Youth Peer Support-Individual (YPS-I) is a strength-based rehabilitative service provided to youth

who are living with a mental health, substance use and/or co-occurring health condition. The

one-to-one service rendered by a CPS-Y (Certified Peer Support – Youth) practitioner models

recovery by using lived experience as a tool for the service intervention within the scope of their

knowledge, skills and education. This service intervention is expected to increase the targeted

youth’s’ capacity to function and thrive within their home, school, and communities of choice.

The service exists within a full family-guided, youth-driven system of care framework and enables

response to the needs of the youth across several life domains, incorporating formal and informal

supports, and developing realistic intervention strategies that complement the youth’s natural

resources and environment.

The services are geared toward promoting self-empowerment of the youth, enhancing

community living skills and developing/enhancing natural supports. The following are among the

wide - range of specific interventions and supports which are expected and allowed in the

provision of this service:

1. Promoting a service culture of respect, wellness, dignity, and strength, by changing the labels

which have emerged in the system and seeing young persons as individuals who can achieve

full, rich lives on their own terms.

2. Facilitating the process for the youth in his/her exploration of strengths and supports of

wellness/resiliency/recovery and ultimately supporting the youth/family voice and choice in

such activities as self-advocating for needs/preferences, assuming the lead roles in multidisciplinary team meetings, holding accountability for his/her own health/wellness/recovery,

etc...

3. Drawing upon their own experience, helping the family/youth find and maintain hope as a

tool for progress towards recovery.

4. Assisting the youth in identifying the tools of wellness/resiliency/recovery available in

everyday life.

5. Creating the opportunities and dialogues to explore behavioral health, what wellness is for

the specific youth and his/her family, so that the individual can define and articulate wellness

and create plans which strengthen their recovery and resilience.

6. Listening to the youth and family’s needs and concerns from a peer perspective and offering

suggestions and alternatives for youth engagement in planning and self-direction process.

7. Assisting the youth and family with the acquisition of the skills and knowledge necessary to

sustain an awareness of their youth's needs as well as his/her strengths and the development

and enhancement of the family's unique problem-solving skills, coping mechanisms, and

strategies for the youth's illness/symptom/behavior management. and relapse prevention.

8. Building the youth and family skills, knowledge, and tools related to the identified

condition/related symptoms/triggers so that the family/youth can assume the role of self-monitoring and self-management.

Job Description for Certified Peer Support – Youth (CPS-Y) – 

9. Through positive collaboration and relationships, promoting access and quality services for

the youth/family by assisting with accessing strength-based behavioral health/health

services, social services, educational services and other supports and resources required to

assist the family unit to attain its vision/goals/objectives including:

a) Creating early access to the messages of recovery and wellness.

b) Helping the family identify natural supports that exist for the youth.

c) Working with youth/young adults to access supports which maintain youth in the

least restrictive setting possible.

d) Working with the youth/young adult to ensure that they have choices in life

aspects, sustained access to an ownership of their IRP and resources developed.

e) Working with youth/young adult to provide adequate information to make

healthier choices about their use of alcohol and/or other drugs.

f) Working with the provider community and other practitioners, the CPS-Y

promotes the youth to self-advocate to:

i. Develop responsive and flexible resources that facilitate community-based interventions.

ii. Create a person-centered, recovery-oriented system of care plan

that correspond with the needs of the youth/family.

iii. Acknowledge the importance of Self Care, addressing the need to

maintain whole health and wellness. This should include support in

building "recovery capital" (formal and informal community

supports).

g) Assisting with identifying community and individual supports (including friends,

relatives, schools, religious affiliations, etc.) that can be used by the youth to

achieve his/her goals and objectives.

h) Assisting the youth and family participants as needed in coordinating with other

youth-serving systems (or at a certain age, collaboration and engagement with

adult-serving systems) to achieve the family/youth goals.

10. Provide resources and educational materials to help assist youth with understanding services,

options, and treatment expectations, as well assistance with developing wellness tools and

coping skills, including:

a) Understanding various system processes, how these relate to the youth’s recovery

process, and their valued role (e.g. crisis planning, IRP process).

b) Understanding what a behavioral health diagnosis means and what a journey to

recovery may look like.

c) The role of services/prescribed medication in diminishing/managing the

symptoms of that condition and increasing resilience and functioning in living with

that condition.

