National Ethical Guidelines and Practice Standards

National Practice Guidelines for

Peer Supporters
Recovery is a process of change through which
individuals improve their health and wellness, live a self-directed life,
and strive to reach their full potential.
~~SAMHSA Working Definition of Recovery
(Last updated in 2011).
The belief that recovery is possible for all who experience psychiatric, traumatic, or substance use
challenges is fundamental to the practice of peer support. The likelihood of long-term recovery is
increased with effective support. Peer support has been demonstrated through research and practical
application to be highly effective.
In addition to the SAMHSA Working Definition and Guiding Principles of Recovery, the following core
values have been ratified by peer supporters across the country as the core ethical guidelines for peer
support practice:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.

Peer support is voluntary

Peer supporters are hopeful
Peer supports are open minded
Peer supporters are empathetic
Peer supports are respectful
Peer supporters facilitate change
Peer supporters are honest and direct
Peer support is mutual and reciprocal
Peer support is equally shared power
Peer support is strengths-focused
Peer support is transparent
Peer support is person-driven

The peer support workforce is at a critical time in its development. Research reveals that peer
support can be valuable to those overcoming mental health and substance addiction challenges and
their families. Thousands of peers have been trained and are working in a wide variety of settings, but
questions remain regarding peer roles, duties and philosophies.
In an effort to create broader understanding, reduce workplace tensions and frustrations and
develop effective peer support roles, a universal set of practice standards is necessary. Such standards
will enable peer support workers, non-peer staff, program administrators and developers, systems
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administrators, funders, researchers and policymakers to better understand peer supporter values, and
the appropriate roles and tasks that can and should be carried out by peer support workers in a manner
that benefits all.
Professional practice standards generally have three basic components: 1) practice guidelines, 2)
identification and description of core competencies and 3) ethical guidelines or a code of ethics. This
project focused on practice guidelines, which are being shared with other organizations with the
intention of having them provide the remaining two components.
A consortium of stakeholder organizations, led by the International Association of Peer
Supporters, has developed a draft of practice guidelines for peer supporters. The guidelines
acknowledge the diverse settings in which peer supporters work and the wide variety of tasks peers are
asked to perform, offering direction to an emerging peer support workforce and universally accepted
guidance that is built upon the strengths and recovery principles peer supporters embody.
Vital to this process is a diverse advisory group that includes representatives from mental health
and addictions fields as well as family support and cultural organizations.
The standards are value based; that is, they are directly derived from the values peer supporters
agree on and hold most dear. The process to gather the values and develop these standards is
intentionally inclusive and includes: 1) website solicitations for input, 2) newsletter and e-mail
communication to solicit input and report progress, 3) focus groups, 4) surveys, 5) informal gatherings of
peer supporters and 6) a literature search and review. Representatives from many stakeholder
organizations are acting in an advisory or steering capacity.
Six focus groups have been conducted across the U.S. and more than 800 people have
responded to surveys. Surveys have been translated into Spanish with outreach to the mental health,
substance abuse, Latino, African-American and Military Veteran communities. Respondents have been
remarkably consistent (98%) in their approval of key values for practice standards development. From
these values, draft guidelines were written by members of the advisory group.
The draft guidelines were reviewed by peer supporters and underwent yet another review by
the advisory group. The solid draft of practice standards is part of this document. The process,
however, will remain dynamic for some time as ongoing review will likely result in modifications over
time.
In addition to a value-based product, the guidelines will be framed in a human rights context.
Below is a passage from the World Health Organizations (WHO) QualityRights tool kit.
In many countries, the quality of care in both inpatient and outpatient facilities is poor or
even harmful and can actively hinder recovery. The treatment provided is often intended
to keep people and their conditions under control rather than to enhance their
autonomy and improve their quality of life. People are seen as objects of treatment
rather than human beings with the same rights and entitlements as everybody else.

