Peer Support Issue Brief

The health care environment is undergoing significant transformation driven by a combination of coverage and reimbursement changes, workforce shortages, technological advancements and changing patient needs and demands. Hospitals and health systems are enhancing the way they deliver care to improve patient care and outcomes, prepare for the future and strengthen sustainability. One key driver to transforming care is expanding the non-clinical workforce to improve patient experience and outcomes and reduce clinical staff burnout. Peer Support Specialists (PSS) can play an impactful role in helping hospitals and health systems achieve these goals. PSS are people with lived experience, living in recovery from psychiatric and/or substance use disorders, who provide non-clinical, strengths-based support to others seeking individualized recovery guidance.

This issue brief will:

• Explain how PSS provide value to hospitals and health systems.
• Describe and provide resources on the role and responsibilities of PSS.
• Provide knowledge of the current certification and training programs for PSS.
• Offer prevention initiatives to support the PSS in their life in recovery.
• Suggest considerations for hiring a PSS.

Value of PSS

Several studies have shown that patients receiving peer support services experienced fewer emergency and acute care visits.¹ One study reported an average reduction of 43% in inpatient services and a 30% increase in outpatient visits; another found a 56% reduction in readmission rates and a lower overall cost of care.² A study from New York found that use of PSS reduced the total cost of care by an average of $2,238 per Medicaid-enrolled month, while another from Colorado showed an ROI of $2.28 for every dollar spent.^3,4 According to Mental Health America, peer support has been shown to “improve quality of life, improve engagement and satisfaction with services and supports, improve whole health, including chronic conditions like diabetes, decrease hospitalizations and inpatient stays, and reduce the overall cost of services.” Patients who engage with a PSS often decrease their use of inpatient services, increase the use of outpatient services, increase and improve engagement with treatment and improve whole health and self-management.⁵

According to a 2023 report from The Substance Abuse and Mental Health Services Administration (SAMHSA), nearly all state Medicaid plans reimburse for peer support services billed in 15-minute intervals.⁶ Many commercial plans, including some from Aetna, Cigna and BC/BS MN, have started to offer coverage of PSS. To provide peer support services to patients who do not have Medicaid, hospitals and health systems can explore alternative payment mechanisms, such as private insurance; federal, state and local grant funding; or public-private partnerships.

The Role of PSS

The role of the PSS does not duplicate clinical efforts but rather builds rapport and trust with patients by providing a sense of connection and firsthand insights. In one study, the PSS’s role was to build a connection with patients in the ED; develop crisis plans with patients; support patients during their hospital stay if admitted to inpatient service; educate them on harm reduction; and link them with community-based resources after discharge.¹² PSS can contribute uniquely to the coordination of physical health and mental health services for individuals with serious mental illness and can improve complex health behaviors in disease prevention and management including in diabetes.^13,14 One meta-analysis reported an average reduction of 0.76 points in HbA1c data while other studies have shown that patients working with a PSS reduced their substance use and infection risk for HIV and hepatitis C.¹⁵ A common finding across these studies is that patients who engage with a PSS are more likely to sustain their recovery, actively engage in treatment for their physical and behavioral health disorders, and improve their whole health.

In 2019, the National Association of Peer Supporters created the National Practice Guidelines for Peer Specialists and Supervisors to help supervisors of PSS understand how the PSS role can best fit into their care team. SAMHSA also created a list of core competencies for PSS to serve as a foundation for organizations to build upon. PSS requirements vary across the country, so it is important to learn your state’s regulations to ensure you are hiring a PSS with appropriate certification as well as the skills necessary for the position, such as strong communication (especially active listening), empathy and interpersonal skills to build rapport.

Involving non-peer support specialist staff (e.g., medical or administrative personnel) in defining the role and writing the job description helps foster buy-in from both internal stakeholders and potential employees by establishing clear expectations, aligning individual roles with organizational goals and providing a foundation for ongoing performance management.¹⁶ Holding information sessions, workshops or town hall events to introduce the recovery support services that the PSS provide can reduce the stigma people may hold towards those who experience behavioral health conditions.¹⁷ As living examples of recovery, peer support staff can attest to the utility and effectiveness of treatment, rehabilitation and support. Such sessions also provide the opportunity for PSS to clarify what their role is (and is not), reinforcing that their position is complementary, not competitive.

