Strengthen Peer Recovery Support Services and Programs

 

Introductory Paragraph

Peer recovery support services and programs are designed to provide social support throughout the recovery process. These services are provided by those who have experienced substance use disorder and recovery themselves. There has been proven success in peer support and recovery programs, primarily because these services are designed and delivered by peers who have been successful in the recovery process. A peer holds a vast amount of personal experience and knowledge, often referred to as “lived experience.” They are equipped to support their peers along the recovery path with a true understanding of the journey via shared life experiences. Peer Recovery Support Specialists also provide lived experience with mental health and with co-occurring disorders.

Key Information

The Substance Abuse and Mental Health Services Administration (SAMHSA) published a guidebook titled "What are Peer Recovery Services?" The guidebook is an all-encompassing coverage of recovery programs. It defines the use of the term peer "to refer to all individuals who share the experiences of addiction and recovery, either directly or as family members or significant others. In a peer-helping-peer service alliance, a peer leader in stable recovery provides social support." Peers provide hope and inspire change by walking together with an individual on their recovery path and providing practical and emotional support. There are four types of social support that peers bring to their work: emotional, informational, instrumental, and affiliational support. These are types of support vs. delivery service models and have been found useful with assisting with community-based peer-to-peer services:

• Emotional - Demonstrate empathy, caring, or concern to bolster person’s self-esteem and confidence. This Includes peer-led support groups and peer mentoring.
• Informational - Share knowledge and information and/or provide life or vocational skills training. This includes parenting classes, job preparedness, and wellness seminars.
• Instrumental - Provide concrete assistance to help others accomplish tasks. This includes transportation, childcare, and assistance with accessing community health and social services. Social support peers are often referred to as “walking resources." It is a peer's ethical responsibility to become familiar with and educated about resources offered in their community and to provide linkage to those resources. Peer support is a person-centered, mentoring approach rather than "doing for" the recoveree. The peer builds self-efficacy within the recoveree so as to maintain their recovery.
• Affiliational - Facilitate contacts with other people to promote learning of social and recreational skills, create community, and acquire a sense of belonging. This includes opportunities within the community and participation in sports and in alcohol and drug-free social events.

Peer support may also be referred to as coaching, peer leadership, or peer mentoring. Delivery of peer support adapts to meet individuals at their current stage in the recovery process. It works throughout all of the different stages of change in the recovery process. Peers work in many settings, such as health departments, social services, child welfare systems, veteran services, youth & family centers, treatment programs, recovery centers, emergency departments, and jails and prison systems. Peers often work on a clinical or programmatic team and, in ideal settings, have well-defined roles. However, one of the challenges to the efficacy of this field is to enhance workplace definition of roles and scope of work of Peer Support Specialists. This is especially true when peers work in a non-recovery-oriented environment. It is critical for them to have adequate support and an understanding from their supervisors regarding their roles. Whether working in a peer-run recovery organization (PRO) or recovery community organization (RCO) or delivering services in a recovery and wellness center or contracting with a drug court, peers face a myriad of hiring options, operational standards, and supervisory concerns. SAMSHA has developed a set of peer core competencies to help guide service delivery of peer support programs and best practices for service delivery. These core competencies were developed by a diverse swath of national experts and peer constituencies. The values and principles are recovery-oriented, person-centered, relationship-focused, and trauma-informed. Guidance is also directed to promote success for behavioral health peer support.

Relevant Research

• SAMHSA:
  • A summary of research on the effectiveness of peer support programs.
  • "Peer Recovery." This infographic summarizes findings from ten articles on peers.

• "Distinguishing Between Recovery Coach and Peer Support Specialists." This book provide an overview of the range of professionals involved in provision of recovery services, and it provides an introduction to the work of six foundational thinkers in recovery.

• "Peer Support and RCOs." This article provides an extensive compilation of research that has been done on harm reduction and the role of RCOs in underserved communities.

• A systematic review of nine different studies that examined peer-delivered recovery support services.

• This article gives alternatives to 12-step programs.

