PeerTAC Peer Support Services Technical Assistance Center

Simply put, peer support is a natural human response when people in a particular circumstance reach out to help others in the same or a very similar circumstance. It is the act of a person who has experienced a particular challenge helping someone else to deal with that same life challenge.”

Naturally occurring peer support offers a person the hope of facing a challenge with the support of someone who“ has been there. It is not limited to mental health or substance use recovery.

While there are similarities, there is a difference between naturally occurring peer support and Peer Support Services. When providing peer support as a service, there are added responsibilities like job tasks, documentation, reporting, working with a variety of colleagues and working under supervision. Those who provide Peer Support Services are usually paid, which makes the relationship with a person more complex, but the benefits of reaching and building trusting relationships with people through the service can be as rewarding as naturally occurring peer support.

Whether provided for youth, family, adult, or older adults these services are known as Peer Support Services and the people providing the services are known as Peer Specialists/Advocates.

Those who provide Peer Support Services are cultural and recovery ambassadors – they promote connection and inspire hope. As members of an integrated care team, Peer Specialists/Advocates make contributions that assist with engagement, practical assistance to achieve and sustain skills, development of coping mechanisms, empowerment, and building relationships.

“Peer Support Services are optional, and do not require OMH prior approval to provide these services (not listed on Operating Certificate) and do not need to be listed on the license.”¹

“Numerous research studies have indicated that when added as a primary service to treatment, Peer Specialists/Advocates play a significant role in improving health and wellness, because of their ability to build trust, form one-to-one relationships, and foster hope for others. Peer Specialists/Advocates know what the struggle is like because they’ve experienced similar challenges. They can understand the thoughts and feelings of people going through resilience and recovery or caring for a child with social and emotional challenges. Peer Specialists/Advocates utilize their lived experience and expertise of resilience and recovery with others in their work.”¹

“The work of Peer Specialists/Advocates is a necessary adjunct to the work done by therapists, case managers, and other members of the treatment team. It is not an “add-on.” It should be there from the beginning. The Peer Specialist/Advocate knows what the struggle is like because they have experienced similar challenges. They use their lived expertise of resilience and recovery in their work. Their experience of learning to grow and thrive, while facing similar challenges, puts them in a position to share meaningful lessons learned in a way that people receiving services view as highly credible.”²

Peer Support Services may be provided in individual or group settings, at the MHOTRS program site or offsite, as well as via telehealth. Peer Support Services may include but are not limited to providing resiliency/recovery-based skills training, facilitating groups, support, non-clinical crisis support, as well as modeling effective coping skills, facilitating community connections and engaging in informed decision making, resilience and recovery.

“When Peer Support Services are delivered, the peer perspective must be integrated into the interdisciplinary team-based approach to care. Further, even when Peer Support Services are not formally added to a person’s treatment plan, the inclusion of Peer Specialists/Advocates as members of an integrated care team can help to support a person-centered/family-centered approach to care.”¹

This service can be broken down into components to serve three separate populations:

• Youth
• Family
• Adult/Older Adult

Each service component has a unique service definition, scope of practice, and specialized staff qualifications.”¹

For more details about the Peer Support Service components, review the NYS OMH Mental Health Outpatient Treatment and Rehabilitative Services (MHOTRS) Guidance on Youth, Family, Adult, and Older Adult Peer Support Services, Effective 11/23/22², pages 5-12.

“The Adult Peer Recovery Support Component is provided by a staff person with lived experience of mental health issues who are personally familiar with the associated challenges. They assist clients with informed decision making, collaboration, whole health, and finding purpose and meaning. Specific activities an adult peer support worker may offer include:

• Self-Advocacy, Self-Efficacy, and Empowerment
• Engagement, Bridging, and Transitional Support
• Peer Recovery Supports and Peer Counseling
• Community Connections with Natural Supports
• Pre-Crisis and Crisis Support Services.”¹

For more details about each of the Adult Peer Support Service components, review the NYS OMH Mental Health Outpatient Treatment and Rehabilitative Services (MHOTRS) Guidance on Youth, Family, Adult, and Older Adult Peer Support Services, Effective 11/23/22², pages 5-8.