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They are not consulted on their care or recovery plans, in many cases receiving
treatment against their wishes.1
The preceding statement supports the need for change and also provides a framework
for understanding the roles and functions of peer supporters. Ultimately, quality behavioral
health care is a matter of social justice and peer supporters are playing a vital role in ensuring
that quality.
Although the roles of peer supporters are many and diverse, within primary and
behavioral healthcare, there are common values and practices for all. While language and some
practice aspects may differ, fundamental values cut across all peer support.
The goals of national practice guidelines include:

The identification of guidelines for developing appropriate and meaningful job

descriptions.
Providing a foundation upon which peer support core competencies can be
identified.
Creating a basis for peer support ethical guidelines.
Creating a foundation for a potential national credential.
Facilitating reciprocity policies (recognized in multiple states).
Providing information that could be used to examine peer supporter training
curricula.

PRACTICE GUIDELINES
With nearly 1,000 peer supporters responding to surveys and participating in focus groups, 12
key values were identified and validated as a basis for this work. Those values include:

ETHICAL GUIDELINES

Peer support is voluntary

Recovery is a personal choice. The most basic
value of peer support is that people freely choose
to give or receive support. Being coerced, forced
or pressured is against the nature of genuine
peer support. The voluntary nature of peer
support makes it easier to build trust and
connections with another.

PRACTICE GUIDELINES

Practice: Support choice

1) Peer supporters do not force or coerce others to
participate in peer support services or any other
service.
2) Peer supporters respect the rights of those they
support to choose or cease support services or use
the peer support services from a different peer
supporter.

WHO QualityRights tool kit to assess and improve quality and human rights in mental health and social care facilities. Geneva, World Health
Organization, 2012.

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ETHICAL GUIDELINES

PRACTICE GUIDELINES

3) Peer supporters also have the right to choose not to

work with individuals with a particular background
if the peer supporters personal issues or lack of
expertise could interfere with the ability to provide
effective support to these individuals. In these
situations, the peer supporter would refer the
individuals to other peer supporters or other
service providers to provide assistance with the
individuals interests and desires.
4) Peer supporters advocate for choice when they
observe coercion in any mental health or
substance abuse service setting.

Peer supporters are hopeful

Belief that recovery is possible brings hope to
those feeling hopeless. Hope is the catalyst of
recovery for many people. Peer supporters
demonstrate that recovery is realthey are the
evidence that people can and do overcome the
internal and external challenges that confront
people with mental health, traumatic or
substance use challenges. As role models, most
peer supporters make a commitment to continue
to grow and thrive as they walk the walk in
their own pathway of recovery. By authentically
living recovery, peer supporters inspire real hope
that recovery is possible for others.
Peer supporters are open minded
Being judged can be emotionally distressing and
harmful. Peer supporters meet people where
they are at in their recovery experience even
when the other persons beliefs, attitudes or
ways of approaching recovery are far different
from their own. Being nonjudgmental means
holding others in unconditional positive regard,
with an open mind, a compassionate heart and
full acceptance of each person as a unique
individual.

Practice: Share hope

1) Peer supporters tell strategic stories of their
personal recovery in relation to current struggles
faced by those who are being supported.
2) Peer supporters model recovery behaviors at work
and act as ambassadors of recovery in all aspects
of their work.
3) Peer supporters help others reframe life
challenges as opportunities for personal growth.

Practice: Withhold judgment about others

1) Peer supporters embrace differences of those they
support as potential learning opportunities.
2) Peer supporters respect an individuals right to
choose the pathways to recovery individuals
believe will work best for them.
3) Peer supporters connect with others where and as
they are.
4) Peer supporters do not evaluate or assess others.

Peer supporters are empathetic

Empathy is an emotional connection that is
created by putting yourself in the other persons

Practice: Listen with emotional sensitivity

1) Peer supporters practice effective listening skills
that are non-judgmental.

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ETHICAL GUIDELINES
shoes. Peer supporters do not assume they
know exactly what the other person is feeling
even if they have experienced similar challenges.
They ask thoughtful questions and listen with
sensitivity to be able to respond emotionally or
spiritually to what the other person is feeling.
Peer supporters are respectful
Each person is valued and seen as having
something important and unique to contribute to
the world. Peer supporters treat people with
kindness, warmth and dignity. Peer supporters
accept and are open to differences, encouraging
people to share the gifts and strengths that come
from human diversity. Peer supporters honor and
make room for everyones ideas and opinions
and believe every person is equally capable of
contributing to the whole.

