large that the workforce becomes meaningless. 

• Recovery – There is a lot of overlap with recovery and peers. Recovery must be integrated 

into the continuum of care rather than an appendage to treatment. Peer services which can 

span across the continuum can help with that. 

• Maturity – As with every human experience, people change and evolve. The participants 

noted that he was a different peer when he was just two years in recovery compared to now 

when it has almost been 20 years. 
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• Concern by Black and African American Participants – Several Black and African

Americans expressed frustration and tension 

around the need to fully integrate DEI 

considerations and that there are still vestiges of

White supremacy. 

Federal Representatives Panel

Through a series of guided questions from Dr. Izquierdo, panelists shared how Federal efforts 

support the peer workforce. 

Share what your agency is doing to support the peer workforce. 

Lorraine Smalls

Ms. Smalls is a Project Officer/Public Health Analyst with the Health Resources & Services 

Administration. She shared that HRSA has programs to help with burnout for clinicians. This has 

included community health workers. Examples include the use of apps; programs to foster 

emotional regulation and distress tolerance; and leveraging data to highlight the concern. 

 

David Awadalla

Mr. Awadalla is a Public Health Advisor with SAMHSA’s Office of Recovery. One of his 

responsibilities has been to develop the National Model Standards for Peer Support Certification. 

This was personally important to him because he is in recovery from SUD and had been 

incarcerated. He was able to receive quality care and peer support. He emphasized that these 

discussions have life-or-death implications.

He went on to explain the process for developing the Model Standards. 

Gina Graham

Dr. Graham is the National Director for Outpatient Services & Psychosocial Rehabilitation with 

the Department of Veterans Affairs. She noted that the VA is the largest employer of peer 

specialists. While most are male, they are intentionally working to expand the pool of female peers. 

In addition to peers, the VA approach is to rely on strength-based programming and use 

interdisciplinary teams. 

The VA offers to cover the certification and training costs as well as for the supervised 

apprenticeship. Peers often supervise other peers. 

Sean Lynch

Dr. Lynch is a program officer with the National Institute on Drug Abuse (NIDA). He shared that 

the Helping to End Addiction Long-Term (HEAL) initiative has a Notice of Special Interest 

Being a peer really should be centered 

around the person you serve. If a person is 

homeless, I don’t check their identity of 

color. I ask them what they need and 

provide it if I can. -Participant 
18

(NOSI) related to research to identify, develop, and/or evaluate strategies that address challenges 

with recruiting, training, and retaining a robust and highly qualified behavioral health workforce. 

He added that NIDA’s Justice Community Opioid Innovation Network (JCOIN) and Consortium 

on Addiction Recovery Science (CoARS) initiatives have components focused on the peer 

workforce. Emerging findings from the Innovations in Recovery through Infrastructure Support 

(IRIS) study that was part of CoARS shows that ongoing efforts are needed to increase peers’ 

compensation, reduce stigma, and facilitate upward mobility, as well as address SDoH. 

He provided several data points that should be tracked to demonstrate peer effectiveness. 

Lindsey Baldwin 

Ms. Baldwin is with the Centers for Medicare and Medicaid Services (CMS). She noted that CMS 

has five new payment codes that offer reimbursement, and they are currently a proposed rule which 

is soliciting public comment.

Discussion

Participants then had an opportunity to provide questions and comments. 

• Inclusion of ASL Services – It was recommended to include reimbursement for ASL 

services to supplement peer services for individuals who are deaf or hard of hearing. 

• Individuals with Disabilities – An individual with a visual impairment echoed that 

Federal agencies need to do more to support the disabilities community beyond just 

providing a 508-compliant website. 

• Federal Jargon – It was noted that there has been a lot of acronyms and terms that are 

unfamiliar to many in the room, and it would be helpful to have a cheat sheet of 

terminologies. 

• Need for Medical Necessity – The medical 

necessity requirement implies a diagnosis, and 

this does not work for peer services. They need 

to get access to the family and address SDoH 

before any diagnosis may be assessed. 

• Model Standards – States were encouraged to 

build reciprocity across States so that peers have 

greater work flexibility. 

Breakout Sessions

Participants were again able to self-select participation in breakout sessions to discuss issues of 

authenticity, financing, and peer to career. These notes are also in Appendix B. 