“The Youth Peer Support Service Component is provided by a young adult between the ages of 18-30 who self-identifies with having a mental health need and has lived expertise with receiving services in the child serving system, either the children’s mental health system or child welfare or juvenile justice. They can inform and support another young person who may be engaging in the mental health system for the first time or really need someone to talk with about how they can address experiences and challenges they may be having with their own mental health.

“The Youth Peer Advocate (YPA) promotes wellness through modeling and can assist the young person with gaining and regaining the ability to make independent choices and playing a proactive role in their own treatment. Specific activities a youth peer worker may offer include:

• Skill Building
• Coaching
• Engagement, Bridging, and Transitional Support
• Self-Advocacy, Self-Efficacy, and Empowerment
• Community Connections with Natural Supports.”³

For more details about the Youth Peer Support Service components, review the NYS OMH Mental Health Outpatient Treatment and Rehabilitative Services (MHOTRS) Guidance on Youth, Family, Adult, and Older Adult Peer Support Services, Effective 11/23/22⁴, pages 10-12

“The Family Peer Support Service Component is provided by a staff person with lived experience of raising a child with behavioral health needs and are personally familiar with navigating the child-serving system. They assist the parent/caregiver in meeting the needs of the child through educating, supporting, coaching, modeling, and guiding on how to advocate for services and resources to meet the child’s needs. Specific activities a family peer support worker may offer include:

• Engagement, Bridging, and Transitional Support
• Self-Advocacy, Self-Efficacy, and Empowerment
• Parent Skill Building
• Community Connections with Natural Supports.”⁵

For more details about each of the Family Peer Support Service components, review the NYS OMH Mental Health Outpatient Treatment and Rehabilitative Services (MHOTRS) Guidance on Youth, Family, Adult, and Older Adult Peer Support Services, Effective 11/23/22⁶, pages 8-10.

Completion of the Family Peer Advocate (FPA) credential, provisional credential, or a plan to complete the credential within the next year is required to provide Family Peer Recovery Support Services.

“Case Management is a collaborative process of assessment, planning, facilitation, care coordination, evaluation and advocacy for options and services to meet an individual’s and family’s comprehensive health needs through communication and available resources to promote patient safety, quality of care, and cost-effective outcomes.”¹

“A case manager will make sure the individual has access to everything they need to get on the road to recovery and will follow up to confirm their needs have been met. The focus is primarily on external factors that support the treatment journey. Peer support, on the other hand, will focus on the individual as a person.”²

“Peer Specialists/Advocates encourage personal development, foster independence, and help people receiving services to develop skills needed to promote and guide their own self-defined path to resilience and recovery. They help people to create and sustain relationships that support recovery. Peer Specialists/Advocates often use strategic self-disclosure from their own lived expertise in resilience and recovery to inspire hope and motivate others.”³

“Peer Specialists/Advocates do not perform clinical assessments to determine what’s wrong with a person. Instead, they help people to discover their strengths, the kind of activities that offer hope and a sense of meaning and purpose, natural supports in the community, and a personal pathway to recovery. Their job is to help people to recover in a way that meets their needs and is best for their life and overall recovery goals.”⁴

“OMH’s vision is to ensure the promise of recovery and resiliency for all. Peer support services are essential to the behavioral health system. OMH is committed to continually evaluating and evolving the inclusion of Peer Support Services in mental health programming. OMH values the partnership and feedback from the peer community service recipients, families, and advocates to further inform our policy and program development and enhancement.”¹

“Peer Specialists/Advocates play an increasingly important role in the recovery process of people living with mental illness or social and emotional challenges. The services they provide have been shown to promote positive health and recovery outcomes, including reduced inpatient service use; enhanced relationships with providers; better engagement with care; higher levels of empowerment and hope for recovery; and improved ability to manage continuing health and wellness.”¹

It isn’t as simple as hiring Peer Specialists/Advocates. “The successful integration of Peer Support Services requires an organizational commitment with an understanding of a new approach to care. Organizational readiness and implementation are an ongoing process that requires preparation and planning to promote sustainability.