PRACTICE GUIDELINES

2) Peer supporters understand that even though

others may share similar life experiences, the
range of responses may vary considerably.

Practice: Be curious and embrace diversity

1) Peer supporters embrace diversity of culture and
thought as a means of personal growth for those
they support and themselves.
2) Peer supporters encourage others to explore how
differences can contribute to their lives and the
lives of those around them.
3) Peer supporters practice patience, kindness,
warmth and dignity with everyone they interact
with in their work.
4) Peer supporters treat each person they encounter
with dignity and see them as worthy of all basic
human rights.
5) Peer supporters embrace the full range of cultural
experiences, strengths and approaches to recovery
for those they support and themselves.

Peer supporters facilitate change

Some of the worst human rights violations are
experienced by people with psychiatric, trauma
or substance use challenges. They are frequently
seen as objects of treatment rather than
human beings with the same fundamental rights
to life, liberty and the pursuit of happiness as
everyone else. People may be survivors of
violence (including physical, emotional, spiritual
and mental abuse or neglect). Those with certain
behaviors that make others uncomfortable may
find themselves stereotyped, stigmatized and
outcast by society. Internalized oppression is
common among people who have been rejected
by society. Peer supporters treat people as
human beings and remain alert to any practice
(including the way people treat themselves) that
is dehumanizing, demoralizing or degrading and
will use their personal story and/or advocacy to
be an agent for positive change.

Practice: Educate and advocate

1) Peer supporters recognize and find appropriate
ways to call attention to injustices.
2) Peer supporters strive to understand how
injustices may affect people.
3) Peer supporters encourage, coach and inspire
those they support to challenge and overcome
injustices.
4) Peer supporters use language that is supportive,
encouraging, inspiring, motivating and respectful.
5) Peer supporters help those they support explore
areas in need of change for themselves and others.
6) Peer supporters recognize injustices peers face in
all contexts and act as advocates and facilitate
change where appropriate

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ETHICAL GUIDELINES

Peer supporters are honest and direct

Clear and thoughtful communication is
fundamental to effective peer support. Difficult
issues are addressed with those who are directly
involved. Privacy and confidentiality build trust.
Honest communication moves beyond the fear of
conflict or hurting other people to the ability to
respectfully work together to resolve challenging
issues with caring and compassion, including
issues related to stigma, abuse, oppression, crisis
or safety.

PRACTICE GUIDELINES

Practice: Address difficult issues with caring and

compassion
1) Peer supporters respect privacy and
confidentiality.
2) Peer supporters engage, when desired by those
they support, in candid, honest discussions about
stigma, abuse, oppression, crisis or safety.
3) Peer supporters exercise compassion and caring in
peer support relationships.
4) Peer supporters do not make false promises,
misrepresent themselves, others or circumstances.
5) Peer supporters strive to build peer relationships
based on integrity, honesty, respect and trust.

Peer support is mutual and reciprocal

In a peer support relationship each person gives
and receives in a fluid, constantly changing
manner. This is very different from what most
people experience in treatment programs, where
people are seen as needing help and staff is seen
as providing that help. In peer support
relationships, each person has things to teach
and learn. This is true whether you are a paid or
volunteer peer supporter.

Peer support is equally shared power

By definition, peers are equal. Sharing power in a
peer support relationship means equal
opportunity for each person to express ideas and
opinions, offer choices and contribute. Each
person speaks and listens to what is said. Abuse
of power is avoided when peer support is a true
collaboration.

Practice: Encourage peers to give and receive

1) Peer supporters learn from those they support and
those supported learn from peer supporters.
2) Peer supporters encourage peers to fulfill a
fundamental human need -- to be able to give as
well as receive.
3) Peer supporters facilitate respect and honor a
relationship with peers that evokes power-sharing
and mutuality, wherever possible.
Practice: Embody equality
1) Peer supporters use language that reflects
a mutual relationship with those they
support.
2) Peer supporters behave in ways that
reflect respect and mutuality with those
they support.
3) Peer supporters do not express or
exercise power over those they support.
4) Peer supporters do not diagnose or offer
medical services, but do offer a
complementary service.