Peer to Career Panel 

Through a series of guided questions from Dr. Izquierdo, panelists responded to peer career issues 

(e.g., pay scale, retention, career ladders, etc. ) 

Provide an introduction and overview of your work related to peer career needs. 

Peers should be embedded in systems 

rather than integrated. That is, they aren’t 

hired by the system but work for a 

community organization that will provide 

oversight, even when they work in a system

setting.

Robert Ashford
19

Mark Attanasi

Mr. Attanasi has been in recovery for 25 years. He is 

currently the CEO of IC/RC which provides peer 

credentialing exams. He noted that over 10K peers have been 

certified through his organization. He noted that when 

SAMHSA published its model standards, the IC&RC quickly 

adopted the standards. 

The IC&RC has also been focused on expanding the career ladder, particularly the role of peer 

supervisors. 

Mark Jenkins 

Mr. Jenkins is the CEO and Founder of the Connecticut Harm Reduction Alliance. He is a disabled 

veteran in long-term recovery. But he had spent extensive time “in systems” (e.g., psychiatric 

facilities and jails).

He noted that he and others in this room are Harm 

Reduction Ambassadors and often feel like outsiders within 

the peer movement. He added that data has shown their 

impact. He also said that youth speak a different language 

and “abstinence” may not resonate with them.

Kelly Davis

Ms. Davis is Vice President of Peer and Youth Advocacy with Mental Health America. She noted 

that she was five years in recovery before she began practicing abstinence. 

She is a mental health peer who also experienced child sexual trauma. She noted that one aspect 

that peer workers provide which other positions do not is 

the rights of the individual. She voluntarily entered a facility

and they committed her. She wasn’t aware that could 

happen. She also said that systems often emphasized the 

message that “something is wrong with me” which creates 

self-loathing. Peers help protect and educate individuals to 

reduce these harms.

Ms. Davis would like to see more research and advocacy done to support peer work. She also 

expressed concern about systems which are really driven around “illness navigation.” She noted 

that research shows that peers are passionate about their work, and it is not just low pay that is 

problematic. They are misunderstood and treated poorly. 

It is a myth that all peers want to be 

counselors. Many just want to be peers, 

but with a career ladder.

Mark Attanasi

Harm reduction service work is based in 

love and a refusal to be judgmental. 

Mark Jenkins

Those with mental health issues are often 

told they can manage their illness rather 

than they can be in recovery.

Kelly Davis (paraphrase)
20

Regarding self-care, it is often talked about, but it is placed as a responsibility of the individual. 

Rather the systems need to be accountable. Peers can’t engage in self-care when they work in toxic 

environments or are put in situations without boundaries. 

Jose Flores

Mr. Flores spent 13 years incarcerated and currently services as a Recovery Support Specialist 

with Texas Health and Human Services.

He noted that the peer workforce provides a community for each other and a critical mass to 

advocate against the system of injustices. For example, in Texas, the peer community support each 

other in training and finding jobs. Recovery, particularly for those who have been incarcerated can 

be isolating. 

He noted that education can be a barrier as well as a criminal record. He shared that is brother was 

released from Federal prison last year and was enthusiastic about doing peer work, but his offense 

was a barrier. 

 

Bill Stauffer

Mr. Stauffer is the Executive Director of the Pennsylvania Recovery Organization Alliance (PROA). He is in long-term recovery and lost two family members from addiction. 

Mr. Stauffer said that peers are bound by their history. This is 

the asset they bring, but also the pain. He also shared the 

history of the larger peer movement and reminded participants 

that the peer movement was born out of the failings of the 

system to take care of individuals (e.g., the Hughes Act) and 

it was individuals in recovery who fought hard for these 

reforms. 

That power needs to be reclaimed for this current work. But instead, new peers are being taught a 

false less empowering history of the peer movement. 

Discussion

Participants then had an opportunity to provide questions and comments. 

• Not Everyone in Recovery is a Good Peer Worker – Several participants shared that 

some peers are condescending or will try to impose their recovery pathway on a person 

they are serving (e.g., you must go to 12-steps).

• Working in the System – There is value of 

working within systems to impact change. 