“Preparations for including Peer Specialists/Advocates on multidisciplinary care teams involve an honest, transparent assessment of the organization’s readiness. The organization and its members must share the values of teamwork and collaboration, be committed to peer inclusion, and have the capacity and skills to adopt new principles, framework, and practices. It is recommended that agencies develop an action plan that includes, at minimum, the following:

• The voice and presence of Peer Specialists/Advocates at all levels of planning;
• The voice and presence of individuals participating in MHOTRS services;
• Each team member’s role and how members work together;
• How Peer Specialists/Advocates complement and achieve the team’s priorities and outcomes (for example, access, continuity, coordination, and communication);
• Policies and procedures, ensuring the use of non-stigmatizing, person-first recovery language throughout; and
• How personnel evaluate progress, and when applicable, how the use of Peer Support Services impacts treatment outcomes.”¹, ²

“Implementing Peer Support Services is not ‘business as usual.’ It is a new approach to care that requires pre-work, pre-planning, and organizational commitment. These are important to the successful start of a peer support program:

• Clear roles and responsibilities
• Training for peers and other staff
• Supervision
• Connection to mentoring and support from other Peer Specialists/Advocates
• Organizational champions
• Organizational leadership “buy-in” to support the successful inclusion
• “These lead to sustainability of a peer support program:
• Inclusive policies and procedures
• Organizational feedback
• Team approach to care
• Ongoing education and promotion of the unique and specialized roles
• Program outcomes tracking.”¹

“The development of multidisciplinary care teams and the inclusion of Peer Support Services signals a change in the approach to working with people with mental illness or social and emotional challenges. This change requires more than simply hiring Peer Specialists/Advocates. It necessitates providing active and ongoing support in the following ways:

• The organization should clearly define Peer Specialists/Advocates’ roles and responsibilities and distribute this information to relevant staff.
• Training could surpass standard peer certification requirements to include further support and skill development (e.g., motivational interviewing, assessing for risk, safety in the community, social determinants of care, etc.).
• Training should be required of all relevant agency staff and supervisors regarding peer roles and their work as a member of an integrated care team.
• Employers should provide regular, ongoing supervision of Peer Specialists/Advocates. When possible, peer professional staff should be given this supervisory responsibility.

“Organizations should choose individuals to act as peer champions within the organization to help promote Peer Support Services and encourage frequent, ongoing staff communication.”¹

Whether Peer Support Services are formally added to a person’s treatment plan or not, “the inclusion of Peer Specialists/Advocates as members of an integrated care team can help to support a person-centered/family-centered approach to care. Peer Specialists/Advocates should attend all clinical team meetings and staff training. Agencies should ensure that treatment staff receive training about Peer Support Services and establish policies and practices to ensure strong collaboration amongst the team.”¹

When providing services, the peer perspective is an important consideration. Including that perspective requires an intentional process of including Peer Specialists/Advocates on the team.

“A multidisciplinary team approach entails:

• Shared responsibility of planning and service delivery via a collaborative and coordinated process
• Routine communication and an “open door” for Peer Specialists/Advocates to feel safe to express concerns and problem solve solutions
• Peer Specialists/Advocates attend all clinical team meetings and staff trainings
• Staff receive training about Peer Support Services and establish practices to ensure strong collaboration amongst the team
• “A multidisciplinary team approach promotes the use of the whole range of professional scope and lived expertise.”²

“Agencies should ensure that sustainable innovations that support peer work are woven into the organizational culture, policy, budgets, and day-to-day practices. To promote the sustainability of Peer Specialists/Advocates, consider the following practices:

• Inclusive policies and procedures that promote a peer workforce and value peers’ unique orientation and expertise.
• Organizational feedback loops that include Peer Specialists/Advocates.
• A culture that emphasizes a team approach to care delivery and recognizes how collaboration can contribute to high quality care outcomes.
• Ongoing education and promotion of the unique and specialized roles of each multidisciplinary team member. It is important to avoid role confusion, splitting, and misuse of services (e.g., use of Peer Specialists/Advocates for therapeutic re-engagement without clinical input and support; use of Peer Specialists/Advocates in an unplanned way; use of Peer Specialists/Advocates to solely address activities and functions not defined in scope such as care coordination, etc.)
• Program outcomes tracking to identify where a program excels and where the organization may need to make modifications.”¹

“In addition, there should also be:

• Career advancement opportunities.
• Competitive salaries/benefits.
• Supervision that Is knowledgeable about peer support.
• Networking opportunities with other Peer Specialists/Advocates.
• Access to support while in the field.”²

Because of the different systems of care, Peer Support Services span the lifespan of people receiving services (youth and families, adult, older adult) and the matching type of peer support providers (youth advocate, family advocate, and adult peer support specialist).

