Strengthen Peer Recovery Support Services and Programs

 

Introductory Paragraph

Peer Recovery Support Services and Programs are designed to provide social support via peers throughout the recovery process.  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 as they are designed and delivered by peers who have been successful in the recovery process.  As a peer they hold a vast amount of personal experience and knowledge, often referred to as “lived experience” and support a peer along the recovery path with a true understanding of the journey via shared life experiences. 
Peer Recovery Support Specialists also provide lived experience for mental health and oftentimes peers offer lived experience with co-occurring disorders. 

 

Key Information

The Substance Abuse and Mental Health Services Administration (SAMHSA) has published a 2009 guidebook on "What are Peer Recovery Services?"   The guidebook is all encompassing of Recovery Care Support Program projects and 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."   

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 models and have been found useful with assisting with community-based peer-to-peer services.

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

Peer support may also be referred to as coaching, peer leaders, or peer mentoring. 

Recovery Care Peer Support Programs have been adapted to meet Individuals at their current stage in the recovery process and work to provide support In the different stages of change and growth though the recovery process. 

Where Do Peers Work
Peers are utilized in many settings and across many populations including treatment programs, Department of Health and Social Services, Veteran's Affairs, Youth & Family Centers, Recovery Centers, emergency departments, jails and prison systems and child welfare systems.  Peers provide hope and Inspire change by walking together with an Individual on their recovery path and providing practical and emotional support.  

Peers often work alongside others on the team, be they clinical or programmatic and in the ideal, have well defined roles. One of the challenges to the future of peer work and which when resolved will enhance their efficacy is ensuring that in each workplace, that their roles and scope of work are well defined. Peers are sometimes embedded in a non-recovery-oriented environment and it is critical for them to have adequate support and an understanding from those with any oversight capacity regarding their roles.  Whether working in a peer-run recovery organization or Recovery Community Organization (PRO/RCO) and delivering services in a Recovery and Wellness Center or contracted out to a Drug Court by employer's peers face a myriad of hiring options, supervisory and operational standards.  

To date, there has been a set of Peer Core Competencies Identified by SAMSHA to help guide service delivery of peer support programs and best practices for service delivery, which was developed by a diverse swath of national experts and peer constituencies.  The values and principles encompass recovery oriented, person-centered, voluntary, relationship focused and trauma Informed.  Additionally, there are several Identified categories for core competencies in peer support for Recovery Care Support Programs to provide guidance and promote success for behavioral health peer support. 

Certification Process for Peers

There is a growing demand for peers in many work settings.  Certification and training to become a certified peer specialist may vary by State or Agency.  Mental Health America provides a National Certified Peer Specialist career roadmap as well as certification requirements by State.
 

 

Relevant Research

Ongoing research has shown the value of peers In the recovery process. The Substance Abuse and Mental Health Services Association provided evidence research for the effectiveness of peer support programs.  

Impactful Federal, State, and Local Policies

Peer and recovery specialist programs can be financed through a variety of funding streams and policies. 

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.   State SABG funds are increasingly being used to hire peers through County Health Departments. 

Substance Abuse Prevention and Treatment Block Grants (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. The State SABG funds are increasingly being used to hire peers through County Health Departments (who receive State funding) and other entities (e.g. SUD treatment programs) who contract with the State Single State Agency (SSA).   

Child Welfare and Recovery Support Specialist programs have utilized Federal funding under Title IV-E Foster Care and Adoption Assistance Program, waivers that 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 through September 2019. 

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 funding. 

Additionally, States are increasingly including peer support funding via State based Medicaid Programs. In 2007 CMS put forth guidelines and requirements for Medicaid Funding for Recovery Peer Support Programs. The guidance and requirements included the following:

1. 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. 

2. Peer providers must complete a training and certification program as defined by the state.

3. Peer providers must receive supervision from a “competent mental health professional.” Such supervision may be provided through direct oversight or periodic care consultation.

4. 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. 

 

 

Available Tools and Resources

• The City of Philadelphia– produced an interactive toolkit to support behavioral health treatment agencies with the process of integrating peer providers into their service settings.
• The New York State Office of Alcoholism and Substance Abuse Services– New York State Peer Integration Toolkit to assist integrating peer services into service delivery system.
• The College for Behavioral Health Leadership– Provided In collaboration with Optum Health provides a peer support toolkit Including peer support job definitions.
• The Veterans Health Administration– Provided from Executive order to employ 800 peer support specialists with the VA. Includes toolkit for VA Peer Support Specialists.
• The Unity Recovery Organizationof Philadelphia – a technology based program that Includes a tele-recovery guide for peer support.
• The Southern Plains Tribal Health BoardA toolkit to assist tribal programs in determining how peer specialists can best serve their tribal organizations and communities.

Promising Practices

Recovery Live on Youtube Includes a virtual event for strategies to provide supervision of Peer Support Recovery Specialists

Supervision of Peer Workers Toolkit-A technical guide to bringing peer support programs to practice

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. 

Operationalizing and Funding for Youth Based Peer Support Programs- Includes an overview of providing youth base services via State based Medicaid.