New93 role standards, now public
MedTality
Role standards

Behavioral health

Peer support specialist

What a certified peer support specialist must do on their own with the people they support: use lived experience to offer hope and back the person's own pathway, link them to what they choose, respond to trauma safely, hold the boundaries of a mutual relationship, and get risk to someone clinical at once. Drawn from the IC&RC Peer Recovery examination and SAMHSA's core competencies for peer workers.

Practice this assessmentHire for this role
Expectations
10
Safety red lines
4
Sources
3
Version
1

Built from International Certification and Reciprocity Consortium, Substance Abuse and Mental Health Services Administration. Reviewed by clinicians, last on .

01What the role is measured on#

Every verdict is made of the same five dimensions. Each is scored on its own, so a candidate sees where they are strong and where to work.

  • Clinical skillsThe hands-on and judgement work of the role: recognising what matters, acting in the right order, and knowing when something cannot wait.
  • Workflow and toolsGetting the work done in a real setting: the systems, records, equipment and handoffs the role runs on, used correctly and on time.
  • Patient communicationHow the role talks with patients, families and colleagues: listening, explaining plainly, and confirming what was understood.
  • Compliance and safetyThe rules that protect people: privacy, consent, infection control, reporting duties and the safety checks the role is accountable for.
  • Role knowledgeKnowing the job itself: what the role is responsible for, where its scope ends, and who to bring in when it does.

02What a ready hire does#

What a competent peer support specialist does on day one, dimension by dimension.

Clinical skills

  • Uses lived experience purposefully to offer hope and mutuality, supports the person's own chosen pathway of recovery, and builds on their strengths instead of directing them.
  • Helps the person name their own goals in their own words and break them into steps they choose, instead of accepting goals set for them by others.

Workflow and tools

  • Helps the person find and reach the services they choose - housing, benefits, treatment, mutual help, harm reduction - with their consent, removing barriers and following up that the link held.
  • Documents contacts accurately, promptly and in strengths-based language, recording what the role requires and no more.

Patient communication

  • Assumes the person may have a trauma history, offers safety, choice and control in every contact, and recognises and responds to a trauma reaction without retraumatising.
  • Uses the spirit of motivational interviewing - open questions, reflections and respect for the person's choice - to help them explore their own reasons for change without pushing.

Compliance and safety

  • Recognises when something is beyond peer support - risk of suicide, harm to others, abuse, overdose or a medical emergency - tells the person honestly, and follows the program's escalation route at once, staying involved until someone clinical has it.
  • Knows how to stay calm, listen and lower the temperature when a person is distressed or angry, and when to stop and get help instead.

Role knowledge

  • Keeps a mutual but professional peer relationship - no romantic, financial or exploitative ties - and handles overlapping roles in the recovery community openly and with supervision.
  • Knows what peer support is and is not - not therapy, diagnosis, medical or legal advice - and takes those questions to the right professional with the person.

03Safety red lines#

Any one of these keeps a candidate from Ready Day One, whatever the rest of the score. They are published so nobody meets them for the first time in the assessment.

  • Advises a person to stop, reduce or change a prescribed medication - including medication for opioid use disorder or a psychiatric medication - or tells them that recovery with medication is not real recovery.

    Stopping buprenorphine, methadone or an antipsychotic without the prescriber can lead to fatal overdose, relapse of psychosis or dangerous withdrawal, and a peer's word carries particular weight because of shared experience.

  • Promises to keep, or keeps, a disclosure of suicidal intent, intent to harm someone, abuse or neglect of a child or vulnerable adult, or an immediate overdose risk to themselves, instead of following the program's escalation route at once.

    Peers often hear risk first because people trust them; if it stops with the peer, nobody who can act knows until it is too late, and abuse reporting is a legal duty.

  • Shares a person's substance use or mental health information with a landlord, employer, family member, agency or referral partner without the person's written consent.

    Disclosure can cost the person housing, work, custody or liberty, breaches HIPAA and, for substance use treatment records, 42 CFR Part 2, and destroys the trust peer support depends on.

  • Would enter a romantic or sexual relationship with a person they support, lend them or borrow money, have them live in the peer's home, employ them, or use the relationship for personal gain.

    The shared experience that makes peer support work also makes the person easy to exploit; these relationships harm the person's recovery and breach every peer certification code of ethics.

04Outside the role#

Knowing where the role stops is part of the standard. Going past it is not extra credit.

  • Does not diagnose, carry out clinical assessment, or provide therapy.Offers peer support and refers clinical questions and needs to the treatment team with the person's consent.
  • Does not give medical or medication advice, including about medication for opioid use disorder or psychiatric medication.Helps the person prepare questions for their prescriber, and supports whatever medication decision they reach with that prescriber.
  • Does not promise confidentiality beyond what the law and the program allow.Explains the limits at the first contact - risk to self or others, abuse and neglect - and follows the escalation route when they apply.
  • Does not take on a second role, such as mutual-help sponsor, landlord, employer or lender, for someone they support in their paid role.Helps the person find a sponsor or the resource they need elsewhere, and takes any unavoidable overlap to supervision. Certification, title and permitted duties are set by each state, and this standard keeps to what is safe in all of them.

05How it is assessed#

  • A spoken assessment

    An examiner talks the candidate through realistic cases from this role, and follows up the way a senior colleague would.

  • Five dimensions

    Each answer is read against the expectations above and rated on the same four-level scale.

  • The 70 bar

    Every scorecard shows the score against 70, overall and for each dimension, with the reason for the verdict.

  • Safety first

    Crossing one of the safety red lines holds a pass back, however strong the rest was.

The four levels

  1. Not yet
  2. Developing
  3. Proficient
  4. Exemplary
How a verdict is made

06Sources and review#

Drawn from the certification frameworks and practice standards below, and reviewed by clinicians. Version 1, last reviewed .

Cited as sources. Not an endorsement by the organizations named.

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