Youth Peer Advocate (YPA) is a person between the ages of 18-30 who has first-hand experience with mental health or emotional challenges, or co-occurring issues. To be eligible to provide Youth Peer services they need to complete, or be in the process of completing, the YPA credential. To learn more about the Youth Peer Advocate credential, click here.

Family Peer Advocate (FPA) is a parent with the lived experience of advocating for a child involved in one or more of the systems of care. To be eligible to provide Family Peer services they need to complete, or be in the process of completing, the FPA credential. To learn more about the Family Peer Advocate credential, click here.

New York Certified Peer Specialist (NYCPS) is an adult or older adult with lived expertise with mental health issues and is personally familiar with the associated challenges. To be eligible to provide Peer Specialist services they need to complete, or be in the process of completing, the NYCPS certification. To learn more about the Certified Peer Specialist certification, click here.¹

Certified Recovery Peer Advocates (CRPA) holds a credential from a certifying authority recognized by the Commissioner of the Office of Addiction Services and Supports (training in substance use recovery support). Those who hold this credential are eligible to work in MHOTRS provided they qualify for and obtain the NYCPS or NYCPS-P (provisional) or Family Peer Advocate (FPA) or Youth Peer Advocate (YPA) credential within 12 months of being hired. It is expected that, within a reasonable amount of time, they will complete full OMH-recognized Peer Certification or Credential their work experience hours post provisional certification/credentialing²

“Qualified Individuals who may provide Adult Peer Support Services include OMH New York Certified Peer Specialists (NYCPS) who:

1. Identify as being actively in recovery from a mental health condition and intentionally self-disclose one’s mental health recovery journey;
2. Possess a certification from, or are provisionally certified as, a New York Certified Peer Specialistbyan OMH-approved Certified Peer Specialist certification program; and
3. Are supervised by any professional staff as defined in 599.4.

The Academy of Peer Services, which is managed by Rutgers University, offers the online training and testing toward certification. Documentation of successful completion of 13 core courses must be submitted to the New York Peer Specialist Certification board along with the other requirements listed in the application for certification, such as statement of lived experience and letters of reference. Instructions to apply for certification can be found on the New York Peer Specialist Certification Board website.

https://www.academyofpeerservices.org/
http://nypeerspecialist.org/

“Adult Peer Specialists can be hired directly by MHOTRS or can be contracted to provide Peer Support Services.”¹

“Qualified Individuals who may provide Youth Peer Support Services include Credentialed Youth Peer Advocate (YPA-C):

1. Who is an individual 18 to 30 years old who has self-identified as a person who has first-hand experience with, emotional (mental health), behavioral challenges, and/or co-occurring disorders;
2. Who is able to use lived experience with a disability, mental illness, and involvement with juvenile justice, special education, substance use disorder, and/or foster care to assist in supporting youth in their resiliency/recovery and wellness;
3. Possess a credential from, or are provisionally credentialed as a Youth Peer Advocate by an OMH-approved credentialing program; and
4. Are supervised by any professional staff as defined in 599.4.

Families Together in NYS/Youth Power in partnership with NYU’s McSilver Institute offer the training and credential. There are six steps toward YPA certification that you can learn about on the CTAC website:

https://www.ctacny.org/special-initiatives/youth-peer-support/youth-peer-advocate-training-and-credentialing/

Additional information can be found on the Families Together Website:

https://www.ftnys.org/yp-ypa-training/
https://www.ftnys.org/yp-ypa-credential/

“Youth Peer Advocates can be hired directly by MHOTRS or can be contracted to provide Peer Support Services.”

“Qualified Individuals who may provide Family Peer Support Services include Credentialed Family Peer Advocate (FPA-C) who:

1. Demonstrate lived experience as a parent or primary caregiver who has navigated multiple child-serving systems on behalf of their child(ren) with social, emotional, developmental and/or behavioral healthcare needs;
2. Possess a credential from, or are provisionally credentialed as a Family Peer Advocate by an OMH-approved credentialing program; and
3. Are supervised by any professional staff as defined in 599.4.

