Exploration

The purpose of exploration is to learn about peer recovery support services, gather important information, and engage in guided discussions to make an informed decision: to move forward with implementation—or not. Exploration is best accomplished with a team approach because a team offers several advantages over a single champion approach. Tasks of exploration include learning about what peer recovery support services are (types of peer professionals, the Wisconsin model, benefits, and evidence) and what peer recovery support services are not (limits). Then, considering need, fit, and organizational capacity will provide the final details to make an informed decision.

Exploration task checklist:

Form a leadership team.
Learn about peer recovery support services (types of peer professionals; the Wisconsin model; what peer professionals do; benefits, evidence, and limits of peer recovery support services), then summarize your learning.
Consider needs, fit, and capacity.
Make a decision: Move forward with implementation—or not.

Form a leadership team

Forming a leadership team to guide the process of exploration, preparation, and action is one of the most important ingredients of organizations that successfully innovate in human services (McGuier et al., 2024). Such a team brings together needed perspectives and expertise, provides the peoplepower to complete tasks in this toolkit, convenes meetings with key staff to provide information and receive input, and makes decisions along the way. Use the Form a Leadership Team Worksheet to guide forming a team.

Types of peer professionals in Wisconsin

A peer professional is a person who uses lived experience, training, and supervision to support individuals in recovery from mental health and/or substance use challenges through delivering non-clinical, recovery-oriented services. There are three primary types of peer professionals operating across Wisconsin: peer recovery coaches, certified peer specialists, and certified parent peer specialists.

Peer recovery coach

Under Wis. Admin. Code ch. DHS 72 (DHS 72), the term peer recovery coach (PRC) refers to the peer professional role that provides peer recovery support services. The PRC is an individual who practices in the recovery field and provides support and assistance to individuals who are in treatment or recovery from mental illness, a substance use disorder, or both. PRCs use their lived experience as a person-in-recovery or caregiver of a person-in-recovery—combined with training and supervision—to guide and support service participants’ recovery process, choices, and goals. Peer recovery support services are non-clinical services provided by the PRC designed to meet the needs of individuals in or seeking recovery. For Medicaid-reimbursement of peer recovery support services, DHS 72 outlines requirements related to the PRC’s training hours, supervision, documentation, and coordination of services.

Certified peer specialist

The certified peer specialist (CPS) is a peer professional with lived experience of mental health and/or substance use challenges who uses that experience—in combination with formal training and supervision—to support service participants’ recovery process through mutual support, skill-building, resource navigation, and recovery-focused services. To become certified, individuals must pass a competency-based exam following comprehensive training. Becoming a CPS is an eligible pathway for individuals to serve in the peer recovery coach role to provide peer recovery support services under DHS 72 when the individual meets DHS 72 training, supervision, documentation, and service coordination requirements.

Certified parent peer specialist

The certified parent peer specialist (CPPS) is a peer professional with lived experience as a parent or caregiver of a child or youth with mental health and/or substance use challenges. A CPPS uses their lived experience—combined with training and supervision—to support other parents and caregivers through mutual support, systems navigation, advocacy, skill-building, and connection to resources that strengthen family well-being and youth recovery. Similar to the CPS, to become certified, individuals must pass a competency-based exam following comprehensive training. Although DHS 72 does not use the term CPPS, DHS 72 recognizes lived experience as a parent or adult family member of an individual with mental health and/or substance use challenges as qualifying lived experience for the peer recovery coach role. A CPPS may provide peer recovery support services under DHS 72 when the individual meets DHS 72 training, supervision, documentation, and service coordination requirements.

Wisconsin model of peer recovery support services

Although the types of peer professionals may differ in population focus and service context, foundational service components exist across all Wisconsin peer professionals. DHS developed the Wisconsin model of peer recovery support services comprising pillars of the workforce, fundamental processes, core skill sets, and the recovery-oriented principles that guide practice. While Wis. Admin. Code ch. DHS 72 provides the framework for Medicaid-reimbursable peer recovery support services, this model describes the underlying components of what makes these services effective.

Pillars of the workforce

Core competencies

The Wisconsin Certified Peer Specialist Core Competencies, P-00972B (PDF), describe the knowledge, skills, and values that underscore effective peer recovery support services. Competency areas include:

Understanding recovery as a self-directed process of change.
Using lived experience and recovery to guide the recovery process.
Maintaining role clarity and professional boundaries.
Effective communication.
Supporting participants in identifying strengths, goals, and recovery priorities.
Resource connection.
Supporting participant voice and self-advocacy.

Services are grounded in a trauma-informed, person-centered, and strength-based approach that aligns with DHS 72 regulations.

