An Assessment of Innovative Models of Peer Support Services in Behavioral Health to Reduce Preventable Acute Hospitalization and Readmissions. 2. Site Selection


A comprehensive environmental scan was completed to address the questions of this study (see Chapter 1). The environmental scan focused on core topics, including:

  • The expanding role of PSS as a part of the behavioral health care delivery system.

  • PSS and its impact on avoidable psychiatric hospitalization, readmissions, and ED utilization among those with behavioral health conditions.

  • The impact of PSS on general health care utilization and other health outcomes.

  • The evidence base for peer-delivered services.

A national panel of experts were convened to advise this study (see Appendix A for a list of panel members). In conjunction with this group and through federal input and other key informants (see Appendix B), about 15 exemplary PSS programs were identified to help address the research questions. Telephonic case reviews were conducted with eight programs. Summaries of these case reports are included in Appendix C. From this list and in conjunction with the Federal Project Officer, four programs were selected for in-person site visits to further explore in-depth how these PSS programs impact unnecessary hospitalizations and readmissions, as well as ED utilization.

Two members of the study team conducted one-day site visits to each of the four selected PSS programs. Agendas were developed in collaboration with the PSS programs. The site visit included scheduled times with the PSS workforce, leadership, PSS programs, and, in some cases, funders. Detailed case studies are provided based on the information collected during the site visit. The four site visits provide a strong foundation for the three-level peer services framework developed. Outcomes of the programs are also discussed and opportunities for further study are reviewed as part of this report.

Case Study -- Selection Process

Based on the recommendations of an expert panel, federal input, and other key stakeholders, about 15 national programs were recommended for review. Eleven PSS programs that fit within this three-level framework were considered for preliminary review. Three of the programs nominated for phone interview/case study were not included based on unresponsiveness or because they were not found suitable for the study. The participating programs are included in Table 5. Overview summaries of these programs are included in Appendix C.

TABLE 5. Participating Site Visit Programs
Organization Program(s) State
Baltic Street, AEH, Inc. Bridger New York
Georgia Mental Health Consumer Network, Inc. (GMHCN) Peer Support, Wellness, and Respite Centers Georgia
Housing Options Made Easy, Inc. Southern Tier Recovery Activities Without Walls (STRAWW), Supported Housing New York
Mental Health Association of Southeast Pennsylvania (MHASP) Peer Support Teams, Recovery & Education Centers, Self-Directed Care Pennsylvania
New York Association of Psychiatric Rehabilitation Services, Inc. (NYAPRS) Peer Bridger New York
Optum Behavioral Health Pierce County RSN Washington
Projects to Empower and Organize the Psychiatrically Labeled (PEOPLe, Inc.) Rose House New York
Recovery Innovations (RI) Arizona Living Room, Peer Recovery Team, Peer Advocacy Services, Community Advocacy, WELL, WRAP, Circle of Friends Arizona

One-hour phone-based discussions were conducted with each of the nominated programs. Semi-structured interview formats were used and each of the review areas included a series of open-ended questions. Two interviewers participated in each review. The topics covered in these reviews included:

  1. The description of the peer services program model, and the extent to which it is a replicable model and can support consistency within the program and comparison across other programs.

  2. The financing of the peer services program and the mechanisms that support the reimbursement of services and employment of peer specialists.

  3. The data and measurement of outcomes that are conducted by the program sites, and the extent to which these inform services and help improve quality of programs.

  4. The training and certification of the peer services workforce, and the extent to which these are mandated by state or program-established requirements.

Based upon the findings of the eight telephonic program reviews, four PSS programs were identified for site visits to examine their impact on the three research questions. These research questions were:

  1. What models or methods of practice demonstrate the most promise toward reducing preventable psychiatric hospitalization, re-hospitalization, and ED use?

  2. To what extent are these models being utilized, and at what level of the system (e.g., states, counties, cities, organizational networks)?

  3. What are the structural supports for these innovative practices -- including funding, training, and credentialing requirements -- offered through or outside the behavioral health care system?

The phone-based case studies (see Appendix C) illustrate the key components of the PSS programs recommended for this study. Each of the programs reviewed has unique and contributory elements. The study design of four site visits required the selection of targeted programs. A number of factors were used to help identify the target sites for this study. These include:

  • Diversity of program design based upon the three levels of PSS identified in the study.

  • Program components and replicability of service model.

  • Geographic diversity.

  • Availability of data relative to hospitalization, re-hospitalization, ED diversion, and other outcome and quality data.

  • Payer sources and types for the programs identified.

  • Other characteristics unique to each of the programs.

Four programs were selected for the site visits: Georgia Mental Health Consumer Network (GMHCN); New York Association of Psychiatric Rehabilitation Services; Optum Pierce County, Washington; and RI (Arizona). Summaries of the site visit case studies are included in Chapter 3.

View full report


"PeerSupServ.pdf" (pdf, 1.24Mb)

Note: Documents in PDF format require the Adobe Acrobat Reader®. If you experience problems with PDF documents, please download the latest version of the Reader®