Families Together in NYS in partnership with NYU’s McSilver Institute offer the FPA training and credential. There are six steps toward certification that you can learn about on the CTAC & Families Together site:

https://www.ftnys.org/workforce/parent-empowerment-program-pep/

Family Peer Advocate Credential | Families Together in NYS (ftnys.org)

“Family Peer Advocates can be hired directly by MHOTRS or can be contracted to provide Peer Support Services.”

“People who hold a Certified Recovery Peer Advocate (CRPA) credential in providing substance use recovery peer support from a certifying authority recognized by the Commissioner of the Office of Addiction Services and Supports (OASAS) are qualified under the condition that they complete the NYCPS-P (provisional), YPA-P, or FPA-P Credentialing within 12 months of being hired. It is expected that, within a reasonable amount of time, they will then complete full NYCPS Peer Specialist Certification or Professional Youth or Family Credential through their work experience hours post provisional certification/credentialing.”¹

“As the field is evolving, programs should be thoughtful about who provides supervision to Peer Specialists/Advocates in order to ensure the inclusion of the Peer Specialists/Advocates into the treatment team. Any professional staff as defined in 599.4 are eligible to supervise Peer Specialists/Advocates, however, recovery values, principles, trauma-informed, and core concepts must be embedded in the supervision practice.

Agencies should ensure that Peer Specialists/Advocates have access to in-discipline supervision, mentoring and support from Peer Specialists/Advocates. This can be accomplished by connecting Peer Specialists/Advocates within the organization and supporting regular convenings. This can also be established in collaboration with local agencies or via contracting with peer-run agencies.

Agency leadership should meet regularly with Peer Specialists/Advocates and treatment team leaders to ensure successful implementation of Peer Support Services and address challenges in a timely manner. Peer Specialists/Advocates should be afforded opportunities to participate in external peer networking, training and conferences, and other activities dedicated to support their continued education and professional development.”^{1, 2}

“Currently, peer staff need to be supervised by a licensed staff professional (LPHA). However, as more peer staff are in these settings we will be able to start a structure that is a good setup for supervision of Peer Support Services.”¹

“Peer Specialists/Advocates need to be supervised by professional staff according to regulation 599.4. However, there could be experienced peer staff who are supervised by the professional who cover some elements of supervision.”¹

Supervision must be provided by a Licensed Practitioner of the Healing Arts (LPHA). There is a difference between pre-admission peer support and peer support provided after admission, when there is a treatment plan. For the purpose of medical necessity, the best way to provide flexibility for peer support during pre-admission was to have the LPHA sign off on pre-admission notes. Once a person is admitted, medical necessity will automatically be determined on the treatment plan. ¹

The Five Critical Functions are Advocate, Educate, Support, Advocate, and Evaluate. These functions help supervisors to organize the tasks of supervision to focus on areas specific to the supervision of Peer Specialists/Advocates.¹

The National Association of Peer Supporters (N.A.P.S.) re-issued the National Practice Guidelines for Peer Specialists in 2019 to include the role of the supervisor in helping peer supervisees to uphold the 12 trauma-responsive core values.

To learn more about the National Practice Guidelines for Peer Specialists and Supervisors, visit https://www.peersupportworks.org/wp-content/uploads/2021/07/National-Practice-Guidelines-for-Peer-Specialists-and-Supervisors-1.pdf

“In order for successful inclusion of Peer Support Services into clinical settings, the clinical team should learn about the role of the Peer Specialist/Advocate to understand how it differs from a clinical role. The Peer Specialist/Advocate role should not reflect that of a clinician, but of a valuable and independent member of the multidisciplinary team who offers the unique insight from the point of view of a person receiving services. While not clinical in nature, the role of the Peer Specialist/Advocate is critical in supporting individual informed decision making around treatment options that lead to individual and family driven outcomes which can lead to better satisfaction with life and increased wellness.”¹

“The use of Peer Support Services can be applied in a variety of diverse and flexible ways. However, to avoid role confusion and other challenges your program should avoid using Peer Specialist/Advocates:

• Solely to “get someone back into treatment” without engagement and informed decisions about resilience and recovery and their interest in continued services
• In unplanned way such as cold calling individuals and families about missed appointments
• To address activities or functions not defined in their scope of work (for example, care coordination)

“Safeguards should be monitored and evaluated on an ongoing basis with program or agency leadership, team members, and the Peer Specialists/Advocates to be sure Peer Support Services are being provided as they were intended.”¹

Academy of Peer Services for the NYCPS / NYCPS-P; Families Together in NYS and NYU’s McSilver Institute for the YPA Credential; Families Together, Youth Power, and NYU’s McSilver Institute for the FPA Credential.

