Orientation and Self-Assessment

This presentation is a revised version of the online orientation: https://www.hhs.texas.gov/providers/behavioral-health-services-providers/peer-support-services/certification-peer-support-a-medicaid-benefit 

Description of Peer Specialist Services

Peer support workers are people who have been successful in the recovery process who help others experiencing similar situations. Through shared understanding, respect, and mutual empowerment, peer support workers help people become and stay engaged in the recovery process and reduce the likelihood of relapse. Peer support services can effectively extend the reach of treatment beyond the clinical setting into the everyday environment of those seeking a successful, sustained recovery process.

Peer Support Role

Peer support workers engage in a wide range of activities. These include:

  • Advocating for people in recovery
  • Sharing resources and building skills
  • Building community and relationships
  • Leading recovery groups
  • Mentoring and setting goals

Peer support roles may also extend to the following:

  • Providing services and/or training
  • Supervising other peer workers
  • Developing resources
  • Administering programs or agencies
  • Educating the public and policymakers

Peer support workers may need to develop additional core competencies to provide services to specific groups who also share common experiences, such as family members. The shared experience of being in recovery from a mental health and/or substance use condition or being a family member is the foundation on which the peer recovery support relationship is built in the behavioral health arena.

Core Competencies for Peer Workers

What Are Core Competencies?

Core competencies are the capacity to easily perform a role or function. They are often described as clusters of the knowledge, skills, and attitudes a person needs to have to successfully perform a role or job. Training, mentoring, and supervision can help people develop core competencies.

Peer workers and peer recovery support services have become increasingly central to people’s ability to live with or recover from mental and/or substance use disorders. Community-based organizations led by peer workers also play a growing role in helping people find recovery. Both mental health consumers and people in recovery from substance use disorders have recognized the need for core competencies, and both communities actively participated in developing these core competencies for peer support workers.

SAMHSA—in conjunction with diverse subject matter experts—conducted research to identify core competencies for peer workers in behavioral health. The draft core competencies were posted online for public comment. The following document represents the final product of that process, which incorporated input from hundreds of people around the United States:

Potential Uses of Core Competencies

Core competencies have the potential to guide service delivery and promote best practices in peer support. They can be used to inform peer training programs, help develop certification standards, and inform job descriptions. Supervisors will be able to use these competencies to appraise peer workers’ job performance and peers will be able to assess their own work performance and set goals for continued development.

Core competencies are not intended to create a barrier for people wishing to enter the peer workforce. Rather they are intended to guide the development of initial and ongoing training that supports peer workers’ entry into this important work and continued skill development.

Principles of Core Competencies

Core competencies for peer workers reflect certain foundational principles identified by members of the mental health consumer and substance use disorder recovery communities. These are:

  • Recovery-oriented: Peer workers hold out hope to those they serve, partnering with them to envision and achieve a meaningful and purposeful life. Peer workers help those they serve identify and build on strengths and empower them to choose for themselves, recognizing that there are multiple pathways to recovery.
  • Person-centered: Peer recovery support services are always directed by the person participating in services. Peer recovery support is personalized to align with the specific hopes, goals, and preferences of the people served and to respond to specific needs the people has identified to the peer worker.
  • Voluntary: Peer workers are partners or consultants to those they serve. They do not dictate the types of services provided or the elements of recovery plans that will guide their work with peers. Participation in peer recovery support services is always contingent on peer choice.
  • Relationship-focused: The relationship between the peer worker and the peer is the foundation on which peer recovery support services and support are provided. The relationship between the peer worker and peer is respectful, trusting, empathetic, collaborative, and mutual.
  • Trauma-informed: Peer recovery support utilizes a strength-based framework that emphasizes physical, psychological, and emotional safety and creates opportunities for survivors to rebuild a sense of control and empowerment.
Frequently Asked Questions for Core Competencies for Peer Workers
  • What are competencies?
    Competencies are defined as the integration of knowledge, skills, and attitudes that contribute to the quality of a person’s work performance. Knowledge is information and understanding learned through experience or training. Skill is the result of applying knowledge or ability to a set of circumstances, and attitude is the way a behavior is performed. Attitudes often align with the principles or values of a practice.
  • What is meant by core competencies?
    Core competencies are the foundational and essential competencies required by anyone who provides peer support in behavioral health services. These competencies are common across a range of roles and environments. Peer roles in some settings or program models may require advanced or specialized competencies in addition to these core competencies.
  • Who are these competencies for?
    These competencies are intended for peer workers who offer formal peer support services within a behavioral health program. A peer worker is a person in recovery from a behavioral health condition who works, for pay or as a volunteer, in an organized program. Peers are defined as a person in recovery from mental and/or substance use disorders or, in the case of family peer support, a family member of a person living with a behavioral health condition.
  • How are these core competencies written and organized?
    The core competencies were written in active voice so that each competency would be an observable action. The competencies are organized into twelve categories for ease of reference and to make them more accessible.
  • How are these competencies to be used?
    Core competencies can be used to promote best practices in peer support. They can be used to guide peer training programs, provide standards for peer certification, and inform job descriptions and performance evaluations. Organizations can use the competencies to build career ladders for peer workers who wish to develop a career in peer support services. Supervisors can use competencies to appraise peer workers’ job performance and, most importantly, provide peers with a clear sense of the expectations of their roles. Peers will have more information to evaluate their own work performance, set professional goals, and become a more competent peer worker.

