How Peer Support Specialists use lived experience to improve engagement, recovery, and continuity of care
Peer Support Specialists, often called “Peers,” have become a vital element of California’s behavioral health system. Their power lies in their lived experience with substance use or mental illness. Peers use this experience, paired with formal Medi-Cal–recognized training, to help people navigate recovery with empathy and credibility.
As California invests in its community-connected workforce, understanding the role of Peer Support Specialists is critical, particularly as the state confronts rising mental health needs, workforce shortages, and landmark behavioral health reforms.
Defining Peer Support Specialists
Peer Support Specialists are individuals with lived experience of mental illness and/or substance use disorder who complete a state-approved training and certification process to provide behavioral health recovery services. They work under the supervision of a behavioral health professional as part of a team-based care model.
Rayshell Chambers, Executive Director at peer-run nonprofit Painted Brain, describes the unique value of Peer Support Specialists in the recovery process during a panel at our inaugural Vision 2030 Solution Symposium:
The certification process for Peer Support Specialists includes several training and lived experience requirements:
- Self-identify as having lived experience with a mental health or SUD condition
- Complete 80 hours of CalMHSA-approved training
- Pass a certification exam
- Commit to a Code of Ethics
- Complete continuing education every two years
Peers can also pursue additional training in four Areas of Specialization, designed to meet the needs of specific populations:
- Parent, Caregiver, Family Member Peer: Supports parents, caregivers, and family members navigating behavioral health treatment for a loved one.
- Peer Services in Crisis Care: Integrates peers into crisis settings; includes training in prevention, conflict resolution, and post-crisis support.
- Peer Services for Unhoused Individuals:Draws on lived experience with homelessness to support individuals navigating behavioral health care, housing resources, and co-occurring conditions.
- Peer Services for Justice Involved: Helps people connect to behavioral health services, prevent further justice-system involvement, and ease reentry.
What Peer Support Specialists Do
Peer Support Specialists provide culturally competent, recovery-oriented services that help people connect to care, stabilize, and sustain long-term recovery. They help prevent relapse, strengthen self-advocacy, build natural supports, and foster independence — enabling people to not only survive but thrive in their communities. Core services include:
- One-on-one peer support
- Group coaching and facilitation
- Recovery goal-setting
- Engagement and motivational support
- Educational skill-building
- Linkages to services and community resources
- Support for families navigating a loved one’s recovery
- Navigation and accompaniment to appointments
Peers can work in clinical, community, home, shelter, crisis, or justice settings — making them one of the most flexible and adaptive parts of the behavioral health workforce.
Where Peer Support Specialists Fit in the Continuum of Care
Peers fill a critical relational and engagement role — helping people stay connected and gain trust in the system. Peer Support Specialists work under the direction of licensed behavioral health professionals. They collaborate closely with behavioral health professionals, social workers, community health workers, and other community-based supports to aid in the full range of recovery.
Peer Support Specialists Versus Community Health Workers
Community Health Workers (CHWs) perform a similar community-based function, but the roles differ significantly. While both Peers and CHWs share a commitment to community connection, their eligibility, training requirements, and service focus vary in important ways.
CHCF’s statewide comparison shows clear distinctions across training, Medi-Cal benefit type, and scope of work: Peers specialize in recovery and behavioral health, while CHWs focus on preventive services and navigation.
A Comparison Table: Peer Support Specialists & Community Health Workers
| Peer Support Specialists | Community Health Workers | |
| Lived Experience Requirement | Lived experience with mental illness or SUD required | Lived experience required, but broader (can include incarceration, pregnancy, DV survivor, homelessness, etc.) |
| Services Focus | Focused on recovery, relapse prevention, coping skills, engagement | Focused on navigation, prevention, health education, screenings |
| Eligibility requirements | Must be 18+ years, have high school diploma or GED | No minimum age or education requirement |
| Certification & Training |
|
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| CE Requirement | 6 hours per year | 20 hours and must recertify every 2 years |
| Supervision Requirement | Supervised by a behavioral health professional | Supervised by a community-based or clinical organization |
| Medi-Cal Benefit Type | Medi-Cal behavioral health benefit | Medi-Cal preventive services benefit |
| Patient eligibility requirement |
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| Covered Services for Patient | Depends on approved care plan | Up to 12 units (30 mins. each) without prior authorization, then must have a written care plan from a licensed provider (valid for up to a year |
The Department of Health Care Services (DHCS) began covering Community Health Worker (CHW) services as a Medi-Cal benefit in 2022. Under CalAIM, CHWs are recognized as providers within Enhanced Care Management (ECM) and Community Supports, which are delivered by Managed Care Plans (MCPs). Peer Support Specialists, however, are not currently included as eligible ECM providers. This limits the settings where peers can provide care, despite their central role in recovery and engagement.
Why Peer Support Works
Peer support is one of the most studied and effective recovery tools in behavioral health. Since the 1990s, research has consistently shown that Peer Support Specialists improve outcomes and reduce system strain. Chambers discusses this in more detail in the below video:
Improves patient outcomes
Quantitative and qualitative research confirms the transformative power of Peer Support Specialists on recovery. Dozens of studies have shown that using peers in recovery care:
- Reduces re-hospitalization rates
- Reduces days inpatient
- Increases use of outpatient services
- Increases quality of life outcomes: Studies show that PEers reduce depression symptoms, prevent relapse, help with employment, and increased social networks
Data tells part of the story, but lived experience brings it to life. In the video below, former foster youth describe their journeys from system-involved teenagers to empowered Peer Support Specialists:
Saves costs and strengthens the behavioral health workforce
Peer Support Specialists not only improve outcomes. They also lower system costs by reducing hospitalizations, inpatient stays, and emergency service utilization.
They also create career pathways for people with lived experience, which in turn builds our under-resourced behavioral health workforce.
In a system increasingly strained by shortages, peers are a sustainable and equity-centered workforce solution that have significant positive impact.
How Peer Support Evolved in California
Peer Support Specialists have existed for decades, but it wasn’t until recently that the state recognized their importance. In 2020, Governor Newsom signed Senate Bill 803, a bill the Steinberg Institute sponsored that requires the state to set up a process for certifying peer support specialists. It also enables counties to be partially reimbursed by the federal government for the services they provide, incentivizing the hiring of more staff to expand the workforce of people who can help respond to the state’s worsening mental health crisis. By 2022, Medi-Cal benefits for peer services went live across Specialty Mental Health Services (SMHS) and Drug Medi-Cal Organized Delivery System (DMC-ODS).
This has resulted in a significant expansion of peer support services. As of 2025, 50 of California’s 53 counties have opted in to provide Peer Support Services through one or both behavioral health delivery systems.
Conclusion
Peer Support Specialists offer something the behavioral health system needs: connection, credibility, and a powerful model of hope. They strengthen recovery, reduce inequities, lower costs, and fill critical workforce gaps. As California transforms its behavioral health system through its Behavioral Health Transformation initiatives, expanding the role of peers is essential to supporting long-term recovery or people with serious mental illness and substance use disorders.
Our TakeCalifornia must expand Peer Support Specialist roles. Peer Support Specialists offer something the behavioral health system needs to support long-term recovery: connection, credibility, and a powerful model of hope. They strengthen recovery, reduce inequities, lower costs, and fill critical workforce gaps. As California transforms its behavioral health system through its Behavioral Health Transformation initiatives, expanding the role of peers — including integrating them into CalAIM’s ECM benefit is not just an opportunity. It’s essential. |