In addition to the training that is available for at the above institutes for Peer Specialist/Advocates, there are courses for Supervisors and Peer Workforce Integration through PeerTAC.

Another important step is to become familiar with the Working Definition of Recovery, Core Values of Peer Supporters, Guiding Principles of Peer and Family-Driven Care, and the SAMHSA Core Competencies of Peer Support Workers. These are outlined in the answers that follow.

Peer support in mental health is based on the guiding principles of recovery and resilience. SAMHSA’s working definition of recovery defines recovery as a process of change through which individuals improve their health and wellness, live self-directed lives, and strive to reach their full potential. The process is highly personal and occurs on many pathways. Peer support services provide ways for those receiving services and their families to explore different pathways toward more informed choices and shared decision making.

The core values and guiding principles of the peer support staff will depend on whether that person is an adult peer specialist, a family peer advocate, or a youth peer advocate. Although similar in meaning, the values and principles for each specialization were developed by separate organizations specifically for the target group that is being served.

“Youth-guided and Family-driven means young people and their families have a primary decision-making role in the care of their own lives as well as the policies and procedures governing care for all youth in their community, state, tribe, territory, and nation.

“The Guiding Principles of Youth and Family Driven Care are:

• Shared decision making and responsibility
• Youth and families have accurate and complete information
• All children, youth, and families have a family voice advocating on their behalf
• Youth and families, and youth/family-run organizations, have access to peer support
• Youth and families direct decisions that impact funding for services and advocate for youth and family to have choices
• Policy and practices are changed from provider-driven to youth guided and family-driven
• Resources (funding, staff, training, and support) are allocated by administrators to adopt and make youth guided and family-driven practices sustainable
• Barriers created by stigma and discrimination are removed
• The diversity of cultures of children, youth, and families are celebrated, and disparities are eliminated.
• Cultural and linguistic responsiveness are continually developed to meet the needs of the diverse community¹

To learn more about the Youth Guided Practice and Family Driven Care Principles, visit Appendix B in the YPA Code of Ethics: https://www.ftnys.org/wp-content/uploads/2020/08/Code-of-Ethics-YPA-Professional-Application-2020-fillable.pdf

The National Association of Peer Supporters (N.A.P.S.) issued National Practice Guidelines (NPG) for Peer Supporters based on 12 trauma-responsive core values:

• Peer support is voluntary (supports choice)
• Peer support is mutual and reciprocal
• Peer support is equally shared power
• Peer support is strengths-focused
• Peer support is transparent
• Peer support is person-driven
• Peer supporters are hopeful
• Peer supporters are open-minded
• Peer supporters are empathetic
• Peer supporters are respectful
• Peer supporters are honest and direct
• Peer supporters facilitate change¹

For each core value, the NPG contains statements describing what the core value looks like in practice. During the consensus phase of development, the NPG received a 98.5% approval rating from 1000 peer specialists nationwide and the NPG has since been used in global guidance issued by the World Health Organization Quality Rights Guidance Module for one-on-one peer support.2 The NPG was updated in 2019 to include guidance for supervisors.

To learn more about the National Practice Guidelines for Peer Specialists and Supervisors, visit https://www.peersupportworks.org/wp-content/uploads/2021/07/National-Practice-Guidelines-for-Peer-Specialists-and-Supervisors-1.pdf

“Another component of understanding the peer role and values are core competencies. The core competencies describe the knowledge, skills, and attitudes a person needs to have in order to successfully perform a role or job. They guide training, role development and performance evaluation.