    Core competencies are not intended to impose requirements upon people just entering the peer workforce, but rather to provide guidance for developing initial and ongoing training that supports peer workers’ continued competency development.
  • What are the benefits of identifying core competencies?
    Core competencies have the potential to guide the delivery and promote best practices in peer support.
  • What is the difference between core competencies and practice guidelines?
    Practice guidelines are usually defined as a set of recommendations developed by practitioners that provide standards of service delivery. Medical, clinical, and other human service professions often have practice guidelines in addition to core competencies or performance standards. There is often much overlap between practice guidelines and core competencies as both articulate standards of behavior and philosophy of the approach.
  • Can these core competencies be customized to specific peer roles in specific work settings?
    Yes. The core competencies may be customized in practice to reflect the variety of peer roles and program settings.
  • How were these core competencies identified?
    SAMHSA asked BRSS TACS to identify and describe core competencies for peer workers in behavioral health services. BRSS TACS staff and a team of experts reviewed the literature, synthesized lists of potential competencies, and came to consensus about this list of core competencies.
  • Does the peer support role only provide resources for support and assistance?
    A peer’s role goes beyond providing reassurance, which may not always be the appropriate response to crisis. The response to any crisis needs to be responsive to the situation and can include active listening and empathy and, if appropriate, reassurance. The response can also include joint or independent problem solving; practical advice; concrete assistance of some kind; reaching out to family, friends, a treatment team, or other key stakeholders; and linkage to specialty services the peer worker cannot provide. The peer workers’ response to crisis is best understood as a continuum of potential responses. The key is being able to apply these different approaches and to know which approach to adopt and when. It’s also important to know to ask a supervisor for help when the best response isn’t clear.
  • What does it mean to “create safe spaces”?
    This refers to one of the values described in SAMHSA’s definition of recovery, which states that “recovery is supported by addressing trauma.” Services and supports should be trauma-informed to foster safety and trust.
  • Are there other crisis supports available for people in addictions recovery?
    Yes, these supports may be referred to as recovery management or relapse prevention.
  • What is meant by “recovery-oriented language”?
    The SAMHSA definition of recovery includes a set of principles that help advance recovery opportunities for many people. These principles promote the use of recovery-oriented language.
  • Who else should peer workers consider collaborating with?
    Peer workers who feel comfortable doing so should consider collaborating with other service systems such as hospitals, housing and homeless services, employment assistance, child welfare agencies, and the criminal justice system.
  • What is meant by a support network?
    A support network refers to the relationships one may have with family, friends and others that provide encouragement and support to help individuals achieve their recovery goals.
  • How to Download Core Competencies?
    SAMHSA in conjunction with subject matter experts conducted research to identify core competencies for peer workers in behavioral health and later posted the draft competencies developed with these stakeholders online for comment. This document represents the final product of that process. As our understanding of peer support grows and the contexts in which peer recovery support services are provided evolve, the core competencies must evolve over time. Therefore, updates to these competencies may occur periodically in the future.