 Job Description for Certified Peer Support – Youth (CPS-Y)

11. Facilitating and creating advocacy, balance, and cohesion on the IRP support team between

the youth/family served, professionals (including CPS-Ps who may be supporting the family),

and other supporting partners.

Interventions are approached from a perspective of lived experience and mutuality, building the

youth’s and family’s recovery, empowerment, and self-efficacy.

Interventions are based upon respect and honest dialogue. The unique mutuality of the service

allows the sharing of personal experience including modeling individual/family recovery, respect,

and support that is respectful of the individualized journey of a youth's/family’s recovery.

Equalized partnership must be established to promote shared decision making while remaining

youth-driven, family-centered. All aspects of the intervention acknowledge and honor the

cultural uniqueness of each youth and family and the many pathways to recovery.

One of the primary functions of the Youth Peer Support service is to promote youth and family

recovery. While the identified youth is the target for services, recovery is approached as a family

journey towards self-management and developing the concept of wellness and functioning while

actively managing a substance use and/or chronic mental health condition, which enable the

youth to be supported in wellness within his/her family unit. Youth are supported by the CPS-Y

in learning to live life beyond the identified behavioral health condition, focusing on identifying

and enhancing the strengths of the youth and the family unit. As a part of this service

intervention, a CPS-Y will articulate points in their own recovery stories that are relevant to

overcoming obstacles faced by the youth-recipient of behavioral health services and promote

personal responsibility for recovery as the youth/family define recovery.

The CPS-Y focuses on building respectful partnerships with families, identifying the needs of the

youth and helping the youth recognize self-efficacy while strengthening good communication

within the families and good partnerships with communities and system stakeholders in

achieving the desired outcomes. This service provides the training and support necessary to

promote engagement and active participation of the youth in the supports/treatment/recovery

planning process for the youth and assistance with the ongoing implementation and

reinforcement of skills learned throughout the treatment/support process. YPS-I provides

interventions which promote supportive relationships between a youth and a CPS-Y that

promotes respect, trust, and warmth and empowers the youth to make choices and decisions to

enhance their recovery.

Admission Criteria

YPS-I is targeted to a youth who meets the following criteria:

1. Individual is age 20 or younger; and

2. Individual has a substance related condition and/or mental illness; and two or more of the

following:

Job Description for Certified Peer Support – Youth (CPS-Y) 

a) Individual and his/her family needs peer-based recovery support for the

acquisition of skills needed to engage in and maintain youth/family recovery; or

b) Individual and his/her family need assistance to develop self-advocacy skills to

achieve self-management of the youth’s behavioral health status; or

c) Individual and his/her family need assistance and support to prepare for a

successful youth work/school experience; or

d) Individual and his/her family need peer modeling to increase responsibilities for

youth/family recovery.

Continuing Stay Criteria

1. Individual continues to meet admission criteria; and

2. Progress notes document youth progress relative to goals which the youth/family identified

in the Individualized Recovery Plan, but treatment/recovery goals have not yet been

achieved.

Discharge

An adequate continuing recovery plan has been established; and one or more of the following:

1. Goals of the Individualized Recovery Plan have been substantially met; or

2. Individual served/family requests discharge; or Service

Exclusions: None

Clinical Exclusions

Individuals with the following conditions are excluded from admission unless there is clearly

documented evidence of a behavioral health condition overlaying the diagnosis: Developmental

Disability, Autism, Neurocognitive Disorder, or Traumatic Brain Injury.

Required Components

1. Youth choice and voice are paramount to this recovery-oriented service but are considered

in the context of the youth’s age, developmental stage, emerging empowerment, and family

dynamics. Younger children will be supported in their articulation of needs/preferences,

symptoms, feelings, status, etc. while understanding the guardian’s ultimate role in some

specific decision-making.

2. CPS-Ys are integral partners as the youth is considering transitions between levels of service,

transitions between youth and adult services, and/or is considering a transition out of service.

The CPS-Y is not the sole supporter of this work but is a leading partner to supporting the

youth's recovery transition.

 - Job Description for Certified Peer Support – Youth (CPS-Y)

Staffing Requirements

1. In delivering this service, the CPS-Y role is not interchangeable with traditional staff that

works from the perspective of their training and status as licensed/certified behavioral health

care providers. The CPSs have unique roles working from the perspective of "having been

there." Through their lived experience with mental health or substance use, they lend unique

insight into behavioral health and what makes resilience and recovery possible for an

individual experiencing one of these chronic conditions.