• Funding Stays on Top – Government funding 

streams often go from National to State to local 

and then community. Too much of it doesn’t get 

to the community. 

Peers are put into situations where they 

are fighting each other for scraps...We are 

blamed when we aren’t doing well, and 

this is a form of discrimination.

Bill Stauffer (paraphrase)

There are allies within the systems and 

there is value in trying to infiltrate systems 

to provide reform from within.

Amy Brinkley (paraphrase)
21

• Supervision Approach Different for Peers – One participant noted that clinical 

supervision of other roles is about case supervision. 

• Abstinence Requirement – Abstinence gatekeeping can be a barrier. 

• Unionize Peers – It was noted that mental health and SUD services were built on the 

“backs of unpaid labor.” Peers need to be recognized for their value. As an example, 

practicums should be paid positions. 

• RCOs Protection of Peers – It was noted that 

many peers are single moms and don’t have 

time for self-care. Her RCO pays staff for 40 

hours for 32 hours of work. Therapy 

appointments are paid for. 

• Reaching Out to Youth – Many youth aren’t 

even aware that being a peer is a career path. 

The public is also largely unaware of what peer services are. 

• Peer Values – There is a need for the peer workforce to be values-based to prevent coopting of the movement. 

• SAMHSA’s Office of Recovery – Several 

participants noted that the Office of Recovery has 

created space to allow peers to unite forces and have 

conversations, even those discussions that are 

uncomfortable or contentious. 

Final Thoughts: Identify a Priority

As the meeting closed, participants were asked to identify 

one priority that they would like SAMHSA to support. 

• How to coordinate a movement with many individuals to work collectively together? 

• Advocacy with States and partners like the Department of Labor and Justice so everyone 

is on the same page and understands issues like authenticity and protection for peers. 

• That there is a mechanism for different stakeholders in the room to share information, most 

notably those that related to policy. 

• Provide a bridge so that peers can be at the table for CMS discussions. 

• Work to be more inclusive. This is still a predominantly Caucasian movement. 

• The American Psychological Association issued an apology for their role in structural 

racism. This might be something that the Office of Recovery could broker at the Federal 

level. 

• A stronger push for harm reduction. 

• It is true that people in this movement have love for others. It is also true that there is great 

risk of harm within the movement. How do we ensure the safety of the most vulnerable 

populations within this movement and the people we serve. 

• Unlimited access to deaf needs by providing ASL interpreters and other accessibility 

accommodations. 

• Integrate harm reduction principles into mental health approaches (e.g., it is about the 

individual identifying what “the problem” is and what they want us to do about it, while it 

is our job to walk alongside them and support them to live a full life. 

How are peers supposed to practice selfcare when they aren’t given the time and 

space to do that?

Racquel Garcia

Sometimes little things matter. When I’m at 

a meeting at the SAMHSA building and go 

out to smoke a cigarette, I don’t want my 

security liaison to judge me. This is an 

example of harm reduction and reducing 

stigma.

Brandee Izquierdo (paraphrase)
22

• More inclusion, emphasis, and support for family/parent peer support, along with Youth 

Peer Support. Both are needed and should be promoted together. 

 
23

Appendix A – Participants List

Van Asher 

Harm Reduction Consultant 

The Puerto Rico Project 

The Perfectly Flawed Foundation 

 

Robert Ashford 

Executive Director 

Unity Recovery 

 

Mark Attanasi 

Executive Director 

International Certification & Reciprocity 

Consortium 

 

Eric Bailly 

Senior Director 

Third Horizon Strategies 

 

Keri Ballweber 

Harm Reductionist 

Point to Point 

 

Sandi Bishop 

Peer Supervisor 

Horizons Mental Health Association 

 

Katie Boardman 

Director of Recovery Corps 

Ampact 

 

George Braucht 

Chief Mission Officer 

Brauchtworks Consulting 

 

Amy Brinkley 

Recovery Support Systems Coordinator 

National Association of State Mental Health 

Program Directors 

 

Jan Brown 

Executive Director 

SpiritWorks Foundation 

 

Linda Buchheister 

Children's Program Manager and Parent 

Peer Coordinator 

Kansas Department for Aging and Disability 

Services 

 

Cherene Caraco 

Chief Executive Officer 

Promise Resource Network 

 