Certification and Training for Peer Support Specialists

Lived experience in recovery from psychiatric or substance use disorders, or both, is the key tool employed by PSS to perform their job across a variety of service settings. Specialists use their experience to provide guidance, hope and support to individuals currently in treatment for similar disorders. Certification establishes standardized training and competencies so that all specialists have a common foundation in ethics, recovery principles and communication skills.

The majority of states (34) offer a single, integrated peer professional certification in the state health system for individuals with lived experience in substance use and/or mental health recovery. Other states (12) offer separate certifications based on the PSS’s type of behavioral health lived experience, whether it relates to substance use or mental health recovery.¹⁸ Some states require criminal background checks; others request self-disclosure of prior convictions.¹⁹

States require a range of approved educational hours for PSS to receive certification. The most common requirement is between 40-46 hours of approved education. Twenty-two state certifications also require supervised work or volunteer hours for PSS seeking certification. For those with supervised work hour requirements, the number of required hours ranges from 200 to 2,000, with the majority requiring 500 hours.²⁰

As of December 2025, there is no nationally accepted training and certification standard. However, the NAADAC, the Association for Addiction Professionals, the International Certification and Reciprocity Consortium and Mental Health of America have created their own certification programs. The National Conference of State Legislatures also provides information on the status of state certification, payment and reimbursement and how the use of PSS can have a positive impact on health outcomes.

Supporting the Mental Well-being of Peer Support Specialists

Hospitals and health systems continue to enhance their support of the mental well-being of their workforce, and this is particularly important for PSS employees and volunteers. Some health care leaders may have concerns about the potential for a PSS to have a recurrence of their mental health symptoms or substance use while employed, and studies have identified preventive measures that can mitigate these risks.²¹ Ongoing training and support for PSS is critical, specifically ongoing training on how to manage individuals with high acuity illnesses. Equally important is training and support in effectively handling patient relapse or — potentially more challenging — patient death. Self-care is a preventive measure against burnout, compassion fatigue and other challenges in fulfilling this role.²² Research has shown that as long as PSS have their own self-care systems in place, including awareness of well-being resources at their hospital, health system or community, and connections with the recovery community and quality supervision, they can separate their role as PSS at a hospital from a peer who is struggling with a mental health or substance use-related crisis.²³

Organizations may also want to consider offering an employee resource group for PSS and/or becoming a Recovery-Ready Workplace by adopting policies and practices that:

• Expand employment opportunities for people in or seeking recovery.
• Facilitate help-seeking among employees with substance use disorder.
• Ensure access to needed services, including treatment, recovery support and mutual aid.

Considerations for Hiring Peer Support Specialists

Figuring out where to start when adding a new role to the care team can be overwhelming. Use the questions below to identify current practices where PSS could be used; consider what steps need to be taken to create the PSS role; and identify data sources that can support the need for the PSS role and monitor the success of the role moving forward.

• Who will lead and champion the effort to add a PSS to the care team?
• What internal resources, including financial resources, will be required?
• Who will supervise the PSS?
• What external resources are necessary?
• What is the anticipated timeframe for adding a PSS to the workforce?
• How will PSS services be reimbursed or paid for?
• How will you gain buy-in from the workforce to add PSS to the care team?
• What are the anticipated barriers to adding a PSS to the care team and how can these be overcome?
• What data do you need to collect to monitor success?
• How will you scale up the use of PSS over time?

The AHA has curated resources and case examples that illustrate how hospitals and health systems have successfully integrated PSS into their organizations.

Resources

Aligning training, regulation, and payment policy to advance the behavioral health workforce
Support is available for states seeking to align training, regulation and payment policies for peer support roles in behavioral health settings in order to combat the workforce shortage and meet community behavioral health needs. 

Assessing the Adequacy of Training for Certified Peer Support Specialists (CPSS) Providing Mental Health and Substance Use Services 
The University of North Carolina Behavioral Health Workforce Research Center explored the extent to which peer providers perceived their CPSS training prepared them for peer support work and identified areas of continued training needs to further bolster this workforce in providing vital behavioral health services. The project includes an abstract, policy brief, manuscript and poster. 

Center for Addiction Recovery Support (CARS)
CARS offers resources and tailored training for organizations to develop and expand their peer-led substance use recovery work.

Emergency Department Peer Support Specialist Program 
This pilot program successfully engaged PSS with patients who presented to the ED with substance use disorders to connect them to community resources such as treatment, social service agencies and harm reduction services. The goal was to decrease future ED and inpatient services utilization and implement post-discharge handoff protocols.