Impactful Federal, State, and Local Policies

• The Substance Abuse Prevention and Treatment Block Grant (SABG) provides funds and technical assistance to all 50 states, the District of Columbia, Puerto Rico, the U.S. Virgin Islands, 6 Pacific jurisdictions, and 1 tribal entity. Grantees use the funds to plan, implement, and evaluate activities that prevent and treat substance abuse and promote public health. SABG funds are increasingly being used to hire peers through county health departments (who receive state funding). Likewise, other entities, such as SUD treatment programs contract with the single state agency (SSA) that manages the block grant.

• Child Welfare and Recovery Support Specialist programs have utilized federal funding under Title IV-E Foster Care and Adoption Assistance Program. Waivers were implemented by the Administration for Children and Families (ACF), which allowed states to use funds more flexibly to test innovative approaches for child welfare service delivery and financing. Other examples of on-going federal funding which were used by these programs include ACF’s Regional Partnership Grants, Temporary Assistance for Needy Families (TANF) and Office of Justice Programs’ Victims of Crime Act.

• The Center for Medicare & Medicaid Services has guidelines and requirements for Medicaid funding for Recovery Peer Support Programs. The guidance and requirements include the following:
  • States must identify the Medicaid authority to be used for coverage and payment, as well as describe the service, the provider of the service and their qualifications, and all applicable utilization review and reimbursement methodologies.
  • Peer providers must complete a training and certification program as defined by the state.
  • Peer providers must receive supervision from a “competent mental health professional.” Such supervision may be provided through direct oversight or periodic care consultation.
  • Reimbursement must be based on an identified unit of service and be provided by a single peer provider, based on an approved plan of care.

• Peer and recovery specialist programs can be financed through a variety of policy-based funding streams. Communities may use existing state and county funds via state Departments of Alcohol and Drug Programs, Mental Health Services, Child Welfare Services, and County Boards of Supervisors’ funds.

Available Tools and Resources

• SAMHSA National Model Standards for Peer Support Certification

• SAFE Project:
  • Integrated-Forensic Peer Recovery Specialist (I-FPRS) Training. This SAFE Project program is a comprehensive set of curriculums designed for Peer Recovery Specialists, organizations, and groups working with justice-involved individuals who experience substance use disorders. This training equips participants to navigate the intersection of behavioral health and the criminal justice system.
  • See the wiki titled "Improve Access to Recovery Coaches for Parents of Newborns" for more detailed information on the effectiveness of the lived experience and training of a recovery coach to provide comprehensive SUD treatment for new mothers.

• The Veterans Health Administration generated a toolkit for VA Peer Support Specialists, in responses to an executive order to employ 800 peer support specialists.

• National Center of Substance Abuse and Child Welfare provides resources and information for peer support and recovery within the child welfare systems including program models and funding resources.

• Mental Health America provides a certification career roadmap. They also offer an online directory of training and certification requirements.

• The Southern Plains Tribal Health Board provides a toolkit to assist tribal programs in determining how peer specialists can best serve their tribal organizations and communities.

• The New York State Office of Alcoholism and Substance Abuse Services provides the New York State Peer Integration Toolkit to assist the integration of peer services into the service delivery system.

• The City of Philadelphia has an interactive toolkit to support behavioral health treatment agencies with the process of integrating peer providers into their service settings.

• 'The Unity Recovery Organization of Philadelphia provides a technology-based program that includes a tele-recovery guide for peer support.

• The College for Behavioral Health Leadership in collaboration with Optum Health provides a peer support toolkit that includes peer support job definitions.

• Recovery Live is on Youtube and includes a variety of virtual events, including this one on strategies to provide supervision of Peer Support Recovery Specialists.

• SMI Advisor offers "Building New Horizons: Opening Career Pathways" for peers with criminal justice backgrounds.

• Youth Move National published a report titled "Operationalizing and Funding for Youth-Based Peer Support Programs." It includes an overview on the delivery of youth-based services via state-based Medicaid.

Promising Practices

This report highlights four programs that have demonstrated positive child welfare and recovery outcomes for families.