Implementing an effective peer support program requires planning and broad stakeholder engagement to define the program's goals, objectives, and structure. Peer support programs are more likely to succeed if there is a commitment from internal leaders of your organization.

Considerations for how to assess the need for a peer support program, scope and design a hospital-based peer support program and obtain necessary internal buy-in may include:

• How do you engage a broad range of stakeholders and solicit the perspectives of people in recovery, family members, and staff early in the planning process to ensure that the program will meet support needs?
• Is there need for a hospital-based peer support program? Are similar services available in your community? Would a hospital-based program duplicate existing services? Are there opportunities to engage peers via partnership with community-based organizations?
• What populations should be the focus of the program (ex: those being discharged from inpatient psychiatric care, individuals seeking crisis care in the emergnecy department, individuals being treated for primary physical health concerns who have underlying behavioral health challenges)? What specific cultural competencies will be needed to effectively engage the target participant population? Are there evidence-informed practices and engagement techniques established for engaging the target participant population?
• What funding is available to support the program? What are the benefits and barriers to providing Pennsylvania Medicaid-reimbursable peer services? Is there grant funding available to pilot the program?
• Who on the leadership team can champion peer support services? How can you engage leadership early in the design process? Who within leadership can advocate for the inclusion of peer specialists within the organization and secure the ongoing resources to support this goal? The ideal leadership champion will have the authority to make the policy and organizational changes necessary to support the program.

Implementing a successful peer support program requires establishing roles and responsibilities for staff and peer support specialists; establishing clear, evidence-informed policies and practices; and hiring, onboarding, developing and retaining effective peer specialists.  

Considerations may include:

• What internal preparation is needed to fully integrate peers into the care team? Is your organization’s culture and language recovery-oriented? How will you educate and orient existing staff about peer support services?
• What are the core skills/competencies necessary for the peer support specialists engaging the target participant population? How do you write a detailed job description to attract qualified candidate? What pay, benefits, and accommodations are necessary to retract and retain peer specialists?
• How do you expand your typical applicant search activities to attract individuals who want to share their lived experience? Who should be engaged in the hiring process to ensure that key stakeholders are invested in candidate success? Are hiring teams clear on the competencies and expectations for the role? Is the hiring team trained on considerations related to interviewing a person with a legal record? What internal waivers or clearances are needed to hire candidates with legal records? Does the hiring team understand the parameters of the Americans with Disabilities Act as it relates to considerations needed during the interview and employment process?
• How do you create a positive onboarding experience for peers who may be new to hospital workplaces? How will you support peer supporters in their professional development and ensure that peer staff have access to resources necessary to succeed in their role? How do you ensure that peer support specialist and supervisory staff have shared, and clear expectations related to boundaries and ethics? How do you ensure that supervisors are equipped with clear guidelines detailing expected functions for providing quality, consistent, supportive supervision?

Assessing the program is an opportunity to monitor the program’s efficacy and identify ways to adapt the program to better meet the needs of stakeholders—peers support workers, participants and clinicians. Considerations may include:

• How can you include a range of perspectives in the evaluation effort? Is there an opportunity to engage program participants in the evaluation of the program?
• How do you solicit the perspective of peer support specialists in evaluating the program?
• What patient data can serve as a source of information and show the clinical impact the program is having on participants (ex. re-hospitalization rates, qualitative participant feedback, opportunities to look at program impact across various participant demographics)?

Sustaining a program requires planning for the future, being willing to change and adapting to meet the evolving needs of those you serve, and potentially expanding the program to new populations. The following considerations are important when looking at the long-term health of peer support programs:

• Are there opportunities to adapt the program to better meet the needs of program participants and peer specialists?
• How do you support peer staffs’ ongoing development? What career ladder exists to retain effective peer specialists? Are supervisors equipped to support ongoing development of peer team members?
• Are there opportunities to expand the program to new participant populations?
• Are there opportunities to stay in contact with program participants after they have received peer services and offer them opportunities to be engaged in the program?
• How do you raise awareness among commercial insurers and HealthChoices Behavioral Health Managed Care Organizations about your hospital-based peer program?

City of Philadelphia Department of Behavioral Health and Intellectual disability Services, Peer Support Toolkit  In-depth toolbox includes modules highlighting promising practices on preparing the organization culture as well as practical tools such as recovery self-assessment tools and assessment facilitator’s guide, sample peer staff function and responsibility statements, sample interview questions for peer staff, peer supervision, and peer self-assessment tools.

HAP Peer Support Spotlight Video:  Angela Elliston, CPS, recovery specialist, community wellness team, Allegheny County Department of Human Services, discusses her role supporting people in recovery.

Johns Hopkins Medicine Armstrong Institute for Patient Safety and Quality, Roadmap to Peer Support:  General guidance on how to build and maintain a peer support program as well as access to tools and resources informed by seven existing peer support programs.

National Association of Peer Supporters:  Website includes National Practice Guidelines for Peer Specialists and Supervisors.

SAMHSA Value of Peers Infographic:  Graphic defining peer support, the role of peer workers, and outlining emerging research on the efficacy of peer support.

Pennsylvania Department of Human Services Office of Mental Health and Substance Abuse Services Peer Support Provider Resources:  Website includes Medicaid Funded Peer Support Services FAQ, Peer Support Services Service Description Review Checklist, and Peer Support Services Bulletin.

Pennsylvania Peer Support Coalition:  Coalition’s mission is to support peer-based professions by offering continuing education, networking opportunities, and advocacy around the development of relevant statewide policies in an effort to promote quality services and strengthen the overall profession. Website includes listing of peer support service providers by county, extensive peer and supervisor training resources, and access to Recovery Ecosystem Coalitions and virtual drop-in sessions to better serve the peer-based professional community throughout the state.

University of Colorado School of Medicine, Behavioral Health & Wellness Program DIMENSIONS of Peer Support Program Toolkit:  Document includes evidence-based information about the effectiveness of peer support programs as well as step-by-step instructions to create a successful and sustainable peer support program. Contains worksheet to support organizational planning.