Sierra Castedo de Martell 

Postdoctoral research fellow 

Chestnut Health Systems 

 

Jamie Chrisman 

Interim Executive Director 

Faces and Voices of Recovery Piedmont 

 

Wayne Cortez 

Peer Support Specialist 

Riverside-San Bernadino County Indian 

Health, California 

 

Sera Davidow 

Director 

Wildflower Alliance 

 

Livia Davis 

Chief Learning Officer 

C4 Innovations 

 

Sharah Davis 

Trainer 

Kansas Department for Aging and Disability 

Services 

 

Kelly Davis 

Vice President of Peer and Youth Advocacy 

Mental Health America 

 

Jessi Davis 

President of the Board of Directors 

National Association of Peer Supporters 
24

 

Johanna Dolan 

Chief Executive Officer 

Dolan Research International 

Steering Committee Member 

Peer Recovery Center of Excellence 

 

Wesley Evans 

Statewide Coordinator Integration and 

Recovery Services 

Florida Department of Children and 

Families 

 

Jennifer Farfalla 

Director, Overdose Surveillance and 

Prevention 

Association of State and Territorial Health 

Officials 

 

Michaela Fissel 

Executive Director 

Advocacy Unlimited, Inc. 

 

Jose Flores 

Program Specialist VII and Recovery 

Support Services Lead 

Texas Targeted Opioid Response 

Texas Health and Human Services 

 

Dana Foglesong 

National Senior Director, Recovery and 

Resiliency Services 

Magellan Health 

 

Lauren Foster 

Behavioral Health Program Manager 

Blue Cross and Blue Shield of Minnesota 

 

Racquel Garcia 

Chief Executive Officer and Executive 

Director 

HardBeauty & HardBeauty Foundation 

 

Courtney Gary-Allen 

Organizing Director 

Maine Recovery Advocacy Project 

 

Brandon George 

Director of Consulting 

Ascension Recovery Services 

 

Kathryn Goetzke 

Chief Hope Officer 

The Shine Hope Company and iFred 

 

Heather Gotham 

Director 

Mental Health Technology Transfer Center 

Network 

Clinical Associate Professor 

Stanford University School of Medicine 

 

Pamela Greenberg 

President & Chief Executive Officer 

Association for Behavioral Health and 

Wellness 

 

Ashley Grimes 

President & Chief Executive Officer 

NAMI Florida 

 

Jesse Heffernan 

Founder & Lead Facilitator 

Helios Recovery Services 

 

Joseph Hogan-Sanchez 

Director of Programs 

Faces & Voices of Recovery 

 

Caren Howard 

Director, Policy and Advocacy 

Mental Health America 

 

Jason Howell 

Executive Director 

RecoveryPeople 

 

John Hulick 

Senior Program Manager 

Palm Beach County Office of Behavioral 

Health & Substance Use Disorders 

 
25

Sarah Hussain 

Director of CARE and PASRR 

Kansas Department for Aging and Disability 

Services 

 

Brandee Izquierdo 

Director of Behavioral Health 

Pew Charitable Trusts 

 

Tom Jackson 

Peer Recovery Programs Manager 

Western State Hospital 

 

Mark Jenkins 

Chief Executive Officer 

Connecticut Harm Reduction Alliance 

 

Laurie Johnson-Wade 

Co-Founder 

Lost Dreams Awaken Center 

 

Jessica Kelley 

Policy Manager 

Association for Behavioral Health and 

Wellness 

 

Darcy Kues 

Project Manager 

Peer Specialist Curriculum Development 

Addiction Research Institute 

South Southwest Mental Health Technology 

Transfer Center 

 

Nanette Larson 

Deputy Director for Wellness and Recovery 

Services 

Illinois Department of Human 

Services/Division of Mental Health 

 

Karran Larson 

Statewide Coordinator SUD and Recovery 

Deaf Hard of Hearing 

Bureau of Substance Abuse Services 

Massachusetts Commission on Deaf and 

Hard of Hearing 

 

Kyneta Lee 

National Director of Peer Training 

Copeland Center for Wellness and 

Recovery 

 

Kris Locus 

TAY Coordinator 

On Our Own Maryland 

 

Cortney Lovell 

Director of Practice Improvement & 

Consulting 

National Council for Mental Wellbeing 

 

Stacey Manser 

Senior Research Scientist 

Texas Institute for Excellence in Mental 

Health 

University of Texas at Austin 

 

Kevin McCarthy 

Board President 

Massachusetts Organization for Addiction 

Recovery 

 

Shayn McDonald 

Youth Program Specialist 

Youth MOVE National 

 

Te Jay McGrath 

Youth Programs Specialist 

Youth MOVE National 

 

Daryl McGraw 

Director 

Formerly, Inc. 