SAMHSA issued 62 competencies under 12 categories:

Category I: Engages peers in collaborative and caring relationships

• Category II: Provides support
• Category III: Shares lived experiences of recovery
• Category IV: Personalizes peer support
• Category V: Supports recovery planning
• Category VI: Links to resources, services, and supports
• Category VII: Provides information about skills related to health, wellness, and recovery
• Category VIII: Helps peers to manage crises
• Category IX: Values communication
• Category X: Supports collaboration and teamwork
• Category XI: Promotes leadership and advocacy
• Category XII: Promotes growth and development¹

For each category, there are statements describing the attitudes, skills, and knowledge required for competent practice. To learn more about SAMHSA’s Core Competencies, visit https://www.samhsa.gov/brss-tacs/recovery-support-tools/peers/core-competencies-peer-workers-behavioral-health-services/frequently-asked-questions

“OMH requires that programs who are providing Peer Support Services develop policies and procedures related to Peer Support Services. These policies and procedures may include requirements for training Peer Specialists/Advocates as well as supervisors and non-Peer staff on providing Peer Support Services; how to incorporate providing Peer Support Services; and address collaboration with the team and supervision, including peers as part of team meetings, etc.”¹

Now that the regulations are effective, these are optional services that can be started immediately. No Administrative Action or PAR is required, and these services do not need to be listed on your license.¹

“Peer Support Services may be provided to individuals, family or other collaterals, or groups of individuals not to exceed 12. The group option requires a modifier and reduced payment. In addition to H0038, Group services require the use of modifier HQ. There is no change to APG Peer Group Base Rates.

“Onsite Peer Support Services are exempt from Utilization Threshold counts when submitted with one of the Health Services rate codes (e.g., 1474). Off-site Peer Support Services will be claimed using the appropriate off-site rate code (e.g., 1507), which is also exempt from Utilization Threshold counts.”¹

“Peer Support Services can be provided offsite. Offsite will use the off-site rate codes.

“When submitting claims for Peer Support Services -individual, providers will use the expanded HCPCS code H0038, self-help/peer services.

For services of a duration of at least 15 minutes, one unit of service shall be billed. For each additional service increment of at least 15 minutes, an additional unit of service may be billed, up to twelve units per day, or 3 hours maximum. Multiple units of Peer Support Services may be provided consecutively or at different times of the day.”²

A Licensed Practitioner of the Healing Arts (LPHA) creates the treatment plan with the individual and family and would identify the need for Peer Support Services. LPHA co-signs the pre-admission notes for the Peer Specialist/Advocates. An LPHA can supervise a Peer Specialist/Advocates.

“Peer Support Services should be used in a planned and intentional way regardless of service frequency. The following highlight the types of documentation Peer Specialists/Advocates will be responsible for contributing to or providing:

Treatment Plan: Ongoing – “When services are planned to address the goals, objectives, and preferences of the individual/family, the service must be listed in the Treatment Plan.

Treatment Plan: Short-term – “Similarly, when Peer Support Services are used in a targeted, short-term manner (i.e., following a clinically significant event, change in status/engagement, etc.) the event and corresponding program response or plan should be noted in the treatment plan including the use of Peer Support Services.

Progress Note: Singular/Ad-hoc – “There may be circumstances in which the individual/family may benefit from a singular or ad hoc peer service intervention (e.g., support during a provider or education/Committee on Special Education (CSE) meeting; resource education/connection, etc.). In these cases, while the service and intervention may not be noted in the plan, there should be evidence of rationale for the intervention via progress note, interdisciplinary team meeting minutes, etc. Progress notes should indicate the type of service provided, the purpose of the contact, response of the individual, and progress.”¹, ²

“Under the State Plan Authority, which authorized the clinic option, there were specific requirements that the program needed to adhere to that didn’t allow for flexibility such as Peer Support Services. The authority was shifted over to the rehab option and that’s why you see a change in the name (Mental Health Outpatient Treatment and Rehabilitative Services or MHOTRS). While it is no longer formally referred to as a clinic, functionally we’re still referring to it that way with the integration of Peer Support Services, which are now available because of that shift in Authority. We also made changes to the regulation part 599, which has been updated to include Peer Support Services.”¹

To learn more about these changes, visit: https://omh.ny.gov/omhweb/clinic_restructuring/

“When Peer Support Services are provided via contract with a MHOTRS Program, every effort must be made to coordinate services to foster an integrated care approach. Collaboration across agencies promotes a comprehensive, holistic, and individual/family-driven team that strategically informs and monitors interventions.

