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. 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 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 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 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 in the recoveree 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) and whether they are delivering services in a recovery and wellness center or are 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

Ongoing research has shown the value of peers in the recovery process. A summary of this research on the effectiveness of peer support programs is provided by SAMHSA.

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, the Center for Medicare & Medicaid Services put forth guidelines and requirements for Medicaid Funding for Recovery Peer Support Programs. The guidance and requirements included 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.

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 provides the New York State Peer Integration Toolkit to assist integrating peer services into service delivery system.

• The College for Behavioral Health Leadership in collaboration with Optum Health provides a peer support toolkit that includes 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 Organization of Philadelphia – a technology based program that Includes a tele-recovery guide for peer support.

• 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.

• 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.

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.