 

Steve Miccio 

Chief Executive Officer 

People USA 

 

Brenda Moes 

DBH Administrator 

State of Nebraska 

 
26

Chandra Monnett 

Recovery Support Specialist and Recovery 

Program Coordinator 

Communities for Recovery 

 

Susie Mullens 

West Virginia Collegiate Recovery Network 

Director 

Marshall University 

 

Keith Murphy 

Director, Alcohol, and other Drug 

Assistance Program at Rutgers-New 

Brunswick 

Rutgers University 

 

Keris Myrick 

Vice President of Partnerships 

Inseparable 

 

Yvette Patricia Pate 

Program Director 

National Association of Peer Supporters 

 

Laura Peters 

Deaf Certified Addiction Recovery Coach 

Niki Inc 

 

Sherrine Peyton 

Statewide Opioid Settlement Administrator 

Illinois Department of Human Services 

 

Joe Powell 

President & Chief Executive Officer 

Association of Persons Affected by 

Addiction 

 

Harvey Rosenthal 

Chief Executive Officer 

New York Association of Psychiatric 

Rehabilitation Services. 

 

Katie Rouse 

Executive Director 

On Our Own of Maryland, Inc. 

 

Kevin Rumley 

Executive Director, North Carolina 

Buncombe County Veterans Treatment 

Court 

 

Amanda Saake 

Chief Advocacy Officer 

New York State Office of Mental Health 

 

Arc Telos Saint Amour 

Executive Director 

Youth MOVE National 

 

Tim Saubers 

Program Coordinator for Workforce 

Development 

Peer Recovery Center of Excellence 

 

Ash Schemenauer 

Recovery Support Peer Specialist (Intern) 

Niki Inc 

 

Athena (Theo) Schwartz 

Transition Age Youth Coordinator 

Utah Department of Health and Human 

Service 

 

Lyndi Seabolt 

Program Coordinator 

Southern Plains Tribal Health Board 

 

Jenna Sheldon 

Consultant 

 

Eric Smart 

CARES Program Assistant 

Georgia Council for Recovery 

 

Sue Smith 

Chief Executive Officer 

Georgia Parent Support Network, Inc. 

 
27

Amy Spagnolo 

Project Director 

Academy of Peer Services 

Faculty 

Rutgers University 

 

Len Statham 

Chief Operating officer 

New York Association of Psychiatric 

Rehabilitation Services 

 

William Stauffer 

Executive Director 

PRO-A 

 

Millie Sweeney 

Director, Learning & Workforce 

Development 

Family-Run Executive Director Leadership 

Association 

 

Karen Taycher 

Executive Director 

Nevada PEP 

 

Morgan Thompson 

Chief Executive Officer 

Prevention Links 

Board Member 

Association of Recovery Schools 

 

Stancil Tootle 

Board President 

Bainbridge Advocacy independence, net 

work 

 

Adam Viera 

Co-Director 

Peer Recovery Center of Excellence 

 

Mike Weaver 

Patient Affairs Coordinator 

South Carolina Department of Mental 

Health 

 

Isha Weerasinghe 

Senior Policy Analyst 

Center for Law and Social Policy 

 

Conni Wells 

NE Regional Director 

Tennessee Voices 

 

Debra Wentz 

President & Chief Executive Officer 

New Jersey Association of Mental Health 

and Addiction Agencies, Inc. 

 

Melanie Whitter 

Deputy Executive Director 

National Association of State Alcohol and 

Drug Abuse Directors, Inc. 