Scope of practice

The Wisconsin Certified Peer Specialist Scope of Practice, P-00972 (PDF), describes the peer professional delivery of recovery-oriented supports that are complementary to—but distinct from—clinical services. Peer professionals use lived experience to guide and support service participants’ recovery choices, goals, and decisions. Within this scope, responsibilities include:

Supporting engagement in behavioral health services.
Assisting participants in skill-building.
Connecting to services, resources, and supports.
Strengthening natural and community supports.
Coordinating services with goals noted on participant service plans when applicable.

Peer professionals operate within the scope of practice on existing clinical teams with collaboration and support from the supervisor.

Code of ethics

The Wisconsin Certified Peer Specialist Code of Ethics, P-00972A (PDF), outlines principles that guide peer professionals in providing services that are respectful, safe, and effective. The code includes:

Honoring service participant self-determination and autonomy.
Maintaining confidentiality.
Avoiding dual relationships.
Maintaining appropriate boundaries.
Operating within the scope of practice.
Proactively seeking supervision.
Practicing cultural humility.
Maintaining personal well-being to provide effective services.

Fundamental processes of peer recovery support services

Connecting

Effective services begin with connecting through building trust, rapport, respect, and engagement in services. Mutuality of lived experience provides the foundation of the peer-to-peer relationship.

Exploring

Exploring continues the connecting process to understand the service participant:

Strengths, values, hopes, and dreams
Past recovery efforts, challenges, and successes
Current concerns, challenges, and priorities

The exploration process informs the focus of peer recovery support services.

Supporting

Based on the service participant’s priorities, the peer professional provides trauma-informed, strength-based support to address identified concerns and challenges. There are several tasks that the peer professional has available to provide effective, person-centered support:

Supporting service participant’s lived experience, self-care, community care, and wellness
Considering multiple pathways to recovery
Exploring decision-making on a range of concerns
Assisting with navigation to address service barriers and support engagement
Sharing part of one’s recovery story to inspire hope

Planning

The supporting process may lead to a planning conversation in which the service participant’s recovery ideas, goals, or dreams are explored. Identifying resources and supports, problem-solving barriers, and outlining next steps can be a part of planning so the service participant can move forward in a self-directed way. When applicable, planning aligns with service goals or coordinated services.

Advocating

Advocating is sometimes required as a follow-up to planning. There are several potential areas for advocacy:

Service participant access or engagement in desired services
Addressing barriers identified during planning
Resolving a specific concern or challenge
Supporting self- and community care efforts

In peer recovery support services, advocating is always done with (not for) service participants in a way that furthers connecting and the relational foundation of services.

Essential skill sets of the peer professional

Communication with OARS+I skills

OARS+I stands for asking Open questions, looking for strengths and Affirming, careful listening with Reflection, periodically Summarizing, and providing Information through a collaborative “ask-share-ask” procedure. These skills embody trauma-informed, person-centered, strength-based services to guide the recovery process, support informed decision-making, and strengthen service engagement.

Cultural humility

Cultural humility is the ongoing practice of self-reflection, openness, and learning that helps peer professionals provide person-centered, strength-based, and trauma-informed support to service participants with diverse lived experiences and identities. Peer professionals approach conversations with curiosity and respect, prepare through continued learning, and remain aware of personal biases. Cultural humility supports meaningful exploration of strengths, values, and recovery experiences; helps identify barriers related to inequitable access; and ensures support is responsive to each individual’s background and recovery priorities.

Self-care and community care

Self-care and community care is the ongoing practice of maintaining personal wellness and supportive connections to sustain effective peer recovery support services. It includes:

Self-awareness of one’s thoughts, feelings, stress levels, and recovery needs.
Engaging in regular activities that support emotional, physical, and overall well-being.
Building supportive relationships with peers, supervisors, and community networks.

Preparation for challenges, use of supervision, and seeking support when personal recovery or well-being is affected are essential to ethical and sustainable practice.

Recovery-oriented principles guide practice

The Wisconsin model of peer recovery support services is guided by the 10 principles of recovery (PDF) from the Substance Abuse and Mental Health Services Administration (SAMHSA).