2. CPSs have an equivalent voice with other professional practitioners and should serve as

valued members of any internal or internal/external IRP support teams.

3. Supervision shall extend beyond performance oversight. For CPS-Ys, it is expected that

supervision considers conducive, youth-centric environments, recovery-oriented culture,

employee development, supportive relationships, etc.

4. Supervisors must attend at least one DBHDD-required Peer Support supervisor training/year.

Clinical Operations

The youth is the primary recipient of the Youth Peer Support; however, there is an expectation

that the CPS-Y is working as an integral member of the supporting team, specifically supporting

the youth in articulating his/her own recovery goals and objectives, working closely with the CPSP who is identified as a supporter to the youth's family, etc.

Service Accessibility

1. YPS may be provided at a service site, in the recipient’s home, or in any community setting

appropriate for providing the services as specified in the recipient’s behavioral health

recovery plan; via phone (although 50% must be provided face to face, telephonic contacts

are limited to 50%).

2. To promote access, providers may use Telemedicine as a tool to provide direct interventions

to individuals for whom English is not their first language. Examples of this include:

• the use of one-to-one service intervention via Telemedicine, connecting the individual to

a practitioner who speaks the individual’s language versus use of interpreters; and/or

• the use of an interpreter via Telemedicine to support the practitioner in delivering the

identified service.

Telemedicine may only be utilized when delivering this service to an individual for whom English

is not their first language. The individual/family must consent to the use of this modality. This

consent should be documented in the individual’s record. The use of telemedicine should not be

driven by the practitioner’s/agency’s convenience or preference.

Job Description for Certified Peer Support – Youth (CPS-Y) 

Documentation Requirements

1. CPS-Ys must comply with all required documentation expectations set forth in this manual.

2. CPS-Ys must comply with any data collection expectations in support of the program’s

implementation and evaluation strategy.

Billing & Reporting Requirements

When Telemedicine technology is utilized for the provision of this service in accordance with the

allowance in the Service Accessibility section of this definition, the code cited in the Code Detail

above with the appropriate GT modifier shall be utilized in documentation and claims submission.

1 Assisting families in gaining skills to promote the families’ recovery process (e.g., self-advocacy,

developing natural supports, etc.);

2 Support family voice and choice by assisting the family in assuming the lead roles in all multidisciplinary team meetings.

3 Listening to the family’s needs and concerns from a peer perspective, and offering suggestions for

engagement in planning process.

4 Providing ongoing emotional support, modeling and mentoring during all phases of the planning

services/support planning process

5 Promoting and planning for family and youth recovery, resilience and wellness

6 Working with the family to identify, articulate and build upon their strengths while addressing their

concerns, needs and opportunities

7 Helping families better understand choices offered by service providers, and assisting with

understanding policies, procedures, and regulations that impact the identified youth while living in the

community

8 Helping families better understand choices offered by service providers, and assisting with

understanding policies, procedures, and regulations that impact the identified youth while living in the

community.

9 Ensuring the engagement and active participation of the family and youth in the planning process and

guiding families toward taking a pro-active and self-managing role in their youth's treatment

10 Assisting the family with the acquisition of the skills and knowledge necessary to sustain an awareness

of their youth's needs as well as his/her strengths and the development and enhancement of the

family's unique problemဨsolving skills, coping mechanisms, and strategies for the youth's

illness/symptom/behavior management

11 Assisting the parent in coordinating with other youthဨserving systems, as needed, to achieve the

family/youth goals.

12 As needed, assisting communicating family needs to multi-disciplinary team members, while also

building the family skills in self-articulating needs/desires/preferences for treatment and support with

the goal of full family-guided, youth-driven self-management; 12. Supporting, modeling, and coaching

families to help with their engagement in all health-related processes

13 Coaching parents in developing systems advocacy skills in order to take a proactive role in their youth's

treatment and to obtain information and advocate with all youth-serving systems.

14 Cultivating the parent/guardian’s ability to make informed, independent choices including a network

for information and support which will include others who have been through similar experiences.

15 Building the family skills, knowledge, and tools related to the identified condition/related symptoms so

that the family/youth can assume the role of self-monitoring and self-management

16 Various system processes, how these relate to the youth’s recovery process, and their valued role (e.g.

crisis planning, IRP process)