“Peer Support Services being delivered through a contract with the MHOTRS Program does not eliminate the expectation of collaboration through Peer Specialists/Advocates being a part of the multidisciplinary team. This is necessary to incorporate the vision of the Peer Support Services as part of the MHOTRS program, and to enhance outcomes by maximizing the important roles of each professional team member. Evidence of collaboration must be documented in the individual’s case record and denoted in the treatment plan, as appropriate.”¹

Yes. “Peer Support Services offered by a qualified Peer as identified by above certified/credentialed peers can be provided, and billed for, prior to admission to engage individuals.”¹

Peer Support Services are billed under the same procedure code both pre-admission and post admission to MHOTRS programs, the reimbursement is the same.

“There is no limit to the number of days Peer Support Services can be provided prior to admission, however, the purpose and goal of the preadmission contacts must be identified and documented in the record. There is a daily billing limit of 12 units per day or 3 hours maximum. Preadmission Peer Support Services may only be provided as an individual service, not in groups.

“Each contact must be documented in the chart and should include the purpose of the contact, response of the individual, and progress made towards the goal. The preadmission documentation for contact by the peer must be signed by the Peer Specialist/Advocate and LPHA.”¹

“Pre-admission Peer Support Services are NOT intended to be stand-alone Peer Services. Ongoing Peer Support Services can only be provided to individuals enrolled in the MHOTRS. However, the first service can be with a peer (if appropriate and necessary to engage the individual in informed decision making, resilience and recovery).

• Pre-admission peer encounters are not limited to 3 encounters.
• Pre-admission Peer Service contacts do not start the 30-day clock for initial assessment Preadmission.
• Pre-admission Peer Support Services may only be provided as an individual service, not in groups.
• Pre-admission documentation for contact by the peer must be signed by the peer and a Licensed Practitioner of the Healing Arts (LPHA).

Each pre-admission Peer Support Service contact must be documented in the chart and should include the purpose of the contact, response of the individual, and outcome of the encounter.”¹

“Peer Support Services may be provided in individual or group settings, at the MHOTRS program site or offsite, as well as via telehealth. Peer Support Services may include but are not limited to providing resiliency/recovery-based skills training, facilitating groups, support, non-clinical crisis support, as well as modeling effective coping skills, facilitating community connections and engaging in informed decision making, resilience and recovery.”¹

One exception: preadmission peer support cannot be provided in groups.²

Yes, Peer Specialists/Advocates can run psychoeducation groups.

No, Peer Support Services can be provided pre-admission in MHOTRS programs, and post-admission as long as the service is added to the treatment plan. Individuals and families can receive ongoing Peer Support Services as long as they are not already receiving Peer Support Services in other billable programs.

Yes. “Peer Support Services may be provided in individual or group settings, at the MHOTRS program site or offsite, as well as via telehealth.”¹

For the purposes of this guidance, we are talking specifically about Medicaid services.  Providers should check with the individual’s  Medicare or commercial plan or within their contract with that plan to see if Peer Support Services are covered.

Child and Family Treatment and Support Services (CFTSS) is a community-based program for Medicaid-eligible children aged birth through 21 and their families. Community Oriented Recovery and Empowerment (CORE) services provide opportunities for eligible adult Medicaid beneficiaries with serious mental illness and/or substance use disorders to receive services in their own home or community. It is possible to be co-enrolled in these services and a MHOTRS program, however, if someone is receiving Peer Support Services through either program it would be a duplication in the MHOTRS program. Duplication of services is not allowed.

No, Peer Support Services and psychotherapy are distinct services and can be provided concurrently.

No, only pre-admission notes need to be co-signed by an LPHA.

Any decision about how services are to be provided to children and families should be made in collaboration with the child and family, in the best interest of the child and family not for the convenience of the provider.

No, an individual receiving ACT services cannot receive the Peer Support Service component from another program.

For Youth ACT, peers are a required component of the staffing so as opposed to being optional it would not be allowable for a child enrolled in ACT to get peer support outside of the ACT team.¹

Medicaid Managed Care will reimburse for Peer Support Services as a billable service.  For commercial managed care plans, the provider would need to contact the individual managed care plan or check their contract with that plan to see if it is a covered service.

The billing codes and units are utilized from the nationally recognized HCPCS Level II manual. If the individual does not have Medicaid, providers should check with the individual’s insurance plan to verify if it is a covered service in their contract.

Yes, MHOTRS programs can refer to CORE or CFTSS for Peer Support Services if the MHOTRS programs cannot offer the service.