Some Considerations around Peer Support as TIEMH Releases New State Compendium

NYAPRS Note: The Texas Institute for Excellence in Mental Health has released a 2016 compendium of state mental health Peer Specialist Training and Certification programs. The report presents an overview of each state's program characteristics as well as Medicaid reimbursement for peer support services in each state.

While it’s clear that peer services are now playing critical roles across our nation, a critical concern lies in the fidelity of those services in terms of role, job descriptions and supervision to the principles of “true” peer support as referenced in Shery Mead’s seminar work on Intentional Peer Support (

While one of the recommendations to states includes “assess the fidelity of peer practice to the training,” there’s no true fidelity if we have myriad training programs that say very different things.

I recall hearing a managed care representatives once describe peer services as “cheap staff who get people to take their medicine.” Not only must peer services be properly compensated for the great skills they bring, they should definitely not be reduced to and incorporated by our systems as a means to simply convince people to see their doctors and take their pills and to take them to follow up appointments.

At minimum, peer support is all about the relationship that starts where people are both in their lives and goals and as where they live, both literally and culturally. That’s the magic…letting these relationships build naturally on the sense of hope, empathy, example and support that’s unique to peer support.

That will mean that states and payers will have to be willing to give the development of that relationship enough time to make that unique connection and to properly reimburse for those ‘outreach and engagement’ efforts, because what happens at the start will almost always dictate what happens months to years from then.

Asking people what matters most, especially during times of crisis which often drive ‘referrals, is what will start that magic off strongly. Maneuvering folks immediately to treatment and medication compliance without the development of that genuine relationship will fail or will not last in many to most instances.

Reducing peer support to the aims of states, payers and providers who are more concerned about meeting HEDIS measures (did folks see their doctor in 7 days and take their medicine within 30) will fully compromise what will be truly meaningful ‘outreach’, ‘engagement’, ‘activation’ and retention.

Medicalizing or misusing peer support and peer supporters will not only render them ineffective, it’ll take the heart out of what’s best about the ‘magic’ of peer support.

Perhaps the best protection against this to go beyond the more generic term ‘peer specialist,’ which frankly can allow anybody to do almost anything under that banner. Perhaps we should develop terms that best define the unique roles and qualifications of this workforce, titles like peer bridgers, peer crisis respite workers, peer warm line operators, peer recovery center or emergency room workers or peer wellness coach.

Peer Specialist Training and Certification Programs:

A National Overview

Texas Institute for Excellence in Mental Health School of Social Work

University of Texas at Austin

The certified peer specialist workforce is relatively new in the behavioral health field, with state recognized certification programs first emerging in 2001. Within this short timeframe, states have recognized the potential of peer specialists to improve individual outcomes by promoting recovery. A nearly universal definition of a peer specialist is: an individual with lived experience who has initiated his/her own recovery journey and assists others who are in earlier stages of the recovery process. As of July 2016, 41 states and the District of Columbia have established programs to train and certify peer specialists and 2 states are in the process of developing and/or implementing a program. A review of the components of these state peer specialist training and certification (PSTC) programs is needed so that states developing training/certification programs may look to those that are more established for advice and guidance, while established programs may benefit from understanding the similarities and differences between existing programs.

This information may also be useful to policymakers and program developers as they create the infrastructure necessary to support the peer specialist workforce to remain relevant and financially sustainable in a changing healthcare environment.

Providers employing, or considering employing, peer specialists may also find the information useful in developing appropriate guidelines and expectations for these employees. Peer specialists themselves, or those interested in becoming peer specialists, should also find the report useful in determining requirements necessary to become certified and the competencies of their peers in the field. The information presented in this report is a compilation of information about existing PSTC programs in the United States, which primarily train and certify mental health-focused peer specialists.

Information about the training and certification processes for each state are reported in a common tabular format, which allows the user to compare and contrast between programs….

Recommendations for State Programs

The authors have also included the following recommendations for states to consider in an attempt to enhance and further advance training and certification programming for peer specialist programs across the nation.

1. Designate a webpage which provides basic information on the training and certification program, as well as a contact person(s) who can be reached to answer questions. The page should be searchable through the state’s sponsoring agency and through search engines (e.g., Google).

2. Include FAQs on the webpage related to the program, types of employment venues in which certified peers work, and types of funding used to reimburse peers for their services (including Medicaid).

3. Any non-proprietary documents related to the program (including application for training, training manual, etc.) should be linked through the webpage.

4. Review information contained in or linked in this report regarding other states’ programs and consider adopting any best practices that could improve your program.

5. Solicit feedback on your training and certification process from people who have attended as well as from people who have applied but were not accepted. Rather than a simple satisfaction survey, find out what stakeholder’s consider the program’s specific strengths or challenges.

6. Assess the fidelity of peer practice to the training and build the evidence for both the training and the competency of peers.

7. Use recovery-oriented language and principles throughout all information and procedures regarding the program and the training and certification process.

8. Provide recovery-oriented implementation initiatives to support peer specialist integration into the workforce.