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ETHICAL GUIDELINES

Peer recovery support is strengths-focused

Each person has skills, gifts and talents they can
use to better their own life. Peer support focuses
on what's strong, not what's wrong in anothers
life. Peer supporters share their own experiences
to encourage people to see the silver lining or
the positive things they have gained through
adversity. Through peer support, people get in
touch with their strengths (the things they have
going for them). They rediscover childhood
dreams and long-lost passions that can be used
to fuel recovery.

PRACTICE GUIDELINES

Practice: See whats strong not whats wrong

1) Peer supporters encourage others to identify their
strengths and use them to improve their lives.
2) Peer supporters focus on the strengths of those
they support.
3) Peer supporters use their own experiences to
demonstrate the use of ones strengths, and to
encourage and inspire those they support.
4) Peer supporters encourage others to explore
dreams and goals meaningful to those they
support.
5) Peer supporters operate from a strength-based
perspective and acknowledge the strengths,
informed choices and decisions of peers as a
foundation of recovery.
6) Peer supporters dont fix or do for others what
they can do for themselves.

Peer support is transparent

Peer support is the process of giving and
receiving non-clinical assistance to achieve longterm recovery from severe psychiatric, traumatic
or addiction challenges. Peer supporters are
experientially credentialed to assist others in this
process. Transparency refers to setting
expectations with each person about what can
and cannot be offered in a peer support
relationship, clarifying issues related to privacy
and confidentiality. Peer supporters
communicate with everyone in plain language so
people can readily understand and they put a
face on recovery by sharing personal recovery
experiences to inspire hope and the belief that
recovery is real.

Practice: Set clear expectations and use plain language

1) Peer supporters clearly explain what can or cannot
be expected of the peer support relationship.
2) Peer supporters use language that is clear,
understandable and value and judgment free.
3) Peer supporters use language that is supportive
and respectful.
4) Peer supporters provide support in a professional
yet humanistic manner.
5) Peer supporter roles are distinct from the roles of
other behavioral health service professionals.
6) Peer supporters make only promises they can keep
and use accurate statements.
7) Peer supporters do not diagnose nor do they
prescribe or recommend medications or monitor
their use.

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ETHICAL GUIDELINES

Peer support is person-driven

PRACTICE GUIDELINES

Practice: Focus on the person, not the problems

All people have a fundamental right to make

decisions about things related to their lives. Peer
supporters inform people about options, provide
information about choices and respect their
decisions. Peer supporters encourage people to
move beyond their comfort zones, learn from
their mistakes and grow from dependence on the
system toward their chosen level of freedom and
inclusion in the community of their choice.

1) Peer supporters encourage those they support to

make their own decisions.
2) Peer supporters, when appropriate, offer options
to those they serve.
3) Peer supporters encourage those they serve to try
new things.
4) Peer supporters help others learn from mistakes.
5) Peer supporters encourage resilience.
6) Peer supporters encourage personal growth in
others.
7) Peer supporters encourage and coach those they
support to decide what they want in life and how
to achieve it without judgment.

GLOSSARY
OF RELATED TERMS
In addition to identifying values upon which practice standards could be developed, it was
necessary to define peer support, peer supporter, peer peer support relationship and
practice standards. Using surveys, literature reviews and consultations with the advisory
group, the following definitions were developed:

PEER SUPPORT
Peer support is the process of giving and receiving non-clinical assistance to achieve long-term recovery
from severe psychiatric, traumatic or addiction challenges. This support is provided by peer supporters people who have lived experience and have been trained to assist others in initiating and maintaining
long-term recovery and enhancing the quality of life for individuals and their families. Peer support
services are inherently designed, developed, delivered, evaluated and supervised by peers in long-term
recovery.2

Definition adapted from White, W. (2009). Peer-Based Addiction Recovery Support: History, Theory, Practice and Scientific Evaluation.

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PEER SUPPORTER
A peer supporter is someone who has experienced the healing process of recovery from psychiatric,
traumatic and/or substance use challenges and, as a result, can offer assistance and support to promote
another peers own personal recovery journey. The peer support volunteers to share portions of his or
her recovery experience in an appropriate and effective manner.