Hiring Guidelines for Peer Support Specialists
A peer specialist is an employee who will bring added value to your organization. The interview process is a vital step in ensuring that the applicant is a good match to the needs of the organization. The guidance in this document may be helpful in exploring how to integrate peer specialists into your practice.

How Peer Support Helps Heal the Culture of Medicine from Within 
By intentionally integrating and leveraging basic and essential elements of peer support in day-to-day operations, it is possible to promote organization-wide change that supports a healing culture and mitigates a lonely and challenging environment.

'If It Wasn’t for Him, I Wouldn’t Have Talked to Them:’ Qualitative Study of Addiction Peer Mentorship in the Hospital
Integrating peer mentors into the patient care team for substance use disorder is a complex but valuable way to engage often-marginalized hospitalized patients and improve both the patient and provider experience.

Peer Support in Coordination of Physical Health and Mental Health Services for People With Lived Experience of a Serious Mental Illness
PSS can contribute to the coordination of physical and mental health services for individuals with serious mental illness by sharing lived experiences and helping patients connect with available resources and services.

Peer Support Specialists: Connections to Mental Health Care
This article from the National Conference of State Legislatures outlines the role of PSS in behavioral health care settings; training and certification information, including reimbursement and financing; and how PSS can help remove barriers for patients who are seeking mental health care.

Peer Support Workers for Those in Recovery
As part of the Bringing Recovery Supports to Scale Technical Assistance Center Strategy, this resource provides basic and advanced tools and information to behavioral health professionals across the country. There are toolkits, video trainings and other resources to help organizations think about how to bring PSS into their workforce.

Recommendations for integrating peer mentors in hospital-based addiction care
Hospitals and health systems are beginning to integrate peer mentors into hospital-based addiction teams, and it can be a complex undertaking. While there are challenges to integrating peer mentors into the stressful hospital environment, hospitals and health systems can create a clearly defined peer mentor role that provides a positive experience for both the patients and the workforce.

SAMHSA Peer Support handout
This infographic offers basic information on peer support, the role of a PSS, and how they can be beneficial in a health care organization.

SAMHSA Program to Advance Recovery Knowledge (SPARK)
SPARK is operated by SAMHSA’s Office of Recovery with support from the Center for Substance Abuse Treatment as a national training and technical assistance center to help states, tribes, territories and communities expand the delivery of recovery support services — such as peer support services, recovery housing, collegiate recovery and more — across the United States.

Supervision of Peer Workers
A guide for organizations on how to supervise peer workers in behavioral health services. It includes a slide deck with trainer notes, a one-page self-assessment tool for supervisors, and other resources.

To Help Others, We Must Care for Ourselves: The Importance of Self-Care for Peer Support Workers in Substance Use Recovery
The peer support workers in this study explained that, just like other health care professions, they need to be present in their personal lives; to establish and maintain effective boundaries; and to ensure ongoing attention to their personal recovery. Self-care was identified as being a preventative measure against burnout and other challenges in the role of peer support specialist, as well as assisting in the management of crossover into one’s personal life.

Whole Health Action Management (WHAM)
Equip your peer service providers with the essential tools, resources and ongoing technical support needed to address chronic physical health conditions in people facing mental health and substance use challenges. WHAM facilitators also connect with a national network for continuous peer support.

Endnotes

1. Hutchison, S. L., MacDonald-Wilson, K. L., Karpov, I., Herschell, A. D., & Carney, T. (2023). Peer support to reduce readmission in Medicaid-enrolled adults with substance use disorder. Journal of Substance Use and Addiction Treatment, 144, 108901. https://doi.org/10.1016/j.jsat.2022.108901. 

2. Recovery Innovations of Arizona Programs. (n.d.). Retrieved May 28, 2015, from https://mhanational.org/wp-content/uploads/2025/02/Evidence-Peer-Support-May-2019.pdf. 

3. Bouchery, E., Barna, M., Babalola, E., Friend, D., Brown, J., Blyler, C., Ireys, H. (2018).The effectiveness of a peer-staffed crisis respite program as an alternative to hospitalization. Psychiatric Services, 69(10), 1069-1074. 