Recovery principles and descriptions

Hope for change: Based on lived experience, peer professionals hold out the belief that recovery is possible. It’s a motivating message of a better future and hope provides a catalyst for change.
Person-driven: Peer professionals emphasize service participants’ self-determination to define their own life goals and unique path toward those goals. Service participants’ autonomy and independence to make decisions is embraced.
Many pathways: Although the peer professional knows what worked in their own individual recovery process, multiple pathways to recovery (example: use of medications, natural supports, faith-based supports) are embraced.
Holistic: Peer professionals recognize that recovery encompasses the whole person (mind, body, spirit, community) and services may include a wide range of supports such as addressing self-care practices, family, housing, employment, transportation, and education, as well as engagement in behavioral health services, health care, and alternative medicine.
Peer support: The mutuality of peer-to-peer support is the bedrock of peer recovery support services. Through helping others and giving back to the community, one helps one’s self and community.
Relational: Recovery is based on relationships that provide a sense of meaning, belonging, and community. Fundamentally, the work of peer support is about developing and maintaining good working relationships with service participants.
Culture: Peer professionals recognize that cultural background (including values, traditions, and beliefs) are keys in supporting service participants’ unique pathway to recovery.
Addresses trauma: The experience of childhood trauma (such as physical or sexual abuse) is common among Wisconsinites and is linked with chronic health conditions later as adults (Child Abuse and Neglect Prevention Board, 2018). Peer professionals are sensitive to the negative effects of trauma and seek to provide trauma-informed supports that foster safety (physical and emotional), trust, and empowerment.
Strengths-based: Peer professionals view all service participants as resilient, possessing inner resources, strengths, aspirations, and dreams that provide a foundation for recovery. Part of peer recovery support services is identifying, affirming, and building upon the strengths.
Respect: Because experiencing respect is critical for dignity, self-acceptance, and positive identity, peer professionals enter into all interactions with service participants with the utmost respect for the person’s preferences and decision-making.

What peer professionals do

Peer professionals deliver peer recovery support services within a wide range of systems, settings, and service formats. Systems include health and human services, health care, and corrections. Settings include specialty behavioral health treatment programs, hospitals, crisis services, community-based organizations, housing programs, peer-run services, outreach teams, and integrated health care settings (Gagne et al., 2018; SAMHSA, 2023; Stack et al., 2022). Formats include one-to-one, peer-facilitated groups, and in-person or virtual services. Within this wide range, peer professionals may:

Provide recovery and wellness support.
Use lived experience to mentor, offer mutual support, and offer hope that recovery is possible.
Assist service participants in identifying strengths, priorities, and recovery goals.
Coach service participants to build skills and accomplish recovery-related tasks.
Connect service participants to resources, services, and supports.
Assist in the development of formal and informal supports.
Help address barriers that affect recovery.
Support service engagement.
Support overdose prevention and multiple pathways to recovery.
Facilitate peer recovery support groups or activities.
Engage family members, parents, or legal guardians when appropriate.
Support service participants in positively engaging in their communities.
Assist service participants in navigating systems.

When considering employing a peer professional, organizations should consider the peer professional’s lived experience in ways that reflect the specific service participant populations and community’s needs. For example, what might be the peer professional’s lived experience related to the justice system, youth and young adult recovery, the crisis continuum, substance use recovery, parenting or caregiving, or other shared life experiences? Considering a candidate’s relevant lived experience is important because it will promote service participants’ engagement and positive outcomes.

Benefits of peer recovery support services

When successfully implemented, peer recovery support services offer several benefits to service participants, the clinical team, the organization, and the larger system (Fortuna et al., 2022; SAMHSA, 2023).

Benefits to the service participant

Increases engagement in recovery and behavioral health services
Strengthens hope, motivation, and confidence in the recovery process
Supports informed decision-making and self-directed recovery goals
Reduces barriers to care through resource connection and system navigation
Strengthens formal and informal support networks
Supports skill development related to wellness, daily living, and community participation
Promotes overdose prevention and multiple pathways to recovery
Aligns with services designed to engage, educate, support, and assist individuals in recovery and to support recovery choices, goals, and decisions

Benefits to the clinical team

Brings lived experience perspectives that complement clinical perspectives
Strengthens coordination around individual recovery goals
Highlights barriers to engagement with focus on resolution
Supports respectful, nonjudgmental communication
Reinforces person-centered, strength-based, and trauma-informed interactions
Supports continuity of care through recovery-focused connection and follow-up
Contributes to team functioning by modeling respectful communication, active listening, and appropriate boundaries

Benefits to the organization

Improves service participant engagement and retention in services
Increases connection between services and community supports
Expands services through delivery of non-clinical recovery support
Supports policy-to-practice regarding person-centered, trauma-informed service delivery
Reinforces of collaborative communication and recovery-oriented engagement approaches
Contributes to workplace practices that support reflection, learning, and recovery-focused perspectives
Inspires supervision to focus on the supervisory alliance
Inspires supervision to focus on ongoing professional development

Benefits to the system of care

Expands access to recovery-oriented supports
Improves integration of community and natural support networks
Strengthens coordination between individuals, services, and community
Reduces barriers to recovery
Sustains funding as a reimbursable non-clinical recovery support

Evidence of peer recovery support services

Peer recovery support services represent a well-established evidence-based practice. This summary describes types of research, general and specific outcomes, the emerging understanding of how peer recovery support works, and successes in Wisconsin. See the references section of this toolkit for the full list of references.

Types of research

Peer recovery support research includes randomized controlled trials (Davidson et al., 2004; Ray et al., 2021), quasi-experimental trials (Kottke-Weaver, 2023), narrative review (Stack et al., 2022), qualitative studies and systematic reviews (Bagnall et al., 2015; Lloyd-Evans et al., 2014; Smit et al., 2023; White et al., 2020).