What Is Recovery?

Through its engagement with key stakeholders, SAMHSA developed the following working definition of recovery:

Recovery is a process of change through which individuals improve their health and wellness, live self-directed lives, and strive to reach their full potential.

This definition does not describe recovery as an end state, but rather as a process. Complete symptom remission is neither a prerequisite of recovery nor a necessary outcome of the process. Recovery can have many pathways that may include professional clinical treatment; use of medications; support from families and in schools; faith-based approaches; peer support; and other approaches. There are four major dimensions that support a life in recovery:

  • Health: Learning to overcome, manage, or more successfully live with symptoms and making healthy choices that support one’s physical and emotional wellbeing
  • Home: A stable and safe place to live
  • Purpose: Meaningful daily activities, such as a job, school, volunteer work, or creative endeavors; increased ability to lead a self-directed life; and meaningful engagement in society
  • Community: Relationships and social networks that provide support, friendship, love, and hope
Minimum Qualifications

To be a peer specialist who bills Medicaid in Texas you must:

  • be at least 18 years of age
  • have lived experience with a mental health condition, substance use issue, or both
  • have a high school diploma or General Equivalency Diploma
  • be willing to appropriately share your recovery story
  • be able to demonstrate current self-directed recovery, and
  • pass criminal history and registry checks (link when live)
Steps for peers to become certified to bill Medicaid
  1. Complete online self-assessment and orientation
  2. Fill out, save, and print the attestation that you completed the self-assessment and orientation
  3. Apply for training with a certified training entity. You can find certified training entities with the Texas Certification Board.
  4. Complete the core peer services training
  5. Complete the SUD Recovery Coach or mental health peer training
  6. Apply for certification with the Texas Certification Board
  7. Complete 250 hours initial supervised work experience
  8. Receive first 2-year certification

Do You Want to Be a Peer Specialist?

The job of a peer specialist is to help instill the hope of recovery from behavioral health challenges or dual diagnosis. Peer specialists use their experience to help others engage in recovery. A person wanting to become a peer specialists must complete a training program and pass written exams.

Peer specialists have the opportunity to be aware of and openly share what they have learned in the recovery process.

The peer specialists training draws strongly on a person’s lived experience and recovery journey. This training can be intense and emotional, and peers are encouraged to carefully examine if they are prepared for this next step and have the necessary resources necessary to complete the training and examination process.

Please take the time to gauge your agreement with the following statements as a way to decide if peer specialist training is right for you at this point in your life.

  • How have you handled disclosing to other people that you have faced behavioral health challenges?
  • What has helped you move from where you were to where you are now? What did you do? What did others do?
  • What have you learned about yourself in your recovery?
  • What strengths have you have developed?
  • What do you do on a regular basis to help yourself feel well?
  • What are some of the beliefs and values you have or have developed that help strengthen and support your recovery?
  • How has facing individual challenges impacted your life?
  • How might you handle sitting in another’s discomfort?
  • What part does a sense of hope or resiliency play in your life and your recovery? What are some words you would use to describe this?
  • How have you dealt with difficult setbacks?
  • What external supports do you use, and how do they help you?
  • I am willing to disclose to my colleagues and peers that I have struggled with behavioral health challenges. I understand that in doing so, I help educate others about the reality of recovery.
  • I have the time needed to participate in a challenging course of study.
  • I have taken and completed formal schooling, adult education classes, have a GED or high school diploma.
  • I am able to travel away from my home for multi-day trainings.
  • I feel ready to be involved in a class that requires active participation.
  • I am able to participate in a full 8-hour training day.
  • I am able to discuss my own recovery story and experience with others
  • I can listen to others’ stories and feel empathy for their experience, even when it parallels painful experiences from my past.
  • I can arrange for my own transportation needs.

Once you finish reviewing this information and complete the self-assessment, you’ll need to complete the form below, save it, and apply to receive training.