 

Greg Williams 

President 

Third Horizon Strategies 

 

Alexia Wolf 

Executive Director, Behavioral Health 

Consortium 

Office of Lieutenant Governor Bethany 

Hall-Long 

 

Ajahrain Yellowhair 

Youth MOVE National 

 

Federal Staff 

 

David Awadalla 

Public Health Advisor 

Office of Recovery 

Substance Abuse and Mental Health 

Services Administration 

 

Lindsey Baldwin 

Hospital and Ambulatory Payment Group 

Centers for Medicare and Medicaid 

Services 

 
28

Sonia Chessen 

Chief of Staff 

Substance Abuse and Mental Health 

Services Administration 

Paolo del Vecchio 

Director 

Office of Recovery 

Substance Abuse and Mental Health 

Services Administration 

 

Wanda Finch 

Special Expert 

Office of Recovery 

Substance Abuse and Mental Health 

Services Administration 

 

Gina Graham 

National Director 

Outpatient Services & Psychosocial 

Rehabilitation 

Veterans Health Administration 

 

Kristen Harper 

Public Health Advisor 

Office of Recovery 

Substance Abuse and Mental Health 

Services Administration 

 

Miranda Herrera 

Regional Behavioral Health Advisory 

Office of Recovery 

Substance Abuse and Mental Health 

Services Administration 

 

Sean Lynch 

Program Officer 

National Institute on Drug Abuse 

 

Christina Ramsey 

Public Health Analyst 

Health Resources Services Administration 

 

Lorraine Smalls 

Project Officer and Public Health Analyst 

Health Resources and Services 

Administration 
29

Appendix B – Breakout Session Reports

Authenticity

How do you define peer identity?

• Definitions include relationship, mutuality, connection, and social justice. 

• Adhere to a set of values. 

• Liberation and freedom. 

• Starts with recognition of oppression. 

• When we become part of the system of oppression, we lose authenticity. 

• Critical thinking lens. 

• Cultural congruence. 

• Intentional outreach to communities. 

• Intersectionality...including with individuals who have different abilities and more 

visible or stigmatized disabilities and marginalized identities

Discuss issues of integration within clinical systems

• Integration goes wrong more than it goes right. 

• Social justice is at the core. 

• Flip the script. Rather than peers invited into clinical environments. Clinicians should be 

invited into peer environments. 

• Being co-opted. 

Other Comments

• Understanding what ‘need’ means with nuances and terms. 

• Reciprocity needs to also include tribes. 

• Alternatives Conference no longer sponsored by SAMHSA. 

• Need more ways to get together on a national level to strategize and advocate. 

• Specialty peer support (e.g., harm reduction, post-partum). 

• Native Americans don’t have a certification training. 

Financing 

• Need to pay for ASL interpreter services.

• Infrastructure considerations.

• Fee-for-service methodology is a mismatch because of potential exclusions related to the 

requirement for “medically necessary” services.

• Lack of flexibility with funding restrictions.

• There needs to be accountability for outcomes, including funding.

• It helps to have civic/leadership support.

• Advocacy

• Leverage opioid settlement funds. (nationalopioidsettlement.com)
30

• Challenges with philanthropy reporting requirements – The Association of Foundations 

came together to minimize the requirements.

• Getting specific about reporting requirements.

• TA to get grants/requirements.

• Braided funding and strategies to diversify.

• Getting at the CMS table early so we can make sure it works for us.

• Infrastructure funding pathway.

• Rural RCO support (Indiana, Maine, New Hampshire).

• Independent practice associations.

• Underinsured communities. 

Peer to Career

• Peer is not an identity. It is a relationship.

• Career ladder means upward mobility.

• Everyone needs economic stability.

• System approves workforce expansion. A systematic reaction rather than creative 

approach.

• Do I lose my “peerness” when I’m not doing direct services? We need more “peerness” 

inside the system. But how do we create this when we have a system that doesn’t want us 

to exist?

• Break down barriers to create the careers that people want. 

• There is a difference between the peer movement and the peer workforce.

• Peer pathways versus careers.

• Unpack the internalized stigma in our own movement.

• Mutuality versus power over.

• Career means a process of opportunity.

• Explore “the weight” we’ve put on the workforce. Data show that certification is not 

moving us professionally. 

• If certification doesn’t improve our art & skill, is there another option? 

• Everyone doesn’t need to be certified.

• There are discriminatory policies re: certification. Private groups benefitting. Lack of 

DEI (e.g., LBGT training).