4. Global Evidence for Peer Support: Humanizing Health Care. (2014). Retrieved from https://ace-usa.org/blog/research/research-publichealth/pros-and-cons-of-the-pfcjoseph-p-dwyer-peer-support-program-act/#:~:text=For%20instance%2C%20a%20Federally%20Qualified,value%20for%20the%20healthcare%20system. 

5. Ibid. 

6. Substance Abuse and Mental Health Services Administration: Financing Peer Recovery Support: Opportunities to Enhance the Substance Use Disorder Workforce. Publication No. PEP23-06-07-003. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2024. 

7. Substance Abuse and Mental Health Services Administration (SAMHSA): Supporting and Financing Peer Services. Publication No. PEP24-02-012. Rockville, MD: Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration, 2024. 

8. Ibid. 

9. Nathaniel Counts, “Medicare Reforms Support Behavioral Health by Expanding Access to Peer Support Specialists and Community Health Workers,” To the Point (blog), Commonwealth Fund, Feb. 16, 2024. https://doi.org/10.26099/1ctc-9t55. 

10. Mariah A. Quinn, MD, MPH, Angela Chaudhari, MD, Chantal Brazeau, MD, Elizabeth Lawrence, MD, and Kristine Olson, MD, MS,” How Peer Support Helps Heal the Culture of Medicine from Within”, NEJM Catalyst, December 11, 2024, https://catalyst.nejm.org/doi/full/10.1056/CAT.23.0373. 

11. Ibid. 

12. Mandeep Kaur, M.D. mandy.drmandeep@gmail.com, and Robert H. Melville, Jr., J.D., C.P.S.S., “Emergency Department Peer Support Specialist Program,” Psychiatric Services, Volume 72, Number 2, https://doi.org/10.1176/appi.ps.72102. 

13. Storm M, Fortuna KL, Brooks JM, Bartels SJ. Peer Support in Coordination of Physical Health and Mental Health Services for People With Lived Experience of a Serious Mental Illness. Front Psychiatry. 2020 May 8;11:365. doi: 10.3389/fpsyt.2020.00365. PMID: 32457662; PMCID: PMC7225331. 

14. Fisher EB, Boothroyd RI, Elstad EA, Hays L, Henes A, Maslow GR, Velicer C. Peer support of complex health behaviors in prevention and disease management with special reference to diabetes: systematic reviews. Clin Diabetes Endocrinol. 2017 May 25;3:4. doi: 10.1186/s40842-017-0042-3. PMID: 28702258; PMCID: PMC5471959. 

15. Jason B. Gibbons, Sachini Bandara, Vivian Flanagan, Carlos Hardy, Marla Oros, Brendan Saloner, Association between peer support services, treatment engagement and overdose risk among Kentucky Medicaid beneficiaries with opioid use disorder, Drug and Alcohol Dependence, Volume 277, 2025,112944, ISSN 0376-8716, https://doi.org/10.1016/j.drugalcdep.2025.112944. 

16. Chinman M, Lucksted A, Gresen R, Davis M, Losonczy M, Sussner B, Martone L. Early experiences of employing consumer-providers in the VA. Psychiatric Serv. 2008 Nov;59(11):1315-21. doi: 10.1176/ps.2008.59.11.1315. PMID: 18971408. 

17. Philadelphia Dept. of Behavioral Health and Intellectual Disabilities Services and Achara Consulting Inc. (2017). Peer Support Toolkit. Philadelphia, PA: DBHIDS. 

18. SAMHSA Peer Recovery Center of Excellence. (2024). *Comparative analysis of state requirements for peer support specialist training and certification in the U.S. https://static1.squarespace.com/static/67017deb9fbcef5ab5aa6989/t/6734dac4aab8ec4124738c31/1731517125502/Comparative+Analysis+of+State+Requirements+for+Peer+Support+Specialist+Training+and+Certification+in+the+US+.pdf. 

19. Ibid. 

20. Ibid. 

21. Christian Williams, To Help Others, We Must Care for Ourselves: The Importance of Self-Care for Peer Support Workers in Substance Use Recovery, HSOA Journal of Addiction and Addictive Disorders, Dec 24, 2021 DOI:10.24966/AAD-7276/100071. 

22. National Center on Substance Abuse and Child Welfare. (2024). *Module 4: Strategies for developing the peer support specialist workforce*. Retrieved from https:// ncsacw.acf.gov/files/peer-support-mod4.pdf. 

23. Ibid