SAMHSA Unveils National Model Standards For Peer Support Certification

On June 6, 2023, the Substance Abuse and Mental Health Services Administration (SAMHSA) released national model standards for peer support certification to be used for peer workers providing assistance for people with addiction disorder, mental health disorders, or families/caregivers of a dependent with behavioral health challenges. Peer workers are individuals having lived experience with addiction and/or mental health disorders. The goal of the model standards is to accelerate universal adoption, recognition, and integration of the peer workforce across all elements of the health care system.

Peer workers provide non-clinical activities such as advocacy, navigation and linkage to resources, sharing of experience, social support, community and relationship building, group facilitation, skill building, mentoring, and goal setting. Peer workers are sometimes referred to as peer supporters, peer specialists, recovery coaches, mentors, peer providers, or peer navigators. A peer worker may be certified by a state certification entity or may be able to provide services without certification.

SAMHSA defined a National Model Standard as a distinct certification criterion that supports the following:

• Promotes quality of and consistency across peer services
• Limits barriers to expanding the peer workforce
• Is based upon guidance from the peer workforce
• Is based upon existing practices utilized by state certification entities

The 11 proposed model standards span across authenticating the lived experience, training, examinations, formalized education, supervised work experience, background checks, recovery, ethics, costs and fees, and peer supervision. Adopting the model standard or aligning existing state standards with the model standard, is anticipated to have eight primary benefits:

1. Increase reciprocity and partnership between state certification entities.
2. Promote quality of peer services being delivered across the country.
3. Protect the authenticity of peers through promotion of and emphasis on lived and living experience.
4. Support state certification entities in the development and/or revision of certification requirements that align with the needs of the peer workforce and the people they serve.
5. Cultivate the peer workforce by elevating the profession and bringing national attention to the critical services they provide.
6. Reinforce the scope of the peer role through distinct certification criteria.
7. Strengthen diversity, equity, inclusion, and accessibility (DEIA) efforts across the peer workforce.
8. Expand career pathways for certified peer workers and peer supervisors.

Model Standard #1: Authenticity and Lived Experience. State certification entities should include a self-attestation requirement (e.g., a written narrative, questions, check box) that promotes the following statements of authenticity across the peer workforce:

• Mental Health and Addiction Peer Certifications: A prospective certified mental health/addiction peer worker should be able to describe lived experience related to a mental health and/or addiction condition, either standalone or co-occurring, and describe strategies utilized to address associated challenges.
• Family Peer Certifications: A prospective certified family peer worker should be able to describe their lived experience as a primary caregiver of an individual with a mental health and/or addiction condition, and describe strategies utilized to address associated challenges.

Model Standard #2: Training: The requirements range from 40 to 60 hours for mental health, addiction, and family peer certifications. Currently most state certifications require between 40 and 46 hours of training on a wide variety of topics. The topics should include:

1. Role, scope, and purpose of the peer (mental health, addiction, integrated, or family)
2. Values and principles of peer support, recovery, and resiliency
3. History of recovery movements in mental health, substance use, and families
4. Recovery and resiliency resources and tools (e.g., recovery planning)
5. Self-help/mutual support groups
6. Community resources (e.g., social, prevention, education, employment)
7. Legal systems and resources
8. Diversity, Equity, Inclusion, and Accessibility
9. Computer and digital health literacy (e.g., computer skills, virtual peer support)
10. Ethics
11. Harm reduction (including suicide and overdose prevention)
12. Communication, language, and group skills (e.g., peer-to-peer engagement, storytelling)
13. Advocacy (self and system) and reducing prejudice/discrimination (e.g., stigma)
14. Crisis response
15. Trauma-responsive approaches
16. Understanding and identifying mental health, substance use, and co-occurring conditions
17. Self-care and wellness (e.g., physical, mental, etc.)
18. Self-determination, choice, and shared decision-making

Model Standard #3: Examinations. Currently 48 state peer certifications incorporate either written or written and oral examinations into their requirements. The national standard recommends that examinations focus on the following:

• Relate directly to and is appropriately based on the peer role (mental health, substance use disorder, or family).
• Only reflect information explicitly covered in trainings.
• Include a general focus on the competencies of peer support.
• Is incorporated into a study guide or similar resource(s) that is provided between training and examination.

Model Standard #4: Formal Education. This refers to structured teachings that occur through an academic institution and follow an official curriculum. It does not necessarily include training that a prospective certified peer worker may complete as part of their certification. Many state Medicaid programs integrate educational requirements, such as a high school diploma or passage of a General Educational Development (GED) exam, and link the requirement to billing/reimbursement. but the national standard recommends that states reconsider such policies in favor of alternative pathways to meet literacy and fluency needs. The model standard recommended the following:

• In lieu of any formal educational requirements, prospective certified peer workers should be able to demonstrate literacy and fluency in the language in which they will be providing services, either through required examinations or other application requirements.
• If a prospective certified peer is unable to demonstrate the literacy and/or fluency needed to complete the certification process, it is recommended that state certification entities provide a list of formal educational trainings/opportunities that may help them achieve certification.

