The field of peer support is quickly gaining prominence and visibility across the domains of behavioral health and substance use services. Georgia was the first state to provide Medicaid-billable mental health peer services in 1999 – it was not until 2012 that Medicaid billing was authorized for the provision of substance use services. Now, 49 out of the 50 states have allowed for the provision of Medicaid-billable peer services (Bell et al., 2024). It has been shown that peer support can bridge the gap between patients and clinicians, improving treatment outcomes and engagement. However, lack of training and adequate supervision, unclear expectations of role clarity and differentiation, and limited opportunities for career advancement are all structural barriers that impact the provision of these services.
The onboarding process is crucial for peers in the workforce, in getting the opportunity to be informed, welcomed, and guided into the policies and procedures of a particular company. Being included in the onboarding process and getting to see how the company operates is crucial to ongoing success. At New York Psychotherapy and Counseling Center (NYPCC), onboarding also provides an opportunity to introduce oneself as a peer and explain the importance of the work and how it can support clientele by focusing on shared, lived experiences, and bridging the gap between providers. NYPCC believes that it is important in combating stigma and misunderstanding of the peer role and unique function of the services provided (BJA, COSSUP, 2023).
Having access and encouragement to attend a wide variety of trainings, both in-house and outside of the company is at the core of NYPCC’s values. This is meant to provide further development within the peer role as well as future professional development opportunities and it is paramount to a peer’s continued engagement and motivation in continuing to learn and develop important skills. Some of these trainings at NYPCC include workshops and presentations on evidence-based practices that may benefit the population served, and getting linked to state-wide peer networks and coalitions to continue networking and seeking advice and support from others in the field, particularly for peers on small, tight-knit teams, where immediate support may not always be available.
At NYPCC, supervision is a space where peers are provided with the resources necessary to perform in their role and allow space for discussions of transference/countertransference that may arise in the working relationship between peer and client. Having regular supervision from a supervisor who has worked with peers in the past and has had training on trauma-informed approaches to peer supervision is especially important to retain peers long-term. Supervision is not only a place to be held administratively accountable, but also a place where there is room for discussion around continuing education and being provided additional support and guidance as necessary. It is also especially important for the peer specialist to be included in group clinical supervision, to provide unique insights into approaches to clients and be a valuable voice to a team of mostly clinical staff (Stefancic et al., 2021).
As a peer, shadowing other departments and individual clinicians can help to see where the responsibilities of a peer differ from those of a clinician or a case manager. It is also important for peers to remain mindful of their scope of practice, and if necessary, to revisit their ethics policies if they are certified or credentialed within their state of practice. The phenomenon of “peer drift” or “co-opting” occurs when peers find themselves outside of their scope of practice, navigating into solely administrative or clinical tasks in nature. This is why it is important for peers and supervisors to continue to be mindful of “peer drift” when a peer evolves into a role that is strictly clinical or administrative in nature and forgets the importance of peer-driven work (Whitson et al., 2025). These practices are part of peer training, onboarding and ongoing development at NYPCC.
It is equally important to be nurtured and grown professionally and intentionally, as peers may choose to seek certification in a more clinical scope of practice or decide to go back to school for further education. This is why supervision is important to be able to discuss professional development openly and be encouraged to grow in areas self-defined by the peer’s background and future goals (SAMHSA, 2023).
In conclusion, peers can be supported in their workplace and professional development, by having an onboarding process that highlights the importance of the peer role and its unique space in both behavioral health and substance use treatment, continuing to have ongoing trainings that further develop the peer’s skills and knowledge, and having supervision that is tailored to the needs of the peer. These protective factors can help a peer navigate the workplace and their role, while also providing resources for professional advancement and continued development.
Christopher Doherty, CRPA, is a Certified Recovery Peer Advocate and Jill Mastrandrea, LMHC, CASAC, is the Director of Program Innovation and Director of the OASAS Clinic at New York Psychotherapy and Counseling Center (NYPCC). For more information, please email JMastrandrea@nypcc.org.
References:
Bell JS, Hagaman A, Beattey J, Fears G, White WL, Watson DP. Advancing peer support workforce research: Insights and recommendations through the lens of professionalization. J Subst Use Addict Treat. 2025;170:209612. doi:10.1016/j.josat.2024.209612.
Stefancic A, Bochicchio L, Tuda D, Harris Y, DeSomma K, Cabassa LJ. Strategies and Lessons Learned for Supporting and Supervising Peer Specialists. Psychiatric Services. 2021. doi:10.1176/appi.ps.202000515.
Whitson S, de Haan Z, Preece S, et al. Family Peer Worker Perspectives on the Critical Issues for Family Peer Support in Youth Mental Health Settings. Early Interv Psychiatry. 2025;19(6):e70066. doi:10.1111/eip.70066.
