A 2013 Cochrane Review of 11 randomized controlled trials concluded that service use outcomes for clients were no better or worse when mental health teams included consumer-providers compared to when they did not. A systematic review published a year later by Chinman et al. concluded that, with the exception of one reviewed study, adding peers to service teams and peers delivering curricula showed positive outcomes compared to use of professional staff only. Both noted the weak evidence and lack of methodological rigor in the studies included in the reviews. Lack of consistency in training requirements and role definition among peer providers make rigorous comparative effectiveness studies difficult to conduct.

This study, which began in Fall 2019 and is conducted jointly by the HWRCs at the University of Michigan and the University of California-San Francisco, has the following aims:

  1. assess the literature to better define worker roles across behavioral health settings;
  2. employ a quasi-experimental design to compare direct costs for behavioral health services in a sample of facilities with peers to facilities without peers; and 3) assess treatment outcomes or treatment adherence with and without peers.

Published literature primarily focuses on peer services to treat serious mental illness. This study will separately consider peer services in mental health treatment facilities and substance use treatment facilities.



In order to assess the effectiveness of peers in helping behavioral health clients achieve and maintain recovery, emotional and instrumental support provided individually and in groups were the hallmark of peer-provided services, with multiple peers describing their provided services as “meeting others where they are” and “walking alongside them in their recovery. The majority of organizations employed between 2 and 10 peers, who were required to complete training and be certified upon hire with career advancement opportunities as a benefit of certification. Titles held by peers were Certified Peer Specialist (7); Recovery Coach (2); Certified Peer Recovery Coach (1); Community Peer Supporter (1); Peer Supporter; Peer Advocate (1); and Recovery Support Specialist; some holding more than one peer support title.

Overwhelmingly, those in non-peer roles advocated for the value of peer services. Despite the merit of peer services reimbursement rates remain low, potentially dissuading peers from practicing in the long-term. Medicaid billing for peer services may motivate organizations to expand peer service availability, but without increased reimbursement rates it is unlikely to prompt widespread adoption. Higher reimbursements rates, in conjunction with greater tracking and evaluation of peer-delivered service efficacy, are imperative for building the needed evidence to support large-scale incorporation of peers into behavioral health care.