Model Standard #5: Supervised Work Experience. This refers to hours worked in a paid or volunteer capacity, within an organization/setting that provides peer support services. Most states (31) do not require any supervised work experience to gain certification. Across the state certifications that require supervised experience, the requirements range from less than 200 hours to more than 2,000 hours. The model standard recommended that states require no more than a maximum of 120 hours of supervised work experience. If a state certification entity sets a minimum requirement, it should accept a combination of paid, volunteer, virtual, and out-of-state hours. If supervised work experience is required, the prospective certified peer should be provided with a list of vetted placement opportunities.

Model Standard #6: Background Checks. Most state certifications (36) have no background check requirements, 10 require background checks, and five require self-disclosure of arrests and/or convictions. Across the 15 certifications that require either a background check or self-disclosure, varying levels of response were noted, depending on the nature and severity of the charge, and resulting in either a case-by-case review (4), permanent automatic disqualification (9), and temporary automatic disqualification (2). The model standard recommends that background checks be the responsibility of hiring organizations rather than part of the certification process. In instances where a state certification entity chooses to obtain criminal background information on prospective certified peers, it is recommended that they: clearly outline potentially disqualifying offenses and include guidelines for time after which such offenses will no longer be considered. Use an initial process of self-disclosure but conduct background checks for confirmation purposes. Prospective certified peers should be able to appeal disqualifications.

Model Standard #7: Recovery status of the peer worker. The model standard noted that recovery pathway-specific requirements for peer certification were identified as a barrier to expanding and strengthening the peer workforce. Two state certifications had explicit abstinence-specific requirements for prospective certified peers. The model standard recommended that state certification requirements exclude recovery pathway-specific requirements from certification requirements. Instead, state certification entities should allow hiring organizations to consider pathway-specific recommendations that meet the needs of the population(s) they serve.

Model Standard #8: Diversity, Equity, Inclusion, and Accessibility (DEIA). These themes have been identified as a critical need of the peer workforce. DEIA is a cross-cutting standard that can be incorporated across peer certification requirements (e.g., training and examinations), general strategies utilized by state certification entities, and practice competencies used by individual peers. With a primary focus on serving and addressing the needs of under-resourced and under-represented populations through behavioral health equity strategies, minority populations benefit from DEIA.

Model Standard #9: Ethics. The standards are intended to elevate the quality of services and the well-being of the people being served by the peer workforce. The national standard recommended that certified peer workers be involved in developing or revising a code of ethics applicable to the peer role and non-clinical services. The code of ethics should define the role, scope, and responsibilities of the peer; how to maintain personal and professional boundaries, how to prevent conflicts of interest; how to ensure confidentiality; and should describe mandated reporting. Prospective certified peers should be required to read, sign, and adhere to a peer worker code of ethics. State certification entities should implement a way to report alleged breaches of ethics by certified peer workers, and alleged breaches should be reviewed by an impartial committee.

Model Standard #10: Costs and Fees. The standards address fees associated with application, training, examinations, and recertification for peer workers. Such fees have been identified as significant barriers to building the peer workforce. The model standard recommends that state certification entities work with the state to find resources to subsidize all costs or fees for both certification and re-certification, and to subsidize costs/fees associated with providing reasonable accommodations. If states must impose fees, the certification entity should clearly outline the exact costs or fees associated with the application, the training, examinations, the total cost of certification, the total cost of recertification, and the costs associated with any Continuing Education Units.

Model Standard #11: Peer Supervision. This takes place in the form of a supervisors’ feedback and guidance to support a peer worker’s performance and growth, and to ensure that the services are provided in fidelity to the model. The national model standard recommends that state certification entities consider developing and implementing a certification process for peer supervisors. Peer supervisors should have direct experience as a peer worker, and should thoroughly understand the skills, values, and principles of the peer role. State certification entities partner with hiring organizations and peer and family-run entities to develop and implement supervisor-specific career pathways for certified peer workers.

Building a national certification program for peer specialists was a primary goal outlined in President Biden’s 2022 State of the Union Address where he announced the national strategy as part of the Unity Agenda to address the nation’s mental health crisis. SAMHSA collaborated with federal, state, tribal, territorial, and local partners including peer specialists, and also requested and incorporated public comments, to develop the national model standards. SAMHSA’s national model standards are not intended as a substitute for any state certifications, but instead have been developed as guidance for states, territories, tribes, and others, to promote quality and encourage alignment and reciprocity across often disparate state peer support certifications.

For more information, contact:

• Substance Abuse and Mental Health Services Administration, 5600 Fishers Lane, Rockville, Maryland 20857; Fax: 240-276-2135; Email: media@samhsa.hhs.gov; Website: https://www.samhsa.gov/