General outcomes

The research shows several positive outcomes when peer recovery support services are successfully integrated into services-as-usual:

Reduced hospitalizations (Gillard, Bremner et al., 2022; Min et al., 2007)
Improved recovery supports, empowerment, and self-determination (Lloyd-Evans et al., 2014; White et al., 2020)
Decreased symptoms across a range of mental health conditions in addition to improvements in self-esteem, depressive symptoms, and general well-being (Davidson et al., 2004)
Decreased substance use, decreased symptoms of substance use disorders, increased rates of abstinence post-treatment, and decreased substance use relapse (Reif et al., 2014; Rowe et al., 2007; Boisvert et al, 2008; Eddie et al., 2019)
Improved rates of engagement in treatment services
Improved rates of treatment retention and successful completion of treatment services
Reduced number of homeless days (van Vugt et al., 2012)
Tend to be more cost-effective and accessible than other types of services

Specific outcomes

Several studies show peer recovery support services can be effective across specific settings, formats, populations, and challenges:

Peer recovery support for people with serious mental illness in a variety of settings was shown to be effective, including treatment centers, individual and group formats, drop-in centers, and online (Reif et al., 2014; Smit et al., 2023).
Peer recovery support for African Americans with serious mental illness was shown to be effective (Ford et al., 2021).
Peer recovery support for Latinos with substance use disorders was shown to be effective (Rojas Pérez et al., 2021).
Among veterans, having another veteran involved in care for peer recovery support resulted in increased use of mental health services, suggesting that having peer recovery support may reduce stigma (Greden et al., 2010).
Peer recovery support for families of children with disabilities found that culturally diverse families were better able to navigate systems of care, access resources, and develop coping skills (Lancaster et al., 2024)
Working with a certified peer specialist in Wisconsin prisons was associated with reductions in major conduct reports during incarceration and lower rates of recidivism post-release (Kottke-Weaver, 2023).
Participation in a peer recovery support program while in prison increased self-reported improvements to mental and physical health, increased motivation to participate in treatment services, and reduced substance use post-release (Ray et al., 2021).

How peer recovery support seems to work

The emerging research points to several active ingredients of peer recovery support effectiveness:

Enhances shared experience and mutuality which fosters connection and a good peer-to-peer working relationship
Increases service participant’s sense of belonging, community, and social supports
Provides hope, inspiration, and empowerment
Supports service participants to develop coping skills and strategies for symptom management
Supports service participants to access resources and services through reducing stigma
Supports service participants to advocate for their needs

Successes across Wisconsin

Wisconsin Medicaid established a new coverage policy for peer recovery support services, which was issued in ForwardHealth Update 2026-05 (PDF).
Many sites across Wisconsin have demonstrated success in implementing peer recovery support services including peer recovery centers, peer-run respites, and several provider organizations.¹

Limits of peer recovery support services

Peer professionals provide recovery support services grounded in lived experience that complement—and are distinct from—other roles (case managers, therapists, clinical supervisors, or medical providers) and functions (clinical, diagnostic, treatment, or ensuring compliance). Here are examples of tasks outside of the peer professional’s scope of practice:

Diagnosing mental health or substance use conditions
Providing therapy, counseling, or other clinical services
Conducting clinical assessments
Developing or directing clinical treatment plans
Prescribing, recommending, or managing medications
Enforcing rules or monitoring compliance
Serving as authority figures in treatment decisions
Coercing, pressuring, or directing individuals’ personal choices
Making decisions on behalf of service participants

Recognizing the limits of the peer professional role is important for several reasons:

Peer recovery support services are most effective when delivered as intended: recovery-focused support that complements existing clinical services. This means the peer professional operates within the specified scope of practice and code of ethics.
Role clarity allows more effective integration of the peer professional into regular teaming, which sets up better collaboration between all team members.
Recognizing limits allows for more effective supervision with guidance tailored to role, scope, and ethical practice.
Role clarity among the peer professional, team, and supervisor directly links to the peer professional’s job satisfaction (Edwards & Solomon, 2023; Mancini, 2018) and reduced turnover (Bell et al., 2025).

In sum, research consistently shows that recognizing the limits of peer recovery support services and embracing role clarity of the peer professional is a critical ingredient of successful implementation (Ehrlich et al., 2020; Elswick et al., 2024; Reeves, McIntyre et al., 2024; SAMHSA, 2023; Shepardson et al., 2019). This is why your leadership team will be encouraged to revisit peer professional’s role clarity in preparation and action phases.

¹ Examples of provider organizations: Wisconsin Community Services (Milwaukee), Safe Communities (Madison), and Solstice House Peer-Run Respite & Warmline (Madison)

Introduction

Preparation