The Critical Role Peer Support Specialists Play on ACT and FACT Teams

For individuals experiencing homelessness, cycling through incarceration, or managing substance use disorders, trust is often the biggest barrier to care. Peer Support Specialists—individuals with lived experience trained to work with people with behavioral health challenges—are often part of multidisciplinary care teams to bridge that gap.

Assertive Community Treatment (ACT) and Forensic Assertive Community Treatment (FACT) are evidence-based models designed for people with the most complex behavioral health needs. These models are proven to work—and peers are a critical part of their success, especially during key moments of transition.

Here’s how ACT and FACT models work, and why Peer Support Specialists are essential to their success.

About Assertive Community Treatment (ACT) and Forensic Assertive Community Treatment (FACT) models

ACT is designed for individuals with serious mental illness who are not well served by traditional outpatient care—often those experiencing repeated crises, homelessness, or disengagement from services.

Rather than referring people across fragmented systems, ACT teams deliver care directly in the community. Services include psychiatric care, substance use treatment, housing support, employment services, and crisis response.

Forensic Assertive Community Treatment (FACT) applies this same approach to people involved in the justice system. It connects behavioral health care with reentry and supervision systems, with the goal of reducing incarceration and supporting long-term stability. In California, FACT is typically delivered within ACT teams or broader care structures, rather than as a standalone program.

Both models rely on multidisciplinary teams that operate with shared caseloads, often with low staff-to-client ratios and round-the-clock availability.

ACT and FACT Models: A Breakdown

Sources: SAMHSA; DHCS

Do ACT/FACT models work?

ACT/FACT models are widely considered among the most effective for supporting individuals with the most intensive needs. Research shows these models help:

• Reduce psychiatric hospitalizations and length of stay
• Decrease homelessness and improve housing stability
• Reduce involvement with the criminal justice system
• Improve engagement in care and overall functioning

The role of peers in ACT and FACT models

ACT and FACT teams include both clinical and non-clinical staff—psychiatrists, nurses, substance use specialists, employment specialists, and Peer Support Specialists.

Although both ACT and FACT teams include peer specialists, FACT explicitly includes a peer specialist with criminal justice experience. For many individuals, engagement depends on trust, which is often built through shared experience.

How peers improve outcomes in ACT and FACT models

Peer Support Specialists bring something clinical roles cannot: lived experience. That lived experience allows peers to build trust quickly, meet people where they are, and stay engaged in ways that traditional systems often struggle to do. Extensive research shows that peer support:

• Increases engagement in community-based care
• Reduces hospitalization and use of high-cost services
• Improves quality of life outcomes

Peers are especially critical for populations that behavioral health systems consistently struggle to reach and sustain engagement with over time.

Peers in homelessness outreach

People experiencing homelessness are frequently described as “hard to reach” due to distrust of systems, prior negative experiences, and complex co-occurring needs. Peers help bridge that gap. Their lived experience allows them to build credibility quickly, communicate in ways that resonate, and meet people where they are physically and emotionally.

Research shows that peers are effective because they can “speak a common language,” understand barriers firsthand, and build relationships grounded in trust rather than authority. In practice, this means:

• Spending time in the field building relationships over multiple touchpoints
• Supporting navigation of housing systems and applications
• Maintaining engagement even when individuals cycle in and out of services

This relationship-based approach is core to ACT/FACT models, which rely on consistent, community-based engagement rather than one-time interventions.

Peers in substance use recovery

Recovery is not linear. It requires sustained support beyond clinical settings. Peers provide non-clinical, relationship-based support grounded in lived experience, helping individuals initiate, navigate, and sustain substance use recovery over time. Specific ways peers do this include:

• Helping individuals set recovery goals and stay engaged in care
• Connecting people to recovery communities, social supports, and services
• Providing mentorship, encouragement, and real-world coping strategies
• Meeting people where they are, including during relapse and re-engagement

Research shows that peer support in substance use recovery settings is associated with:

• Increased treatment engagement and retention
• Reduced substance use and relapse rates
• Stronger social connections and recovery support networks

Peers also help rebuild what formal systems often cannot: a sense of belonging and belief that recovery is possible, in a setting where disengagement and relapse are common. Peers help teams stay connected to individuals through those moments, turning short-term stabilization into long-term recovery.

Peers in criminal justice and reentry

Research and policy guidance increasingly emphasize that peers are uniquely positioned to improve engagement and continuity of care for justice-involved populations, particularly those with co-occurring mental health and substance use conditions.

Many individuals cycling through jails and prisons have learned not to trust behavioral health or government systems. Peers help rebuild that trust through:

• Helping individuals navigate the transition from custody to community care
• Connecting people to services immediately upon release
• Reducing fear and stigma around engaging in treatment

Due to their lived experience, peers can anticipate barriers that traditional providers may miss and intervene earlier.

Why this matters for ACT and FACT teams

ACT and FACT models are built on continuous, community-based care for people with the most complex needs. Peers make this possible by keeping individuals engaged throughout the complex realities of recovery.

They help build trust where systems have failed; sustain engagement through crisis, relapse, and instability; and help translate clinical care into real-world recovery. Without peers, ACT/FACT teams risk becoming just another program people cycle through. With peers, they become a pathway to long-term stability.

How ACT, FACT, and peer support work in California

California delivers ACT and FACT through Full-Service Partnerships (FSPs), the state’s “whatever-it-takes” model for people with the most complex needs. FSPs integrate clinical care, housing, and substance use services into a single, coordinated system, with ACT and FACT representing the highest level of care and long-term engagement.

Under the Mental Health Services Act (MHSA), Peer Support Specialists were incorporated into outreach, crisis services, and recovery-oriented programs. But for years, peer support was not Medi-Cal reimbursable, limiting how widely it could be integrated into care teams. That changed in 2020 with SB 803, which established certification and enabled reimbursement.

The Behavioral Health Services Act (BHSA), passed through Proposition 1 in 2024, builds on that foundation by expanding community-based care to substance use disorder treatment, increasing county funding for Full Service Partnerships, and integrating ACT/FACT models into Full Service Partnership standards of care.

With behavioral health initiatives—namely CalAIM, the Behavioral Health Services Act, and BH-CONNECT—being implemented across the state, the California Department of Health Care Services (DHCS) has developed thorough guidelines for integrating peers into ACT/ACT teams. These guidelines outline staffing model requirements and the unique roles peers should play in delivering care:

• ACT/FACT Staffing Requirements: A full-size ACT/FACT team must have two peer support specialists. Smaller teams must have at least one.
• Peers’ Role on ACT/ACT: Peers can help “bridge the gap” between providers and clients by promoting a respectful, inclusive team culture. DHCS also references their ability to offer direct support to clients and their loved ones, and provide referrals and linkages to other supports.

To ensure peers are fully integrated into care delivery, fidelity measurement is critical. As part of California’s broader CalAIM behavioral health initiative, the state—in partnership with the UCLA Center of Excellence for ACT and FACT—is also requiring ACT and FACT teams to implement fidelity measures. Teams begin with a baseline assessment using the Core Components Checklist, then progress to the Tool for Measurement of Assertive Community Treatment (TMACT), a more rigorous tool that evaluates how well those elements are implemented in practice. These fidelity measures reinforce that they are not simply an add-on—they are essential to engagement, trust-building, and sustained recovery.

With peers now reimbursable, expanded FSP capabilities, and clear fidelity guidelines, California has an opportunity to more intentionally embed Peer Support Specialists—especially those with lived SUD and justice system experience—within ACT and FACT teams.