• Certification is valuable and empowers peer specialists. 

• How can we be a peer and clinician or case manager?

• Direct services - level of scale requires a level of bureaucracy. The demand is bigger than 

our advocacy to dismantle. 

• Scaling issues and pathways.

• What are we protecting the public from?

Peer to Career (Virtual)

Major Themes: Honor individual/individuality if lived experiences/unite on fundamental beliefs, 

treating people with acceptance. Empathy. The work we do and the way we do it is the 

distinction from other parts of the system, focus on our foundations in social justice, creating 
31

healing environments, being our true selves and ongoing learners who evolve from and with 

people we help, partnership leverages an independence of function/operations based on values – 

the interdependence for partnership with other providers makes hem need to listen. Tradeoff is 

non-integrated cannot influence other parts of the system as much which impact success on the 

piece they have)

What does peer to career mean to you? 

• Training and community. Feeling the spirit of the peer community and the movement 

while attending the peer trainings is empowering. 

• The career is also part of a wellness journey and pathway to recovery, a significant 

support was finding organizations that have peer support and having allies and 

mentors throughout the way. 

• Meeting other people who believe in this profession and support those with lived 

experience to help them practice and grow. 

• As peer sharing experience in all the various spaces including state entities and 

funders is empowering for a career. 

• Trying to go back to basics for peer support and on how integrate peer services into 

clinical work while maintaining authenticity. 

• Being in the room with this community with similar experiences ignites the fire of 

passion for this field. 

• Stigma/ discrimination is a barrier to stay within this profession and to grow. How do 

we decrease the discrimination and education bias for the role of a peer to allow them 

to grow and make this into a career because peers are leaving this field for better pay 

and better work environment where they do not have to continue to advocate and 

fight to prove their value within their agency. 

• The education bias halts any career advancements and better pay. 

• Being able to make a living wage is the beginning of the process of peer to career. 

What are the various components or priority areas that we should discuss in developing peer 

support specialist and recovery coaching career goals? 

• Decreasing the stigma/discrimination within the profession. 

• Fair pay. 

• Peer support- distinguishing the difference between identities/experiences and the 

actual support workforce. The support part of the workforce requires a connection 

and disclosure to create connection. Support as a valuable service while the word peer 

is a noun that refers to people identity or experiences so how they use their 

experience to provide support is an important aspect of the work. 

• Referring to the Document “maintaining our roots”- peer support grew on its own and 

grew beyond the capacity of the volunteer initiative which increased the demand for 

the paid services. Specializing and certification in peer support is essential for the 

advancement and value of the profession. 
32

• It’s about facilitating peer support to those we serve and not only being a peer. 

Acknowledge its value in society and embedding mechanisms throughout the system 

that values and recognize the need for peer support. 

• There’s no mandate for peer operated agencies and it’s the best environment for 

authentic peer support as compared to Medicaid mandates for peer services. 

• Leadership/supervisory roles- the mechanism for the experience in providing 

supervision, that includes experience in providing peer support and not based on a 

clinical background. Peer operating agencies should play a role in developing that 

mechanism. 

• Developing clear job descriptions that are created by those who do the work and not 

clinicians who believe they know what peers are supported to do. 

• The challenge is on the system level and the clinical/medical oversight for this field 

and their values are the ones that are predominant and that determines where the 

funding goes. Part of the challenge as peers is to be able to demonstrate our values 

and worth to the clinical roles. 

• It’s about helping peers learn how to function in multidisciplinary teams and to keep 

their authentic work and it can be a lonely space if they’re the only peer on the team. 

That’s the element of training that gets overlooked. Teaching peers how to advocate 

for their worth and their role in front of other professionals. Having a support system 

that offers a safe space to have these conversations and the needs of this profession. 

There’s a notion that peer support is a non-clinical enhancement to the clinical 

services, but it needs to be looked at that we are as valuable as clinical services to get 

respect to elevate our positions. 

• There is more research demonstrating the effectiveness of peer support than there is 

on another professional helping role. We need to work harder to educate more people 

on this research because most other professionals do not know about the evidence for 

our efficacy. It has also been shown in other professions like HIV peers and criminal 

justice peers, the peers need to continue to educate themselves to help advocate for 

their role.