PEER SUPPORT SERVICES March 2022 

Background 

In a 2007 letter to State Medicaid Directors, the Centers for 

Medicare and Medicaid Services (CMS) defined peer support 

services as “an evidence-based mental health model of care 

which consists of a qualified peer support provider who assists 

individuals with their recovery from mental illness and 

substance use disorders.” The letter announced that these 

services could be reimbursed through state Medicaid Plans, 

subject to a set of minimum requirements including training, 

credentialing, and supervision for peer specialists and 

incorporation of these services within a “comprehensive, 

individualized plan of care that includes specific 

individualized goals.” The structure and specific details of 

these training, credentialing, and coordination mechanisms 

were to be determined by each state. The peer workforce has, 

since then, continually increased in size and developed a 

comprehensive set of core competencies and ethical standards. 

Most states have their own certification programs, practice 

profiles, core competencies, and ethics for their peer 

workforce. 

Peer support as a service model was developed in tandem with 

the recovery movements. Based on the notion that people with 

shared experiences have a unique capacity to help each other, 

the model has become an integral component of mental health 

and substance use disorder recovery programs. Although 

initially developed as a recovery support model, peer support 

currently plays a crucial role throughout the care continuum in 

many behavioral health systems. Peer support models have 

also been adapted to areas of health care such as diabetes and 

other chronic conditions. 

Basic Principles 

Support services provided by peer specialists can take many 

forms depending on the cultural context and health condition. 

However, they have several features in common. They are all 

structured around a non-hierarchical and reciprocal 

relationship between a service recipient and a qualified 

support provider who has lived experience of the health 

condition. The model is non-clinical by design. In contrast to 

most clinical models where providers and service users often 

come from different backgrounds and have differing 

worldviews, peer support fosters a deep understanding and 

mutual trust. Peer supporters provide help in the daily 

management of the health condition, the treatment/recovery 

process, and their social and emotional impacts on daily life. 

Another important function of the model is to help with 

linkages to community resources. In fact, knowledge of 

available resources and supports in the community is one of 

the required core competencies for peer specialists. Finally, 

peer support relationships typically continue over extended 

periods, keeping people engaged with treatment, recovery, and 

wellness promotion. These features make the model a valuable 

supplement to clinical and case management services. 

Self-directed, person-centered, and trauma-informed service 

provision are key values of peer support; therefore, the model 

integrates well with other evidence-based interventions 

governed by similar principles, such as WRAP, ASIST, and 

Healthy IDEAS. 

Is it a Good Fit for My Agency? 

Peer support models have been adapted to integrated health 

and community settings and have been implemented by 

Centers for Independent Living. They have been used 

successfully with a broad range of populations including older 

adults, people who are homeless or at risk of losing their 

home, people with co-occurring physical health conditions, 

and high users of emergency services. The model is best suited 

to organizations with a recovery-oriented mission, clearly 

defined peer roles, and the capacity to provide reasonable 

accommodations for staff with disabilities or behavioral health 

conditions. To deliver peer support services with fidelity, 

organizations must have behavioral health professionals who 

meet the minimum supervision requirements for peer 

specialists, either on staff or through a partnering organization. 
 

 

 

 

 

 

 

 

 

 

Implementing and Financing Peer Support Services 

Incorporating Peer Specialists into the 

Agency 

Training and credentialing requirements for peer specialists 

and reimbursement policies for their services vary from state 

to state. Copeland Center’s Peer Specialist Database provides 

comprehensive information about each state’s policies 

regulating the peer workforce, along with information on 

training resources and costs. This information should be of 

help to organizations that already employ people with living or 

lived experience and have interest in providing peer specialist 

training and credentialing. Researchers have identified some 

organizational best practices for incorporating a peer 

workforce. These include, but are not limited to 

 Trainings and group discussions to familiarize all staff 

members with the peer support approach, including the 

value of person-centered service provision 

 Clearly defined organizational roles for peer specialists 

and associated recruitment and other HR practices 

tailored to their specific needs and strengths 

 A mechanism for supervising peer specialists, with 

supervision provided by a qualified practitioner with deep 

understanding of peer services 

In many agencies, adopting these organizational best practices 

garners whole-organization culture change that favors 

recovery-oriented and trauma-informed services, open 

communication among staff members, transparency in 

organizational policies and practices, inclusiveness, and 

workforce diversity. 

Potential Funding Sources 

Peer support services, especially in behavioral health, are now 

covered by Medicaid in many states. However, many 

organizations braid funds from multiple sources to ensure the 

sustainability of their peer-delivered services. Some potential 

funding sources are federal block grants, discretionary grants 

such as the Treatment, Recovery, and Workforce Support 

Grant and the Building Communities of Recovery Program, 

state appropriations, and foundation grants. In some states, 

peer support services have received funding from the 

Temporary Assistance for Needy Families Program. 

A recent report on Enhancing Community Recovery Capital in 

America provides useful information for community-based 

organizations on financing recovery support models (including 

peer supports), and case studies of innovative approaches. 

Benefits of Peer Support Services 

There are numerous evaluation studies demonstrating the 

positive impact of peer support services on a range of health 

and wellness measures. The following are a sample of 

research results: 

Evaluation of a 10-week mental health peer support 

intervention for older adults found a 30% decrease in average 

Geriatric Depression Scale scores and a 17% increase in health 

and functioning as measured by Quality-of-Life Index. 

An outcome study of a peer-run care transition program found 

that the average number of admissions per person decreased 

from 0.58 during the six months prior to program start to 0.27 

during the six months after program start. Average inpatient 

days per patient decreased from 12.2 to 3.1 during the same 

period. 

A three-month pilot study of an intervention to improve selfmanagement among older adults with mental illness and 

comorbid medical conditions delivered by certified peer 

specialists found a 55% increase in average scores on the 

Illness Management and Recovery Scale. 

Expected Impact on Healthcare Costs 

A Blue Cross Blue Shield review of a peer recovery program 

for people with substance use disorders in Rhode Island found 

improvements in treatment adherence and a 12% decrease in 

pharmacy costs. The study projected a 67% decrease in longterm healthcare costs for program participants. 

A 2016 Optum report on the value of peer support for its 

health plans found that peer support programs offered to plan 

members transitioning from a hospital to the community in 

New York resulted in a 62.7% decrease in the number of 

inpatient days per person and a 47.1% decrease in overall 

behavioral health costs per person (from $9,999 to $5,292). 

How to Learn More 

SAMHSA’s web page on Recovery Support Tools and 

Resources provides useful links to training resources and 

FAQs about peer workers. The SAMHSA-funded Peer 

Recovery Center of Excellence offers valuable training and 

technical assistance resources. The National Association of 

Peer Supporters offers a comprehensive Resource Library. 

The Gillings School of Global Health at the University of 

North Carolina, through its Peers for Progress project, 

published a Program Development Guide for organizations for 

planning, implementing, and evaluating peer support services. 

The guide is a working document updated periodically.