PEER
In the context of peer support, a peer is a person who has lived experience with a psychiatric, traumatic
and/or addiction challenge, and may benefit from peer support.

PEER SUPPORT RELATIONSHIP

The qualities that make an effective peer supporter are best defined by the individual receiving support,
rather than by an organization or provider of care. Matching peer supporters with peers often
encompasses shared cultural characteristics, such as age, gender, ethnicity, language, sexual orientation,
co-occurring challenges, and experience in the military or with the criminal justice system or any other
identity-shaping life experience that increases common language, mutual understanding, trust,
confidence and safety.

PRACTICE STANDARDS
Practice standards are rules or guidelines used as the basis for informed decision-making about
acceptable work performance and practices. They are established by an authoritative entity through a
collaborative process with input from a wide range of people who perform the work. Standards are
based on values, ethics, principles and competencies.
Having a core set of standards is one important way to legitimize a field of practice.3 Practice standards
generally have three basic components: 1) practice guidelines, 2) identification and description of core
competencies and 3) ethical guidelines or code of ethics.

Adapted from Wilma Townsend, Presentation at Pillars of Peer Support (2012).

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About the International Association of Peer Supporters (iNAPS)

Our name has changed, but our mission remains the same.
On January 1, 2013, the National Association of Peer Specialists (NAPS) was renamed the International
Association of Peer Supporters (iNAPS) to reflect an increasingly global membership and correct a
widespread misperception that NAPS was only for certified peer specialists in the mental health
system. iNAPS is open to anyone who provides peer recovery support (paid or as a volunteer) for mental
health, addiction, or trauma recovery; anyone who aspires to provide peer recovery support, or anyone
who is a champion for recovery and the peer support movement.
Individual membership to iNAPS is available.

Benefits of membership include:

Membership certificate
Regular newsletter with periodic email updates
Discount on registration fee to the annual National Peer Supporter conference

Membership applications are accepted by postal mail only. See next page or visit the iNAPS web site to
download a copy of the membership form (http://na4ps.wordpress.com/join-us)
Visit us online:

www.naops.org (home page, current events, quick access to forms and links)
http://na4ps.wordpress.com (iNAPS main web site / wordpress site, includes detailed
explanations of the International Association of Peer Supporters organization and its projects
and initiatives)
http://na4ps.wordpress.com/7th-annual-national-conference/ (National Peer Supporter
Conference web page - includes access to registration forms, travel and hotel information,
program updates, and more)
http://na4ps.wordpress.com/national-standards/ (National Practice Standards site
information about the efforts to establish Practice Guidelines for peer support providers)
http://na4ps.wordpress.com/library/ (Resource Library with training materials and other
resources that can be helpful for peer supporters and those who are receiving support)
https://www.facebook.com/NA4PS (Like us on Facebook and join the ongoing discussion
about peer support!)
http://rtp4ps.org/ (Recovery to Practice page on the iNAPS web site, with information about
the SAMHSA-Funded Recovery to Practice continuing education program for peer support
providers)

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International Association of Peer Supporters (iNAPS)

A non-profit organization

Membership Form
The Inter-National Association of Peer Supporters (formerly the National Association of
Peer Specialists) welcomes all who support peer support in healthcare. We promote the
use of peer support in a variety of settings, including but not limited to mental health and
addictions. Members receive a certificate, e-mail newsletter, and registration fee
discounts for the annual national peer support conference.
Join our ranks to be informed, involved and bring peer support to those who need it most!

To join, simply complete the following information form. The cost of membership
is $25 annually. If you do not have an e-mail address or would like to receive your
quarterly newsletter in hard copy form, please check the box.

Please Print Clearly!

Name_________________________________________________________________

Address_______________________________________________________________

City______________________________________ State________ Zip_____________

E-Mail ________________________________________________________________

Amount Enclosed: $______________

Please mail me a hard copy version of the newsletter.

Please mail completed form to: iNAPS, 720 Clarkson Dr., Sparta, MI 49345
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